Breaking Bad News Demonstration - OSCE Guide | Breast Cancer Diagnosis | UKMLA | CPSA
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- Опубликовано: 7 июн 2024
- This video provides a demonstration of breaking bad news (a breast cancer diagnosis) in the context of an OSCE station using the SPIKES framework.
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Chapters:
00:00 Introduction
00:17 Set up
00:49 Perception
02:28 Invitation
02:59 Knowledge
05:40 Empathy
07:02 Strategy & summary
11:03 Closing the consultation
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Meredith: When you walk into a room to tell someone that their loved one has died, it’s more than just a list of bullet points you’ve memorized. Yours is the face they will remember for the rest of their life. They were fine before they met you. They picked up their children from school, they made dinner, and they got a call. The police showed up at their door and brought them here with those children to this room so that you can give them the worst news of their entire life. You are changing this person’s life forever. You are responsible for this moment. For the instant that person goes from wife to widow is you. All you. Nobody but you. So this person isn’t an inconvenience. They not a box on a list to be checked off. You are a part of their life now. Your words, your face. So take that seriously and recognize the important of your role. And respect the fact that that person’s pain is the biggest thing in the room.
☝🏻 This dialogue is one of the examples of how we should treat someone who is in immense pain and grief.
is it from Grey's Anatomy?
@@oishi5518 Yes
really helpful, thank you geeky medics for all the hard work you put for us 💜.... The lady who played the patient is a great actress, I've noticed in some other videos too👏
Great actor and great doctor. Thank you for the very informative video.
When I saw this on my feed I legit thought this was some news regarding breaking bad 😂.Great video though!
me too
Literally same!🤣😂🙆🏽♂️
When I had a traumatic injury my doctor shot it to me straight! She didn't sugar coat it and didnt give me false hope of a recovery and that was just what I needed in the moment. I didnt want to be lied to bc I knew what was going on. She let me react to a certain degree but basically signaled me to reign it in after a period of time. Her reaction was raw but it really helped me process in the moment and in retrospect.
However, I know everyone reacts differently to different methods.
I came to this subject searching about that but in a corporate environment, but now I realise, the only bad news is given in hospitals, the rest are just casualties.
Big up to those professionals that can keep a straight face in such tough moments but also have empathy for the ones in need. That's a sad job, but somehow beautiful.
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In our hospital there was that old man who thought he was being treated for pneumonia in the surgical ward. We (students) were examining him and then the treating surgeon came in and casually dropped that the patient had small cell lung cancer. The man was utterly devastated. Our doctors are quite skilled but have absolutely no clue how to communicate. There are stories of another patient who jumped from the 8th floor and committed suicide.
Oscar 🏆🥇 winning performance by both actresses,didn't know before that to become a good international doctor you need too be good actor too.
It took too long before she give the info.
Such a necessary point to cover! Dealing with emotions just isn't easy.
When they diagnosed my dad with bladder cancer a few years ago the doctor just sat him down and didn't beat the bush about it. My dad reacted by just leaving the hospital and crying in the car. My mum was in the car picking him up so she grabbed him and stormed him back into the hospital to find out more info re prognosis, therapy etc lol. I am surprised they let him just leave.
This incoming osce exam will be the most stressful experience in my life
The most shocking thing is that it is not that time-consuming. So time is not an excuse to just drop the bomb.
Thank you very much, really gaves me an idea about how to breaking bad news to someone
This was perfect demonstration of SPIKES!!! 👏👏👏
What does spikes stand for
@@philltchigiya1229
Situation - ensure you are in a quiet and comfortable environment
Perception - what does the patient understand has happened so far?
Invite - would they like to be told the news now? How much medical information do they like?
Knowledge - offer the information in sizeable chunks
Empathy - respond to their emotions
Strategy and Summary - establish a plan for steps going forward
Thank you so much for this
I , personally, would be very suspicious of a long intro as this and would be more nervous….thus prefer straight to the point! I guess everyone is different 🌝
Absolutely - there's no perfect way to break bad news. There is often a tension between exploring a patient's current level of understanding and avoiding unnecessary delay in delivering the bad news. Understanding the patient's current state of mind can be helpful in tailoring the delivery of bad news and addressing patient concerns.
Breaking bad news isn’t something an OSCE can teach or assess. There isn’t a checklist to go down. There isn’t a “use this phrase to sound empathetic”, or a “ask them how they are going before shell-shocking them”
Geeky Medics is a great resource for medical knowledge and being a good doctor clinically. They nail OSCEs
Breaking bad news shouldn’t be an OSCE. In my opinion of course. Humanity can react in so many different ways, some laugh, some cry, some stare at you saying nothing, some swear at you, some start throwing things around. What they need is a human. Not a checklist.
It’s the one time where, as a medical person, you pull the veil down and show you are more than a permanent student who spent 6 years with your head in a book.
You are a human telling another human something they either weren’t expecting or don’t want to hear. You can’t treat it like a textbook, patients will say (and have said in the past) that they felt like their doctor felt fake, didn’t care, or was reading from a script.
The advice I got for breaking bad news? Three things: Know your audience. Be without ambiguity. Patients and family members won’t remember exactly what you said, but they will remember how you said it and how they felt.
At the end of the day, that’s all that matters. Be that a hand hold, a hug, an informal approach, a detailed explanation with many big words, even a joke…. It’s about the people, not the process. They are learning something awful, when they look back did their doctor make them feel better or worse?
Thanks Phil, I think you raise lots of really valid points. Ultimately you need to develop your own humanistic style and there is no single way to break bad news “well”. The reality in the context of medical education however is that breaking bad news does frequently appear as an OSCE station and mark schemes are often based on structures such as SPIKES, so we felt the need to cover it after a lot of demand. Thanks for taking the time to provide your thoughtful comments, I really appreciate it.
Lewis Potter
Founder
I agree that you can't properly learn to break bad news from an OSCE - it comes from your individual approach, your relationship with the patients, and experience.
However, it's useful to first learn a structure so that you have something to guide you when you are new to breaking bad news.
At the end of the day, if you are very empathetic but unprofessional, stressed and disorganised, it won't help to reassure the patient. They need the doctor to be calm, collected, and supportive, and to tell them what they need to know.
I understand you need to use spikes for the osce markscheme, but as a patient I would feel soooo stressed with the doctor dilly dallying and not getting straight to the point. In real life surely as soon as you start saying things like "are you happy for me to discuss the results now, do you need anyone with you" they'd start getting stressed
the suspense u feel actually helps your brain prepare better. it’s a necessary part of making sure to lower the shock the patient feels
Trust me, that layering is the most humane way to break bad news
they'll get stressed either way, do you prefer dealing with syncope from shock?
That's the whole point, it's a warning shot that something really bad is coming.
Excellent video!
Awesome video❤
Very good video
Please do this for all of plab topics
I can see every vdo is more than 8 minutes will we be able to finish in 8min in plab 2 cheers!
Great ❤❤❤❤❤
Would it be appropriate to give the patient some statistics, such as "In X amount of cases the cancer can be treated."? This doesn't feel too big of a stretch from the discussion they had about cyst vs cancer commonality.
This would be a difficult statistic to offer accurately in this moment before staging (i.e. has it metastasised) and assessment of tumour characteristics (e.g. genetic profiling) have been performed.
10/10
She wouldn’t get that much doctor time on the NHS
That's very wrong to say.... This is just 12 mins... And patinets do get this much time