Communication & Professional Conduct Competency 1.10

Competency 1.10

The ability to communicate bad news to patients in an empathic and understandable way

This competency deals with the capability of the trainee to discuss subjects with patients that may be of a difficult and often a distressing nature.

Best Form Evidence

In an ideal situation the Assessor would probably prefer to witness this via Direct Observation but in reality this is unlikely to happen.  The most likely methods of sign off are via Role Play / Case Scenarios, examination of Patient Records and Questioning.

Communication is the keyword here.  The Assessor will search for evidence of usage of appropriate language, both verbal and non-verbal.

Example of possible scenarios:

From the Patient Episode Request sheet you should be able to demonstrate this competency with a record of a patient with either an immediately sight threatening condition or irreversible visual loss of vision as a result of, for example, ARMD.

Other such examples which would be suitable include,

  • Having to tell a parent that a child has an eye problem (e.g. strabismus)
  • Having to tell a patient they have ARMD
  • Having to tell a nervous patient that a referral is needed
  • Having to tell a patient they no longer are legally satisfying the vision standards for driving
  • Discussing a referral for an tumour
  • Telling an optimistic patient that “new spectacles” will not improve acuity
  • Telling an older child that they have a colour deficiency and may not be able to pursue a chosen career

Unacceptable Evidence

This competency examines the ability to discuss bad news in an empathetic and sympathetic manner as necessary.  If there is no demonstration of compassion and consideration for the patient’s feelings or emotions (without disruption of the patient-practitioner relationship) then this will ensure a fail.

It is difficult to annotate a record card with empathy so consider appropriate phrasing.  For example “Explained to Px : no longer fulfils driving standard.”

Though dealing with sensitive subjects here the trainee should consider that overdramatic hand gestures, crossed arms, towering over the patient or excessive shaking of the head may cause the patient further distress.

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