Practical Plans for Difficult Conversations in Medicine: Strategies that Work in Breaking Bad News

February 24, 2011

Author: Robert Buckman

Edition: First

Publisher: Johns Hopkins University Press

Pages: 160

Price: £28.50 and £15.50

ISBN 9780801895579 and 5586

There are few moments quite so daunting for the practising clinician as the walk down the corridor towards a difficult conversation; the sense of dread in the knowledge that the next five minutes are going to be predictably unpleasant. Whether this involves breaking bad news, trying to put the lid on a situation of simmering conflict or attempting to challenge unrealistic expectations, there is a feeling that these conversations are never going to end well.

Fortunately, most medical undergraduate curricula reflect a greater awareness of the importance of good communication skills. This is also recognised by professional bodies; the higher examination for membership of the Royal College of Physicians has a dedicated role-playing station that assesses candidates' ability to manage challenging conversations with actors in different scenarios.

But although there are an ever-expanding variety of teaching paradigms in communication skills, translating these into practice is not always straightforward; they are often bogged down in the theoretical underpinnings of doctor-patient interactions and the psychological variables upon which effective communication can be based, while losing sight of what works within the process. Although you can read a book or listen to a lecture about swimming, it's meaningless until you put on your trunks/costume and goggles and are actually immersed in the water.

Practical Plans for Difficult Conversations aims to ground its ideas firmly within the real world of clinical medicine. All of the examples are set in real situations and this is the book's main strength. Readers will recognise, immediately, the areas that do cause problems, and will be able to imagine themselves within each scenario. The difficult conversations are divided into broad categories: breaking bad news, disclosing error and managing conflict.

The general principles outlined can be used in different ways for individual interactions and the author explicitly reiterates throughout that these are guidelines rather than didactic rules. While many of the "tips" may seem a little obvious, the general mnemonics and plans of action that are suggested may, at least, provide a strategy for interactions with patients that have the potential to be "difficult". There are a limited number of references, but generally theory takes second place to practice, which is something that busy clinicians working in the real world will appreciate should they need to dip into it.

There is an accompanying DVD that aims to illustrate some of the conversations with actors, although there are some problems with sound and text placement - and things also appear to go a bit more smoothly than they probably would in real life. However, as a general aid to preparing for challenging situations and, perhaps, for postgraduate examinations that are likely to feature these scenarios, Practical Plans is an accessible and constructive resource.

Who is it for? Undergraduate and postgraduate medical students; any health professional.

Presentation: Clear text and tables.

Would you recommend it? Yes.

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