Ep. 32 Having Difficult Conversations
Episode Summary:
In this episode of 'It's Not In Your Head,' Dan and Justine discuss the intricacies of managing chronic pain, highlighting the importance of having difficult conversations between patients, caregivers, and medical providers. The episode delves into strategies for effective medical decision-making, including how to prepare for worst-case scenarios, manage communication challenges, and maintain control and clarity in complex medical situations. Listen for practical tips and innovative approaches to getting what you need done, so you can foster better relationships with providers and improve care outcomes.
Episode Overview: Key Themes and Takeaways
Drawing from both professional and personal experiences, Dan and Justine delve into communication barriers, medical decision-making, and maintaining effective support structures for individuals managing complex chronic pain.
1. The Importance of Planning and Communication
Both hosts emphasize the importance of preparing for difficult situations—such as surgery or acute health changes—by proactively discussing potential risks, goals of care, and personal wishes.
These conversations are best held before a crisis, making future decisions easier, not necessarily easy.
2. Barriers to Communication
Cognitive Challenges: Conditions like brain fog or memory issues make it hard for patients to process and relay information from appointments.
Medical Jargon: Clinician language often doesn't match patient understanding, contributing to miscommunication.
Both hosts encourage using patient-friendly summaries, support people at appointments, and tools like recordings and patient portals to improve recall and clarity.
3. Tools for Supporting Patients
Structured Notes: Patients are encouraged to keep rigorous notes and, where appropriate, record appointments.
Patient Letters: Dan provides written summaries tailored to patient language, with embedded educational resources, while Justine records her Zoom calls, gives appointment summaries, and shares follow-up prescriptions within an app for patients to engrain learning.
Closed History Taking: When patients struggle to recall events, clinicians can use focused, closed questions to guide the discussion and obtain necessary information.
Recognition of Storyteller Patients: Dan notes the importance of gently redirecting patients who tend to provide lengthy narratives, explaining the rationale to avoid the feeling of not being heard.
4. Decision-Making Frameworks
Risk Analysis: Dan illustrates using a structured approach to discuss medical interventions by breaking down risk into:
Likelihood (low, moderate, high)
Severity of potential outcomes (mild, moderate, severe)
For example, the risk of falls in elderly patients is weighed against feelings of autonomy and dignity.
Family Inclusion: Including all key family members in care discussions ensures everyone is aligned with the plan and aware of the patient's wishes.
5. Discussing End-of-Life or Major Interventions
Dr. Dan shares his personal experience discussing resuscitation and intensive care decisions with his mother, including:
Exploring what level of dependency would make life unacceptable to her.
Detailing the realities of CPR for older, frail patients (e.g., low survival rates, significant side effects).
Bringing all stakeholders into the conversation, establishing clarity, and creating future decision-making structures based on whether the patient gets better, worse, or stays the same.
6. Caregiver Self-Management
Dan describes the emotional toll and frustration faced when a loved one is hospitalized, including communication barriers with busy medical staff.
Strategies for caregivers include staying constructive, managing emotions to avoid negative impacts on care, and expressing appreciation to staff
7. Relationship Building with Healthcare Teams
Building rapport with nurses, doctors, and support staff yields better care outcomes.
Small gestures (e.g., providing treats, expressing gratitude) make staff more likely to respond positively, especially in complex cases.
8. Patient Agency and Advocacy
Justine discusses her experience weighing the risks and benefits of removing a spinal cord stimulator, illustrating how needs and risk profiles change over time.
Patients and their support networks are encouraged to define thresholds for ending therapies or interventions, especially when cognitive capacity is compromised.
9. Practical Tips for Patients, Families, and Providers
Use summaries and recordings: Both to reinforce understanding and ease anxiety.
Prepare for foreseeable scenarios: Especially for chronic conditions where decline or crises are more predictable.
Establish medical power of attorney: Ensures the patient’s preferences are respected when they can't speak for themselves.
Provider accessibility: Dan highlights the benefits of sharing his phone number for urgent questions, which rarely leads to abuse but increases patient security and trust.