Managing the Challenging Questions

Sarah Thompson Clinical Librarian

NHS Direct

Outline of this session Types of Challenges Challenging Questions What to Avoid Issues to explore

Types of Challenges Give me everything you have on... Level of Understanding Unable to find the information Method of Delivery Dealing with Emotion Delivering Bad News Ethical/ Moral Conflicts Information, not Advice

Give me everything you have on...

Information Needs Assessment What do they already know? What level of detail do they require? Open Ended and Closed Questions

Level of Understanding Assessing their level Level of detail Information must be meaningful

Unable to find the information Have a plan: a list of websites/ resources for

particular enquiries, e.g. Medicines enquiries, conditions and treatments, travel health, NHS services, complementary and alternative treatments, guidance, etc.

Can also refer patients to other services as appropriate, such as their healthcare team, NHS Direct, PALS, Medicines helpline services, specialist support groups for their condition.

Method of Delivery Email, postal, over the telephone,

computer access Access requirements; Braille, large print,

audio tape, different language Additional support; dyslexia, learning

difficulties, etc.

Dealing with Emotion Identify and Manage Tearful, irritable, angry, vulnerable, helpless,

anxious, frightened, etc. Listen, Acknowledge and Deal (LAD) Calm, professional and compassionate Help them to gain control through knowledge

and understanding Offer quiet place, or to take information away

with them

Delivering Bad News Provide a complete answer Withholding or censoring information Facts, not opinions Offer support, along with the information Stay within your role boundary Compassion, not pity Professional and calm

Ethical/ Moral Conflicts Your ethical or moral beliefs may be tested Plan for all eventualities to prepare yourself Ensure you are ready to put your own feelings

on a back burner to help the patient Examples might include; abortion, safe sex

advice, safe ways to self harm, information on assisted suicide, etc.

CILIP Ethical Principles and Code of Professional Practice

Information, Not Advice Support the patient to make their own

informed decision Allow them to have an informed discussion

with their healthcare provider Not the role of an information provider to

provide medical advice, what to try or avoid, but to offer a range of information from reliable, evidence based sources.

Use a disclaimer to protect yourself

What to Avoid Making Promises Personal Experience Giving Opinions Interpret information to a personal

circumstance Promote individual treatments Provide access to e-resources that

exclude patients and carers from licenses

Challenging Questions #1

What causes the discrepancy in my leg length?

We can’t tell them what has caused their condition, but we can provide information on causes in general, offer information on musculoskeletal structure, and suggest visit to GP for a diagnosis specific to them.

Challenging Questions #2

A friend of mine, who is into her complementary therapies, has recommended seeing an iridologist to see if the colourations in my iris can help detect health problems, is this reliable?

We cant say yes or no, but we can provide some links to studies which have investigated the reliability of iridology, offering a balanced response.

Challenging Questions #3I think my granddaughter is using her crutch

wrong, she had knee surgery and is holding the crutch in her opposite hand, is this right?

Cant advise on the right way to hold a crutch as this can vary for different reasons, e.g. type of surgery, where the patient is with her recovery, etc. She should have been given this information by her care provider, delicacy required with third party requests.

Challenging Questions #4

After a recent holiday in Mali (Sub-Saharan Africa) I've been diagnosed with Guinea Worm. I've heard that they exit the body in a gruesome way, can you tell me if this is true?

This is straightforward in content but the extraction of guinea worms is unpleasant and is challenging in that it requires tact and sensitivity to pass the information on.

Challenging Questions #5

How long does cocaine stay in your system, will it show up on a urine test?

Does providing the answer condone illegal drug use?

What if this query was from an Airline Pilot, would you have a responsibility to let the airline know?

Challenging Questions #6I've had stomach pain for a while now, please can

you give me some information on Stomach Cancer?

Self-diagnosis? Refer to GP to assess the pain and find out what's causing it. Provide basic information?

All symptom based enquiries should be directed to a health professional for advice and where necessary, a diagnosis.

Challenging Questions #7

Female asks how she can treat cuts and bruises at home without seeing anyone.

Do you question if she has the cuts and bruises, and if so, how she got them? Or just answer the question with first aid advice?

What if she is suffering abuse and this is a chance she has of someone noticing something is wrong and offering help?

Challenging Questions #8Daughter is caring for her mother who has

dementia and asks for some information. During the conversation she tells you she thinks her mother’s quality of life has reduced significantly.

Do you ask how she's coping? Should consider the daughters emotional needs here too along with the information on dementia.

Need to assess the risk that she might cause harm to herself or her mother if she doesn't receive support.

Issues to explore Third Party Enquiries Legal Restrictions Child Protection Safeguarding Adults

Policy and Guidelines

Develop a set of policies and guidelines for how your service will deal with enquiries which might be deemed challenging or controversial.

More than just answering the question Information Need Vs Information Want Often more complex than first seems Need to discuss with patient to explore situation Right to Information Vs Ethical/ Moral Conflicts Remember they may not be able to process

information at the time of the request

Conclusion

?sarah.thompson@nhsdirect.nhs.uk

Any Questions?