Getting it right when giving the diagnosis of MS. #ClinicSpeak #MSBlog #MSResearch
"On Tuesday I got it wrong and need to apologise. I work in a teaching hospital and tend to have several medical students or visiting fellows in my consultation room at any one time. In addition to the medical students I supervise at least two other doctors who have separate consulting rooms. Hence, I am in and out of my room and people come and go during consultations. On this particular occasion I was giving someone the diagnosis of MS and was disturbed three times during the consultation. Although this particular patient was expecting the diagnosis - she had previously been diagnosed as having CIS - she was still very upset and simply needed my undivided attention and not divided attention. On reflection her experience of this consultation must have been terrible. What prompted me to write this post is the very sensitive and moving article below that I read on the Tube going to work yesterday. Although it was about dying with dignity in ITU it covered several issues about compassionate care; reading it made me realise that I have to improve the way I deliver care in my current working environment. What this blog, and interacting with MSers outside of clinical practice, has taught me is how poor neurologists are in general, in giving MSers the diagnosis of MS; me included."
"Several of the points in the table below summarise what compassionate care is all about and is not only relevant to the dying patient, but to someone who is being told that they have MS or any other life-changing diagnosis."
Cook & Rocker. Dying with Dignity in the Intensive Care Unit. N Engl J Med 2014;370:2506-14.
Examples of the ABCDs of Dignity-Conserving Care.*
Attitudes and assumptions can affect practice.
- Reflect on how your own life experiences affect the way in which you provide care.
- Be aware that other clinicians’ attitudes and assumptions can affect their approach to patients.
- Teach learners to be mindful of how their perspectives and presumptions can shape behaviors.
Behaviors should always enhance patient dignity.
- Demonstrate with nonverbal methods how patients and their families are important to you.
- Do not rush; sit down and make eye contact when talking with patients and their families.
- Turn off digital devices and avoid jargon when talking with patients and their families.
Compassion is sensitivity to the suffering of another and the desire to relieve it.
- Elicit the personal stories that accompany your patient’s illness.
- Acknowledge the effect of sickness on your patient’s broader life experience.
- Recognize and relieve suffering.
Dialogue should acknowledge personhood beyond the illness.
- Explore the values that are most important to your patients.
- Ask who else should be involved to help your patients through difficult times.
- Encourage patients and their families to reflect and reminisce.