9- Put it into Practice: High-Value Communication

GREET TOM

Hey Tom,
How're you doing?
What brings you in today?

I'M JUST IN SO MUCH PAIN. I WAS IN A CAR ACCIDENT A COUPLE OF YEARS AGO THAT BROKE MY COLLARBONE AND FRACTURED MY SPINE. EVER SINCE THEN, EVEN WITH ALL THE SURGERIES AND EVERYTHING, I'VE HAD THIS PAIN THAT'S, LIKE, ALL DAY EVERY DAY. I'VE BEEN ON AND OFF MEDICATIONS, AND I JUST FEEL LIKE I NEED SOMETHING STRONGER…

LET TOM CONTINUE

I’M SORRY TO HEAR THAT. LET’S TALK ABOUT YOUR OPTIONS.

...I CAN'T MANAGE WITH THIS. I'VE GOT A WIFE, TWO KIDS, AND THEY'RE BASICALLY GROWING UP WITHOUT ME BECAUSE I CAN'T PLAY WITH THEM. I BARELY GET OFF THE COUCH WHEN I'M HOME, AND I CAN'T CONCENTRATE AT WORK. DOCTORS DON'T SEEM TO KNOW WHAT TO DO WITH ME.
THEY CAN'T PINPOINT WHAT'S CAUSING THE PAIN, AND THEY DON'T WANT TO GIVE ME MORE THAN ACETAMINOPHEN, BUT WHAT AM I SUPPOSED TO DO? I CAN'T LIVE LIKE THIS. I NEED SOMETHING STRONGER.

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I WASN'T DONE YET.

Continue

I CAN UNDERSTAND HOW THIS MUST BE INCREDIBLY FRUSTRATING FOR YOU, NOT ONLY TO BE IN PAIN BUT TO HAVE IT AFFECT YOUR FAMILY LIFE. TELL ME MORE.

YES, I UNDERSTAND YOUR FRUSTRATION. IT’S JUST THAT OPIATES HAVE BEEN SHOWN NOT TO BE HELPFUL WITH CHRONIC PAIN, AND I DON’T THINK THEY’D BE GOOD FOR YOU IN THIS SITUATION.

I UNDERSTAND WHERE YOUR’RE COMING FROM, BUT I’VE LOOKED AT YOUR CHART, AND YOU’VE HAD IMAGING. I DON’T SEE ANYTHING THERE THAT’S CAUSING YOUR PAIN.

I'M SO GLAD YOU'RE TAKING ME SERIOUSLY!

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I love any time I get to spend with my kids. Tommy's just getting into baseball, and I want to be able play catch with him. I feel like if I can't play with them and be a part of their lives, what good am I? This time is so valuable. I need these meds so I don't miss out.

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You don't understand how this is affecting my life and my family. I have friends on opiates and they seem to work for them!

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Great! Another doctor who isn't going to listen to me. Just because you don't see something doesn't mean my pain isn't real. My pain is real!

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Yes, I love playing with my kids, too, and I want to help you get back to it. What do you think would help with this pain?

Would you like to hear more about pain and effective ways to manage it?

I know it’s a difficult situation. I broke my arm about a year ago, and I know the pain can be frustrating. But opiates are dangerous. Have you heard that there’s currently an opiate epidemic? I don’t prescribe them for this.

Would you like to hear more about pain and effective ways to manage it?

I think oxycodone would help. I've got friends on it, and they seem to manage really well.

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Here comes the lecture...

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I guess that just means I should learn to live with this pain, right? Some people can't handle meds, so I don't get any?

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What I hear you saying is that you’re having a lot of pain and this is really affecting your life. We need to do something to help you get your life back on track.
Do you want to hear more about pain and effective ways to manage pain?

Would you like to hear more about pain and effective ways to manage it?

Be that as it may, I just don’t prescribe opiates for this. We’re gonna need to find a different solution.

Would you like to hear more about pain and effective ways to manage it?

Tell Tom about pain and opiates.

Sure.

Continue

But you're not giving me any solutions. You're just telling me what you're not going to do.

Continue

Although opiates and other medications can help relieve pain, they are also addictive and can be deadly. They do not actually treat the real problem causing your pain. We want for you to get better, and I worry opiates will not make you better.
Acetaminophen and ibuprofen along with other non-medication therapies can be effective at improving your pain. Are there any other strategies you have tried to reduce your pain?

Continue

What I hear you saying is that you’re having a lot of pain and this is really affecting your life. We need to do something to help you get your life back on track. Do you want to hear more about pain and effective ways to manage pain?

Tell Tom about pain and opiates.

Well, when I go to yoga with my wife, it seems to feel a little bit better. Just not for long. The pain comes back.

Continue

That's promising! I feel like I'm really being listened to!

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I can give that a try, but it's not like I just wasn't trying hard enough. This pain is real!

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Okay, so what about if we continue with the acetaminophen and start you on physical therapy? What do you think about that? Would you like to go to yoga more often with your wife?

Okay, so we’ll start you on physical therapy.

You need to get started on physical therapy. Why don’t you come back and see me once you have been doing that for a couple of weeks?

That’s great! Doing exercise will really help you manage your pain. Let’s talk about physical therapy or massage.

Yeah, that’s alright, but we need to do more. Let’s look at physical therapy or massage.

That’s not enough. You also need to do physical therapy.

Okay, so what about if we continue with the acetaminophen and start you on physical therapy? What do you think about that? Would you like to go to yoga more often with your wife?

You need to get started on physical therapy. Why don’t you come back and see me once you have been doing that for a couple of weeks?

Okay, so what about if we continue with the acetaminophen and start you on physical therapy? What do you think about that? Would you like to go to yoga more often with your wife?

Okay, so we’ll start you on physical therapy.

Yes, we both enjoy that. I'll go with her more regularly, too.

Continue

Okay...

Continue

Doctor, I really don't feel like you're listening to me. This is a waste of my time. I'm going to go somewhere else.

You don't want to give me meds, but you think what I'm doing on my own 'isn't enough.' What do you people even want?!

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Okay, great. Now can you tell me the plan, just so I know I explained it well?

Okay great. Thanks, Tom. Please meet with my nurse to discuss your physical therapy.

Okay, great. I need to get to another appointment, but my nurse will help you with the details.

Okay great. Thanks, Tom. Please meet with my nurse to discuss your physical therapy.

Okay, great. I need to get to another appointment, but my nurse will help you with the details.

While doing exercise will really help manage your pain, what I meant to say was that sporadic exercise will likely give you only sporadic and impermanent relief, like you described. Physical therapy will help to really address the pain.

You need to get started on physical therapy. Why don’t you come back and see me once you have been doing that for a couple of weeks?

I'm finally being listened to! Maybe this is starting to turn around.

Continue

Yes, we're gonna keep trying the acetaminophen and I'm going to start physical therapy. I'm going to keep continue doing yoga, too. But I have a question. If this doesn't make a difference, can we revisit stronger pain medication?

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Thanks, Dr. Peterson.

But I still have questions.

Yes, certainly. I'll make a note in my report to revisit this. Thank you, Tom. Please see the front desk to schedule your follow-up appointment in a couple of weeks and to schedule physical therapy.

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That didn't go so well. Let's try again. Review your report card below.

See detailed performance breakdown

That wasn't ideal. Though Tom accepted your explanations and treatment decisions, he didn't seem very happy or convinced. Review your report card below, and try again if you like!

See detailed performance breakdown

Great job! Tom was satisfied with your explanation and how you arrived at your treatment decisions together. Review your report card below, and feel free to play around with the other responses if you'd like!

See detailed performance breakdown

Knock on the door to greet your patient.

Interact with Tom.

COMMUNICATION ASSESSMENT

How’d it go with Tom? Overall, you did pretty well, but there are some areas that could use improvement. Read the Performance Breakdown for more information.

How’d it go with Tom? There were some essential communication opportunities that were missed. Read the Performance Breakdown for more information.

How’d it go with Tom? Overall, you did a great job! Congratulations. Read the Performance Breakdown for more information.

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9- Put it into Practice: High-Value Communication

MODULE 7 | Section 9 of 10

Put it into Practice: High-Value Communication

COMMUNICATION ASSESSMENT

PERFORMANCE BREAKDOWN

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