Paeds Vivas · professional-practice-and-evidence
Conflict, complaints and difficult clinical encounters — branching viva
Viva on de-escalating an angry parent, managing a goals-of-care dispute, responding to a complaint, and supporting the clinician as second victim.
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Study tools
Target exams
RACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
Ward: a father is shouting at the nurses' station because his daughter's scan result, promised yesterday, has not arrived; he is distressed but not violent; the child is stable on the ward.
Opening (candidate)
My first move is safety. I confirm there is no weapon, threat or intoxication, keep an exit available, and move the conversation to a private space with the right people. Then I listen actively and ask openly what has happened and what he most needs today, before offering any explanation or defence. [5] [3]
References5ShowHide
- [3]Steinmetz D The 'difficult patient' as perceived by family physicians. Family practice, 2001.PMID 11604370
- [5]Richmond JS Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup. Western journal of emergency medicine, 2012.PMID 22461917
- [6]Schneiderman LJ Effect of ethics consultations on nonbeneficial life-sustaining treatments in the intensive care setting: a randomized controlled trial. JAMA, 2003.PMID 12952998
- [1]Hickson GB Patient complaints and malpractice risk. JAMA, 2002.PMID 12052124
- [9]Scott SD The natural history of recovery for the healthcare provider 'second victim' after adverse patient events. Quality and safety in health care, 2009.PMID 19812092