1. Managing Difficult Conversations Social Psychology 201 For ED’s Stephen H. Anderson M.D., FACEP President, WA State Chapter ACEP

2. Seven Conversations Grieving 1) Someone is dying/ died. 2) Your child is going to have a bad outcome.

3. Seven Conversations Sheriff/ Parenting 3) I think you have a drug/ alcohol problem. 4) I think you’re here too often. 5) Why are you REALLY here?

4. Seven Conversations Colleague/ Political 6) I disagree with you as a colleague. 7) That’s not how administration foresees it.

5. Overlying Principles There are rules/ givens. You have to listen.

6. Principles Know your allies… Know their allies. Find your support… Find their support.

7. Principles Believe in WIN- WIN. To thine own self be true. Document.

8. There Are Rules/ Givens Some are hard… Some are soft. Some are “ours”… Some are “only mine”.

9. There Are Rules/ Givens The Key Ownership

10. You Have To Listen Conversations are two way. Find out their goals. Find out their fears. Give them enough rope…

11. Know Your Allies… Rally your troops. Build your allies. Do you want to be an expert witness?

12. Know Their Allies… Introductions for EVERYONE. Note “Alleged Allies” not present Acknowledge as appropriate.

13. Find Your Support Find Their Support Key to the Grieving Conversation If you’re headed to war… take them with you.

14. Believe In WIN-WIN Try never to define your win, by their loss.

15. Believe In WIN-WIN Listen Repeat back Work toward a common goal Compromise?

16. To Thine Own Self Be True Never Lie Never LIE!

17. These Are Difficult Stressful Conversations! Debrief Avoid being the one with the disease

18. Not All Conversations Will End WIN-WIN Some won’t end. Have an exit strategy.

19. Document ANY conversation with “potential” is worth documenting. Two documented views are better then one. “They” know how to document too!

20. Someone Is Dying/ Died It’s someone’s job, take ownership. Find your support Find their support #1 Most Important

21. Someone Died Focus on the closest, talk to everyone Listen Account for beliefs/ cultures Physical contact, the “healing touch”.

22. Someone Died Goals To Express 1) We did everything appropriate. 2) Address pain & suffering. 3) “Now we are here to help you… & others.”

23. Someone Is Dying Don’t lie Don’t steal hope Be realistic

24. Someone Is Dying Listen ( Is the PATIENT speaking through an advanced directive?) Find your support/ Find their support Start the conversation Geography/ proximity

25. Your Child Is Going To Have A Bad Outcome Find your support/ Find their support Don’t steal hope Be honest “in that moment”

26. Bad Outcome Negative attitude leads to negative outcomes… Blame is for later

27. Bad Outcome Child’s safety first When do you include the child in the conversation?

28. I Think You Have A Drug/ Alcohol Problem Society/ Legislature/ Peers now tell us We MUST have these conversations THIS is the pivotal time.

29. Drug & Alcohol Problems The Principles There are rules/ guidelines Listen first Your allies/ their allies “Their support” might turn out to be your best ally!” WIN-WIN Be true to yourself

30. Drug & Alcohol Tools to Help Old Records EDIE WA state Prescription Monitoring Program Educate patients that these exist

31. I Think You’re Here Too Often PRC Patient’s Requiring Co-ordination

32. You’re Here Too Often New WA Hospital Requirements Identify PRC clients upfront Notify their PCP of visit Discharge patient with instructions along: “the right patient-to the right place-at the right time” Shouldn’t be a punitive discussion

33. You’re Here Too Often “You’re Unique, but…” Educate “The Econ Lecture”

34. Why Are You REALLY Here? Constructively focuses the scatter. Gives an opening to the REAL difficult conversation. NEVER demean the answer

35. I Disagree With You As A Colleague Fatal Error VS. Difference Of Opinion Fatal Error Success comes through education first

36. Difference of Opinion With A Colleague Praise in Public/ Debate in Private Ask yourself going in: What’s my goal? Am I a team builder? How can I make this WIN-WIN? Focus on the patient

37. Difference Of Opinion With A Colleague Listen Agree on the easy, Work toward the hard. Set the stage for “The Next Time” If necessary, use the chain of command.

38. That’s Not How Administration Foresees It

39. Administration’s Viewpoint The Golden Rule 1)Do unto others, as you would have others do unto you. 2)Those with the gold, make the rules. Every pathway has an economic angle.

40. Administration’s Viewpoint What brought you to the table? 1)What do they need from you? 2)What motivates you? Principles Priorities

41. Administration’s Viewpoint Great leaders get input from great followers

42. Managing Difficult Conversations There are rules/ givens You have to listen Know your allies/ know their allies Find your support/ find their support Believe in WIN-WIN To thine own self be true Document