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Psychosocial concerns

Communication > Difficult encounters

Possible stations

With a patient

  • Concerned about a test

    • Try to find the underlying reasons for their concern

  • Wants a sick note because of problems at work

  • Wants to self-discharge because they need to care for a partner at home

  • Wants to die

  • Wants to lose weight because a relative died recently of obesity-related health problems

  • Wants to make a complaint

    • Donโ€™t forget to mention the patient advice and liaison service (PALS)

    • You can say you areย sorry they feel that way/went through thatย but generally donโ€™t apologise/admit guilt

  • Feels another doctor examined them inappropriately/didnโ€™t offer chaperone

With a patientโ€™s relative

  • Carer struggling

    • Social services can do a care assessment to provide money/respite/help

    • Charities (e.g. carersuk.org and carerssupport.org.uk) offer help and support groups

    • Health visitor for children

    • Stress theyโ€™re not alone

  • Concerned about social care arrangements for elderly relative

    • Social services can arrange care

    • There are also private care organisations

    • In a crisis, doctors can refer to the rapid response team for short-term care

  • Carer says patient has stopped taking their medication and wants to know how to make them take it

  • Is concerned their relative may have cancer because they know someone else who had similar symptoms and then died of cancer

With a colleague (e.g. doctor, nurse, midwife, student, secretary, receptionist)ย 

  • Another member of the team is not pulling their weight, is always late, makes mistakes, or smells of alcohol etc.

    • Options include speaking to the culprit directly (usually best initially), and then considering speaking to their senior (offer to be present)

    • If patients are/may be at risk, you must take action and inform a senior. You should tell the culprit you are doing so.

  • Being bullied by another member of the team

    • Could they approach the perpetrator? Can they speak to their supervisor/senior/human resources? Offer to be present if possible.

    • If they have tried to resolve it but had no success, they may need to make a formal complaint

    • Screen for depression (but remember you are not their doctor and should direct them to their GP if needed)

  • Issues at home affecting work

  • A colleague who is stressed

  • Shaken up by something that has happened (e.g. a patient died)

    • They will need ongoing support โ€“ can they speak to their supervisor or occupational health? Offer to be present if possible

  • A colleague has made a mistake

    • Have a non-judgemental attitude

    • Emphasise the โ€˜no blameโ€™ culture when mistakes are admitted

    • Incident reporting can help everyone learn so the same mistake doesnโ€™t happen to others

    • Honesty is the best policy

  • A health visitor concerned about a child abuse within a family without any evidence because he/she missed a similar problem previously

Aims of the station

  • Be non-judgemental
  • Empathise
  • Listen!
  • Pick up on cues and show you have heard them
  • Address their ideas, concerns and expectations (ICE)
  • Suggest possible solutionsย 

Arrange room

Chairs at 90หš to each other rather than head-on

Introduction

and build rapport

Gather general information

โ€ข Listen
โ€ข Use open questions to probe for information
โ€ข Respond to cues

Gather psychosocial information (ICE – Ideas, Concerns and Expectations)

1. Physical
2.ย Social:ย home/work/social life,ย e.g. โ€˜Who can you talk to?โ€™, โ€˜Who is at home with you?โ€™
3. Psychological:ย e.g. โ€˜How have you been coping?โ€™, โ€˜How is your mood?โ€™

Explanation/reassurance

If required & check understanding

Management options

Give them the choice

Plan

1. Help options
2. Who can they talk to?
3. Follow-up appointment/meeting
4. Leaflet (if relevant)

Summarise

and invite questions

Tips

  • Donโ€™t be afraid of silence
  • These stations can be difficult because there isnโ€™t a goal like completing a history or explaining a test. Most patients just need a sympathetic ear and some guidance.
  • There is often a hidden agenda that the patient will only disclose if you probe with โ€˜ICE-typeโ€™ questions, e.g. they may come in for a sick note but actually they are being bullied at work
  • Use the patientโ€™s name and show empathy
  • Respond to cues! It is important to concentrate on what the patient is saying. Donโ€™t distract yourself worrying further questions.
    • Cues may be verbal or non-verbal
    • Comment on it, e.g. โ€˜You look worried.โ€™
    • After recognising a cue, repeat it back to the patient and then ask more about it (e.g. โ€˜You mentioned that sometimes you feel down โ€“ can you tell me more about that?โ€™)
  • Donโ€™t treat a colleague like a patient โ€“ chat informally if you โ€˜know themโ€™ and listen sympathetically. But if thereโ€™s a medical problem, you cannot treat them โ€“ you need to advise them to see their own GP.
  • It is not your job to solve their problem โ€“ just listen and suggest possible ways to address it. If you donโ€™t know of any services that could help them, say you will look into it and arrange to meet them again to discuss further.
  • If you need to involve somebody else (e.g. their supervisor/manager), ask the patient/colleague/carer if it would help if you were present too 

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Difficult encounters