In this episode of BackTable ENT, Dr. Gopi Shah and Dr. Melanie Sulistio, associate dean of student affairs at UT Southwestern, talk about the importance and art of having difficult discussions with patients and medical colleagues.

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SHOW NOTES

First, Dr. Sulistio explains why the humanity in medicine is centered on a foundation of communication between patients and physicians. She emphasizes that scientific advancements cannot help society if physicians cannot communicate them to their patients. Then, she gives examples of obstacles that may make communication challenging, such as an unfortunate diagnosis, language barriers, family dynamics, biases, cultural backgrounds, and different goals and priorities of each party.

She suggests strategies to overcome these barriers, such as scheduling the appropriate length of time to share the news, checking that it is a good time for the patient to receive the news, and making sure the provider themselves are emotionally ready to share news. She encourages providers to show emotion, but not to the point that the patient has to comfort them. Dr. Sulistio also emphasizes including the support system of the patient in the discussion and evaluating what the patient understands about their condition before beginning the discussion. She warns against assuming that you know what the patient is feeling, bringing up personal experiences, and apologizing inauthentically. Body language cues are also important, such as eye contact and pulling up a chair to meet the patient at their level. She recommends speaking to the nurses, techs, and medical assistants about the patient before entering their room, as they have the most exposure to the patient everyday.

Next, the doctors discuss how to deal with language barriers and translation services. Dr. Sulistio notes that physician humility is an important aspect to these discussions, as providers should never make non-English speaking patients feel like a burden to treat. She notes that although wording may be lost in translation, physicians need to remind themselves to speak to the patient instead of to the translator.

Finally, Dr. Sulistio gives advice about having difficult conversations with medical colleagues and trainees. Before entering these discussions, she makes sure to check on her own implicit biases and emotions. She proposes the idea of compassionate assumption, or believing that other people are always doing the best they can in every scenario. In her opinion, simulation is the best method for teaching medical trainees how to navigate difficult conversations.

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RESOURCES

Dr, Sulistio’s Grand Rounds Presentation at the Mayo Clinic:

https://mssvideoupload.mayo.edu/media/Creating+a+Culture+of+Diversity+on+a+Personal+Level%2C+Navigating+Hard+Conversations/1_58oap0g7

Think Again: The Power of Knowing What You Don’t Know by Adam Grant:

https://www.amazon.com/s?k=think+again+adam+grant+paperback&hvadid=496397429222

Brené Brown podcasts:

https://brenebrown.com/podcasts/

Abraham Verghese books:

https://www.abrahamverghese.org/books/

Atul Gawande books:

http://atulgawande.com/books/