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Before entering the next SOO station, you read the prompt: â€œYou are about to meet a patient whose clinical presentation and investigations are suggestive of a new diagnosis of lupus.â€ You eloquently perform a review of systems, provide an excellent management plan and arrange follow up with the patient… But you are NOT deemed a SUPERIOR CERTIFICANT. What went wrong?
It was actually a â€œBad Newsâ€ scenario, and you didnâ€™t use interviewing techniques that the FMEP Course hopes to see in a SUPERIOR certificant.
The good news is that we have the tips and tricks you can use when a similar situation shows up on your exam. We have summarized an excellent AFP article that will help you be an FMEP Superior Certificant on your SOO.
How might â€œbad newsâ€ show up on your CCFP exam SOO station?
- You might need to need to disclose a new diagnosis of cancer
- You might need to inform them of a new diagnosis of a chronic disease (e.g., diabetes, hypertension, kidney failure)
- You may need to discuss the aftermath of an injury leading to significant life changes
- You may need to address a deteriorating condition and advise them that improvement is unlikely (e.g., end-stage chronic obstructive pulmonary disease, congestive heart failure, etc.)
- You might need to inform a family member that their loved one is unwell and may not recover
Some general tips for your SOO:
Before you memorize any mnemonics, remember these universal tips:
- Deliver the news in person (no kidding!)
- Use clear, easily comprehensible language
- Avoid medical jargon, like â€œHodgkin lymphoma with metastatic spread.â€ This is not the right time to demonstrate that you know your oncological lymphoma staging. Check their understanding first by saying, â€œWhat have you been told so far about todayâ€™s encounter?â€
- Give the patient your full attention
- Do not write notes on your scratch pad while thinking about how to FIFE them. Look them in the eye. This should feel natural.
- Leave enough time for questions
- Involve the patient in their management plan
- Ensure that the patient feels heard
- Say things on your SOO like, â€œHow does that sound?â€, â€œDo you have any questions?â€, and â€œIs there anything else you would want to add/address?â€
- Weâ€™ll give you more management tips and demonstrations of delivering bad news during the FMEP Course
- Be honest and realistic while remaining compassionate
How should I approach the â€œBad Newsâ€ SOO scenario?
Hereâ€™s where you might want to get memorizing! Letâ€™s talk about SPIKES.
- Review the patientâ€™s medical history
- Use the tissues that will likely be close by
- Maintain eye contact
- Ask if the patient wants any loved one(s) present with them during the conversation
- Position yourself appropriatelyâ€¦ â€œWould it be okay if I sat next to you?â€
- Gauge how much the patient already knows about his/her condition and investigations to date
- Start with broad questions
- Consider… â€œWhat is your understanding of what Iâ€™ve told you about your MRI results?â€
- Ask if the patient is ready to hear the news (if not, arrange another appointment)
- Ask how much information the patient would like to hear
- Consider… â€œDo you have a preference on how much information you would like me to discuss with you today?â€
- Use clear, simple language
- Be empathetic and allow the patient to express their emotions
- Provide small pieces of information, check in often to make sure the patient understands, and give the patient opportunities to ask questions
- Include a warning statement before delivering the news
- Considerâ€¦ â€œUnfortunately, the test results are not what we were hoping to see.â€
- Acknowledge and accept the patientâ€™s emotions
- Your response should be empathetic, validating, supportive, or exploratory, depending on their concerns
- Considerâ€¦ â€œYou mentioned you were worried about your husband. Could you tell me more about where this worry is coming from?â€
- Strategy and Summary
- Give a summary, discuss options, and explore patient-specific goals
- Arrange for follow-up (tests, referrals, treatments)
- Give the patient a way to contact you if they have questions
- Consider… â€œIâ€™ve shared information that you were not expecting to hear today. You may come up with additional questions later onâ€¦ if you do, feel free to write them down and we can discuss them at our next appointment.â€