Having ‘difficult’ conversations

Witnessing her father’s care in ICU convinced Julia Tabrah that staff need better training on dealing with distressed relatives.

I was living in India on a two-year career break, when I had the phone call that all ex-pats dread. My dad had a massive heart attack and was critically ill in an intensive care unit (ICU). I caught an overnight flight and was by his bed the next day. An entourage of staff on the ward came to look at his charts. The registrar started quizzing the junior doctor on my dad’s condition, without acknowledging me or making any attempt to explain what they were talking about. Once the junior doctor had been duly undermined for failing this quiz, they all strolled off (totally ignoring me). When I later asked for an update I was spoken to in a way that is too painful to repeat. The care that dad received on ICU was excellent, but the communication skills of most of the staff was eye-wateringly terrible. A prognosis of short months was casually dropped into conversation by a nurse, who was then not able to answer the questions that followed.
I think that physiotherapists are generally very good at communication. But how many of us feel fully armed to tackle those difficult conversations that we sometimes come across? Like coping with distressed relatives, or explaining that somebody may not walk again, or dealing with the fall out when someone has just been given bad news and they want you to explain it to them. How many of us have had difficult conversations training and why is this not part of our ongoing continuing professional development agenda? Should it be part of our undergraduate programmes so that we are instilling these skills in our students? What peer support do we have to help each other cope with difficult conversations and to learn from each other’s successes and failures? This is not just relevant to staff working in oncology or advanced practitioner roles, it is relevant to all of us, at every level in every team. Please give it some thought. 
If you are interested in knowing more about difficult conversations training, contact your learning and development team. In my trust it is provided by Macmillan nurses.
  • Julia Tabrah, spinal extended scope practitioner. She is on a career break from Berkshire Healthcare NHS Trust
Julia Tabrah, spinal extended scope practitioner

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