1. Recognising and Resolving Disagreement in the Consultation Janko Kersnik

2. Kersnik J. Recognising and resolving disagreement, Kranjska Gora 2004 2 Aims - by the end of the session you will... become aware of disagreements learn about causes and consequences of unresolved disagreements learn how to detect disagreements learn about the strategies for action in the case of a disagreement

3. Kersnik J. Recognising and resolving disagreement, Kranjska Gora 2004 3 Veterinary vs. doctor A veterinary came to the doctor’s office and asked for treatment. On the doctor’s questions about the signs, symptoms and problems he responded: “You should know, you are the doctor, I am also not able ask my animals.” The doctor gave him a prescription and made the appointment for the next week. The veterinary came back and he complainted, that he had not improve. The doctor wrote a note on a piece of paper: “To be slaughtered immediately”.

4. Kersnik J. Recognising and resolving disagreement, Kranjska Gora 2004 4 The consultation enables both parties to co-operate in decision making processes  good communication can render higher patient satisfaction, compliance and better health care outcomes  dysfunctional communication can diminish expected health care benefits and presents a potential threat to the quality of care

5. Kersnik J. Recognising and resolving disagreement, Kranjska Gora 2004 5 Consequences I was called for a home visit to an elderly Gipsy due to shortness of breath. On my questions about the symptoms I got the answer: “You know, you are the doctor.” At the house I encountered a family reunion and partly due to the signs and symptoms and partly due to my stubbornness and knowing usual expectations of Slovene patients in that shape I suggested hospitalisation. His son grasped me for my collar and threw me towards the door and hit me twice in my bottom...

6. Kersnik J. Recognising and resolving disagreement, Kranjska Gora 2004 6 Consequences Form groups of three and discuss for 3 min: Consequences for the patient Consequences for the doctor Consequences for the utilisation of health services Consequences in terms of litigation, complaints, costs...

7. Kersnik J. Recognising and resolving disagreement, Kranjska Gora 2004 7 Consequences for the patients  dissatisfaction,  non-compliance  formal complaints

8. Kersnik J. Recognising and resolving disagreement, Kranjska Gora 2004 8 Consequences for the doctors Emotional: job dissatisfaction, tension and stress, loss of certainty, control, autonomy and disruption to working patterns

9. Kersnik J. Recognising and resolving disagreement, Kranjska Gora 2004 9 Consequences for the utilisation Shopping the doctors Swapping the doctors Avoiding the doctor vs. frequent attender

10. Kersnik J. Recognising and resolving disagreement, Kranjska Gora 2004 10 Legal consequences Litigation Complaints Financial

11. Kersnik J. Recognising and resolving disagreement, Kranjska Gora 2004 11 Causes A 70 years old woman came for a regular check up visit for her blood pressure and she complained on occasional palpitations, she had had a few times prior that visit. I asked her, if she noticed, that her collars might be too tight for here recently. After a visit to emergency room a few days later she visited me again and expressed her dissatisfaction with my interest in her dressing habits...

12. Kersnik J. Recognising and resolving disagreement, Kranjska Gora 2004 12 Causes Go in buzz groups of 5 for 5 min. List possible causes for disagreement from your experience.

13. Kersnik J. Recognising and resolving disagreement, Kranjska Gora 2004 13 Causes of disagreement Discord between the doctor and the patient: patient refuses GP proposal and vs. GP refuses patient demands Differences in the perception of the health problem Problems with shared decisions

14. Kersnik J. Recognising and resolving disagreement, Kranjska Gora 2004 14 Uncovereing the disagreements Usually hidden DISCO - DISagreement in the COnsultation

15. Kersnik J. Recognising and resolving disagreement, Kranjska Gora 2004 15 Avoiding and resolving the disagreements Good communication skills are necessary Exploration of the consultations with odd outcomes Discussion with the people involved Organisational structures

16. Kersnik J. Recognising and resolving disagreement, Kranjska Gora 2004 16 Conclusions Disagreement may happen and cause undesired consequences. We do not know the figures how many times they happen. Shared decision making is a key element of “preventive” communication pattern. The DISCO tool might help in discussions on disagreement.

17. Kersnik J. Recognising and resolving disagreement, Kranjska Gora 2004 17