Introduction

Difficult conversations in medicine are those conversations that raise negative feelings such as frustration, anxiety, and guilt, within the healthcare team and patients alike. It is understandable and predictable for patients to express strong feelings when presented with the need to change behavior such as reducing or eliminating prescription opioids. Pain medications can become a patient’s primary coping strategy for dealing with physical, emotional, psychological and post-traumatic pain. Delivering the change message can be triggering and even terrifying for patients and families. Strong emotions are commonly expressed and directed toward the healthcare team. Communication that demonstrates empathy, compassion and strong limit setting, will lead to more positive clinical outcomes. Health care teams can develop their capacity to authentically engage in difficult conversations with their patients.

The resources that follow are intended to help healthcare teams transform difficult conversations into a type of medicine that is safe, effective, and satisfying for patients and families as well as the healthcare team.

Handouts

Videos

Examples: Conversations Gone Bad

Examples: Conversations with Positive Outcome

  • Diversion Scenario (4:13 min): Provider suspects patient is diverting medication and demonstrates compassion and boundary setting.
  • Positive UDS Scenario (4:12 min): Patient positive for un-prescribed benzodiazepine; provider does good job of setting boundaries and using safe decision making.
  • High Risk Low Benefit (6:03 min): Provider uses good listening skills, motivational interviewing, and overall effective communication strategies in the face of a poorly motivated patient.
  • Scope of Pain-Boston University: Offers video case studies that model complicated provider-patient interactions around prescribing opioids for chronic pain including provider debriefs and reflections.

Books

Articles and Commentaries