More on Caring Conversations…
“The family is unreasonable.”
When faced with a family who is not in agreement with our plan, we are often left wondering, “why would a seemingly normal family choose a path that is so clearly ‘misguided?’” We can spend hours reviewing information in an attempt to get patients or families to agree with us on code status, hospice and other treatment plans. Often this results in fatigue, feelings of defeat and burn-out.
How can we do better? We have to recognize that there is conflict. Then we have to acknowledge our biases and perhaps most importantly the effectiveness of our own communication. Next time you find yourself in conflict with a seriously-ill patient or their surrogate decision-makers about the plan of care, take a pause and consider that people filter our words through their own beliefs and experiences. Rather than repeating medical facts, consider de-coding their behavior by listening to their experience across three realms: the facts, their feelings, and their identity. Using these tools to understand their position on all three levels will improve your chances of successfully navigating the difficult waters of conflict and help to establish a common ground.
We have a responsibility to guide our patients/surrogates through the channels of decision-making in serious illness. We have the knowledge and we can improve our communication skills to maximize our effectiveness as physicians. A conflict between a physician and our patient/surrogate need not be the end of our value as physicians; it can be the beginning of a new conversation.
After you try this approach, please send an email and let us know how it goes.
For more reading on published evidence about managing conflict in medical care: Back, Anthony L.; Arnold, Robert M., “Dealing with Conflict in Caring for the Seriously Ill”; JAMA. 2005, v293(11): 1374-1381.
This is one of many skills that can be practiced with the Caring Conversations Program. Established by a group of Henry Ford physicians in 2012, the goal of the program is to improve conversations between providers and patients.
Caring Conversations has roots in the VitalTalk format and accordingly, utilizes highly skilled improvisational actors to create an ideal environment for experiential learning.
Henry Ford Health System Caring Conversations team members are: Rana Awdish, M.D.; Dana Buick, M.D.; Kristen Chasteen, M.D.; Michael Mendez, M.D.; Maria Kokas, Ph.D.; and Cari Williamson, BA.
Visit the Caring Conversations website for more information, or contact Cari Williamson, program administrator CWILLI30@hfhs.org.