CSA case = Breaking Bad News (Done well)
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- Опубликовано: 29 июн 2013
- Breaking bad news in one form or another occurs in almost every CSA diet. It's usually a diagnosis or explaining a sinister result.
Have a look at the BBN downloads from the Pennine website and follow the video consultation skills time-line
www.pennine-gp-training.co.uk/...
Also have a look at our CSA course
www.pennine-gp-training.co.uk/...
For those of you saying that the consultation is too long, it is the way of breaking bad news! Patients need time to digest information and I think she has done an amazing job.
And please focus on her soft skills, her dress code is not relevant in this case. In reality, she may be dressing inappropriately, but that's not the main point of the video.
One thing I do agree is that she has skipped the step of inviting any patients' relatives to hear the bad news at the beginning. But she did mention about it at the end, so I think it is a very minor mistake.
On the contrary, dress code is very relevant, especially in a real consultation, which this is supposed to mimic. It reflects professionalism, which couldn't be more important in a serious situation like breaking bad news.
the best thing she could mange is the time factor ...but I have some note on her :
1-she didn't ask the patient if he prefers to get the information now or latter ....if he prefers to be with company or alone before Breaking the Bad News
2-she should have said .(tumor) not Cancer initially , that would be less scary
3-she should be more empathetic with him . 4-ask how would he go back home and if he prefers someone with him ....safer
5- provide availability for the patient.. she may provided him with contact Number of the clinic for any inquiry .these are some suggestion but generally she was good :)
we've been taught to be clear and say cancer not tumour
best to say cancer and not tumour...patients will return saying you never informed them they had cancer :/ i have seen this happen before.
4:35 smiling might be taken as insult
I know that every medical school teaches you to say what Mohammad said in point 1, but I just find that really weird. It makes the news sound even scarier "I'm about to ruin your life in 3, 2, 1", " would you like a helmet before I push you off this cliff?". Maybe it's just me?
Pancreatic cancer is pretty much the *worst news* a person can ever get.
She did well here. Even when she made missteps inadvertantly suger coating it, she corrected
I cant hear what she is saying.....volume is up and still cant.
Am i deaf or she is whispering
Turn down for WHAT
That's a technique
Doctors should break bad news in a soften tone in order to show that it is a sensitive and serious news. Also giving the patient time to absorb the information which is hard to apply when someone is talking loudly.
Your not deaf she's speaking very low. Either that or the audio isn't strong enough.
If you have a look at the Pennine GP Training website, go to the MRCGP section, look at the CSA case videos, look at consultation 3 and there is a download that plots the consultations skills on display for this video against the timeline. So play the video and use the timeline to see the wide array of skills displayed
I am good at this kind of counseling and breaking bad news I had made in Ethiopia once I was in the school of the public health officer, so now she has had great skills in the way of counseling and telling or breaking bad news I am appreciating her that she is great motivative
PLEASE USE MICRoPHONE. !!!!!!!!!!!
In order to deliver bad news, you must be empathic with them
how he knows he has cancer and act so soft smooth like that ...should act like a real patient no anticipation
Extremely low volume even on highest volume of speaker phones and head phones!
very well done and used SPIKES effectively.
why the ques @ 3.09 and would it be appropriate to treat the pain ?
Can we have the feedback on the performance as well please? It seemed excellently done. But at the level of learners you never know the tiny bits of mistakes you do that cost you alot.
very helpful video!
Well done. Spikes effectively used and news broken in layers
But would it have been appropriate to check how much of the information patient wants to know about the result of the scan?
tell him he's about to buy the farm. it's over Johnny .
great encounter , love it
Thanks for your videos, you helped me in my NAC OSCE exam
NAC stand for what pls?
National assessment collaboration its the Canadia OSCE
Thanx
@@roupenodabashian1666 thanx for answer
i think i am deaf
HSE required viewing for palliative online course (HSE is Ireland's gov't health service.)
It was such a struggle hearing her.
very helpful video for consultation skills. would be greater with better sound quality
AGREE!!!
Ay I got sensorineural hearing loss at the age of 31 :(
Breaking bad news is good and appropriate, However in management everything was thrown on specialist. I'd suggest to give more information about treatment i.e chem/radio and surgical and other management such as pain control, mcmillan and support group. I'd add the social impact of the patient after having the bad news such as pancreas Ca.
+Bilal Ahmad u shouldnt discuss the management in the 1st meeting itself. Itll be too much for the pt to grasp. U need to give the pt time to comprehend the situation and discuss everything else when hes ready unless ofcourse if the pt insist on knowing everything which usually is not the case.
Very well done but I couldn’t properly hear what the lady was saying. I know its a technique to soften one’s voice but for learning it was hard to listen
It's tooo soft! Can't hear anything!
I have learned a lot from these videos but can you please upload more new videos. I have exam in a month of MRCGP international
so, how was the exam?
He didn't make it. Somebody needs breaking the bad news to the family.
Pretty much giving a death sentence.
I hope they are actors.
I hope they're not, that would be tragic news for them.
if I had a £ for every decibel...
Quite good for a BBN consultation.
Pauses by doc could probably be a bit longer still.... give him more time to absorb and fire his first question even sometimes without her having to ask.
At 4:40 and just before - CUES about "im only 47" and a few others just before this....
"I'm really sorry to have to break" but it doesn;t seem as empathetic as I was expecting for someone showcasing it on RUclips and saying "done well".
Why she is laughing while saying...cancer!!!!
The volume is so low that makes the video not useful
Sound is not appropriate . it could be better if there should use Mike
just tell him, don't start a new book because he won't finish it
That was SOOO long. With all kinds of back and forth, not getting to the point until almost 5 min mark. I an see plenty of patients freaking our with such a long introduction. By the way, SPIKES is very artificial protocol and should be replaced with something more realistic.
🙏❤️
cant hear anything
you should manage your voice in vedio plz... use Microphoooone
please tell me this was a roleplay exercise, the doctor has a perma grin on her face...
Can't hear, low volume
Not listening to her guys , why listen?
The sound is poor
3years ago. My uncle went to hospital for his treatment. That time he got to know that he is suffering from the fourth stage cancer. He could not believe and he didn't tell us.when he came back from hospital we asked him about what is the reason. What doctors said him.why he is getting weaker. Than he told us there is no serious thing. Every thing is allright. Next 6 months he used to go at his job. He was the constable in hariyana police. He used to eat painkillers. When we brought him in hospital. After ct scan doctors declared that he has only 2 months left. After tow months he died. Now we are regretting that if we started his cancer treatment before six months then there was a chance to save his life.
his stubborn pride and emotional blocks prevented him getting support yaar. hope i don't do that, i can be very stubborn and mistrusting
Need new mics...
Good structure of the consultation.She appears rushing to break the news.May be due to she is oncall.Also used some jargon i.e abdomen..The actor doesn't appear quite worried hearing the news which makes easy for the doctor.
abdomen is not jargon in the english language
Poor audio 😐
i dunno... a foreign dr would have failed this consultation if he/she had used the exact same words verbatim...glaring red flags,PSO etc etc missed.... that is why this exam has gained notoriety for being unjust & unfair.
I personally think this is great up untill the last part. Is it not premature to be giving the patient information on pancreatic cancer? as the mass could be a number of things: for example an iron deposit caused by primary hemochromatosis. Why is the doctor only printing off information for cancer and not the other possible conditions?! There are a lot of conditions that can cause a mass and it feels like the doctor has already decided that the patient has cancer even though the mass has not been biopsied. It is not definitively cancer. If that mass comes back as an iron deposit as a result of hemochromatosis, that patient is going to be quite upset. If the mass is benign the doctor has cause undo distress, but it is unlikely the patient will complain as the doctor did say it was not definitive. I think it is a difficult balance to make sure the patient is aware of the risks without terrifying them. If I was that patient I would have thought it was not definitive until the doctor gave me the print out of cancer. I would be so scared that I had cancer and under a lot of stress. So I reiterate my question: is it premature to give a cancer booklet? I think it is and it would be more effective to print out information about the process of getting tested and the stages of testing. The booklet needs to be titled something on the lines of “They found a mass, Now what?” The information proved should have names of test and simple descriptions, including what a biopsy is… I just think this would benefit the patient and tell them what they can do rather than scaring them.
Note: the booklet is a lot of writing: I would like to see more flow charts and diagrams.
Why is she apologising? she informed him that he may have cancer NOT that he has cancer… It sounds like they have been working quickly and providing a good slandered of care. She broke the news kindly and respectfully. Why is she apologising “I am sorry to brake the news to you like this” ? I do not understand because she did a good job. If she had made a mistake and corrected herself I could understand that, but I do not get it.
probaby being british@@katie_144
what does CSA stand for?
clinical skills assessment
Confederate States of America
her body language is not suitable with the situation
Very poor sounds
3:30 closed body behaviour
Would you explain more pls?
Is this real or not?
Nope
did anyone notice? Jiggle jiggle jiggle
Speak up, lady!
Doesn't this break patient confidentiality?
Charlottie Green
It's a simulated consultation.
Glad I am not the only one who couldn't hear her... not going to finish watching because I can't hear her, not going to give a like either I am afraid...
Well.......sorry this example will not get one through any OSCE, forgive my bluntness
why's that?
She is not dressed appropriately.
Given so many people commenting (especially men) are obsessed and slathering about the modest amount of cleavage on this doctor, I worry greatly about these men going anywhere near a woman for a breast examination - or any kind of intimate examination. They are the very kind that female patients complain about.
You don't see the point. It's about whether it's appropriate for the setting, which it is not. In the context of a breast examination, it is obviously clinically necessary for the patient to be adequately exposed. Therefore, it would be appropriate and even expected in that clinical context. It wouldn't be an issue. However, as a doctor, a low plunging neckline or cleavage on display is not acceptable. Full stop! She is there in a professional capacity, not having a drink with a friend. Dress code is there for a reason: it projects a professional image and maintains professional boundaries, and all doctors know this from day 1 in medical school: long before they hit the consultation room!
Also, you have a strange use of the word "modest" - displaying any cleavage to your patient when you're acting in a professional capacity is excessive. There is nothing modest about it. In fact, that's why half those outfits are designed that way in the first place. Nor is dress code a gender issue either, before you go there. Men are also required to follow dress code, but the truth is that this issue rarely arises with men, because sadly we live in a society where women's outfits are sexually motivated, men's less so - maybe that's a gender issue you should be far more worried about. Ironically, it's something that people like you often fail to complain about.
@@swcoast honestly, in a situation as grim as this I hardly paid attention to her cleavage.
@@swcoast literally focusing on the least important thing . Good job with the kind of mindset you got there
Audio sucks, so i'm not going to watch it
Nice, but would you really chat and smile in such relaxed manner with a 40 something year old person and then 2 minutes later announce they might have potentially one of deadliest cancers? I don't think so. But good for exam purposes, i guess.
So it could be a effing beningn cyst on the pancreas which is easily aspirated?..and you have scared him to death about cancer!! FAIL!
The comments about her cleavage are completely inappropriate. A female's chest is a normal part of a body like an arm or a leg. Stop over-sexualizing her. It is your problem if you find her dress distracting.
So are the penis, vagina and anus. What is your point?
It is very normal for men to find a woman's cleavage very sexual and thus he should not be reprimanded when commenting on it!!! Men don't have the need to show their cleavage so why do women???
This is the second time I've watched this video, and I didn't even notice her cleavage the first time. I only notice it now because everyone is mentioning it. Super inappropriate.
@@rodeo9 Laughable. Are you really so fatuous that you compare the penis and vagina to a little cleavage? Go to Saudi Arabia if you can't cant't control yourself over seeing a little cleavage. This is misogyny, plain and simple. How she dresses is none of your business.
If this was a real situation, I'd like to see the doctor looking more soberly professional. Deep decolletage definitely out of place here.
+hairyyetta Agree with you there
her acumen was effective imo
Why jump to the conclusion of cancer so soon? let the specialists say that.
+undhyu patil Thats the whole point of "breaking bad news"
I don't think it was done well. Bad news are broken nicely with a hammer which the doctor in this case didn't make use of.
Lol all these people complaining about her quiet voice when in reality they just aren’t used to her northern accent xD
. No questions about constitution, terrain, lymphatic excess or use rational empirical scientific arguments, not just a prognosis and fear or an in repairable condition that is told will spiral out of control and kill the patient... doctors should speak about how to drain out the cancer through lymphatic system or at least describe that the cancer is a result of a dysfunction of the immune system brought about by lifestyle factors or living.. that once addressed can be corrected. Cancer cultures are nothing but white blood cells that have encapsulated against the viruses and has sorted to metabolise the toxins through the lymphatic system...
cancer is not just a dysfunction of the immune system and lifestyle wont correct it once its already there.It has nothing to do with toxins,cultures or white blood cells,have you even finished med school?
@@scarred10 your argument is like barbarians in avignon trying to convince romans of constantinople that they inherited intellectual tradition and not the romans....for people like yourself cannot begin to enter into the realms of empirical medicine....since you see it as a medieval light of salvation.... but is only a tool.
@@scarred10 yeah it is a random germ that gets you...right? you have no idea on the relationship with the environment and constitution with disease.. m this is a philosophical nature and tenet of greco roman thought and is a principle of science axiom in nature...
@@danube466 dude,do you even speak the English language?Furthermore, cancer has nothing to do with any pathogen apart from HPV.
doc's soooo cute.
Dr is so cute pretty
Its nice but the non verbal communication skills are not good .. the legs are crossed and she's moving with the chair
In a situation like this I don't think the patient is going to give 2 shits and a fart about her body language.....
. I have been a hospital doctor for 15 years. The doctor is not appropriately dressed. Lots of 'ok' words and unnecessary hand movements on the doctor's part. If any person has a suspicious mass diagnosed on imaging the MDM team gets involved and they have a specialist nurse who breaks the news in the presence of relatives/friends. It's not left to the GP to do that. What a pseudo exam! I am taking my CSA soon! God help me!
the way she is sitting is not appropriate...
Not laud at all
Lots of misogynistic comments about the doctor's dress sense from from extremely backward and feeble-minded people rather than anything she actually did or said in the consultation. Shows sexism is alive and well amongst so-called medical professionals around the world. Why is it that so many people 1. Seem to think how a woman chooses to dress is ANY of their business 2. Can't get over their immature, hypersexualised objectification of women? She is feminine, well presented and smartly dressed.
It's got nothing to do with sexism. Men and women are both required to follow dress code. It's a GMC requirement.
A lot of a consultation is not about what one says anyway, it's about non-verbal communication and presentation. So, actually, comments about dress code, especially for a doctor, are very relevant comments.
A doctor acts in a professional capacity, so it's actually everyone's business who has contact with the doctor in that role, be it employers, colleagues, and, of course, patients. Not all patients will appreciate it! A doctor also has a wider responsibility to project a professional image of the profession itself. Again, GMC requirement. It is her business when she is acting in the role of herself, i.e. in a personal or social setting - she is seeing patients, not friends for a drink. It does not match the setting.
Again, you have no idea of the words you use. "feminine" - I hardly think a woman's femininity is defined purely by how much of her cleavage is on show. I don't know if you realise or not, but that is actually a very demeaning idea, and if this was said by a man, someone like you would regard it as sexist. "Well presented" - perhaps by your standards, which I imagine are not very high, but certainly not by GMC standards - check up on it. "Smartly dressed" - ever noticed how "smart dress" for a woman means she needs cleavage on show, whereas a man can be covered top to bottom and still be considered smart: now that is gender inequality, but you seem to miss that.
Finally, I assume you miss the irony in describing comments here as "sexual objectification of women" whilst advocating outfits strategically designed to sexualise women.
Worst presentation, Ill-minnerd doctor. I did not want to see it all.
she's not a minner
stfu lol
I'm a doctor and my job is to always break the bad news to you, then I will prescribe medications to you so I can get paid and be able to buy an Audi R8, Patek Philippe Watch, 10,000 sq ft. Mansion on the seaside and luxury clothing. How about that? :-)
How's that tin-foil hat feel?
+dmana3172 You are one jealous crazy nutcase!
No, it is my job. f1764+, you gotta get back with me because you have serious illness and I'm going to have to prescribe you medication. Now do you think I'm nut? :D
Yes you vacuous fucknut!.. oh and I'm not going to bother check on what you say in response. Please learn to spell by the way.
Very well said f1764b! :D That's how doctor make their money.