Perception of the Patient – How to Break News

00:00 The next in the spikes model, the next step is going to be perception.

00:07 And the key point here is before you tell anything you should ask. You should try to figure out the patient's perception of what's going on.

00:16 So, we've talked about in previous lectures, this idea of Ask-Tell-Ask.

00:21 That's asking the patient, what do they know about the situation, telling them some information and then asking them for reaction to what you've told them? So, way this might happen is when you start the encounter.

00:37 What have you been told about your medical situation? What's your understanding of how things have been going? What's your understanding of why we did this test? Or tell me in your own words, what you've been told about.

00:49 Maybe there's another clinician that was talking to the patient previously.

00:54 So you want to know what they told the patient.

00:58 Asking the patient for that information, then helps you understand the patient's perception, their perspective of the situation.

01:07 In the telling, the patients are going to give you a clue about how they're handling the news or potential news.

01:15 So for instance, is the patient able to create an illness narrative? Are they showing signs that they accept? What might be coming? Or are they in complete denial, like, they don't think anything is wrong.

01:28 I've had situations where I've tried to have conversations with patients, and they say, "Oh, I don't want to talk about my history." A clearer idea that for instance, like in a situation of cancer, they're just overwhelmed by what's been going on.

01:44 That ability to give an illness narrative to tell the story of their what trajectory, what their journey has been, as an important way of knowing how then this information that you're going to give them is going to land with them.

01:58 So, it could be acceptance, it could be denial.

02:02 There could be elements of the patient expressing wishful thinking.

02:05 You know, they know that something serious is going to be coming when you're talking to them.

02:09 But they're still hopeful.

02:10 That they're still wishing that things are different.

02:13 Maybe they omit details.

02:16 That the things that were unfavorable in what's happened in their story so far.

02:21 Maybe that's a clue as to how they're handling things.

02:25 Maybe they're going to have unrealistic expectations, and how you frame the information, how you give those chunks of information, might help to get them more into what's realistic, and what to expect from the diagnosis or the news that you're going to give them.

02:42 It's also an opportunity for to identify whether there are going to be any areas of conflict, or anxiety, or apprehension, even just reading the patient's face, how they are responding when you initially greet them, you may get a sense of are they fearful, are they anxious? You might need to do things to just calm their anxiety, before you get to the information.