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Communication 101.5: 
Tips and Techniques to Address 
Challenging Interactions in Clinical Practice
A DrossmanCare and Rome Foundation Educational Product

Author, Publisher and Director
Douglas A. Drossman, MD

Production Associate
Johannah Ruddy MEd

Videography and Editing
DrossmanCare created and produced this video program in collaboration with Davis Stillson Associates, who provided the technical production, and the Rome Foundation, who provided the marketing and distribution

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Communication 101.5: Tips and Techniques to Address Challenging Interactions in Clinical Practice

Communication 101.5 is a unique video learning tool for clinicians that explains how to address challenging situations when seeing patients with Disorders of Gut-Brain Interaction (DGBI). During a clinic visit, clinicians may be faced with difficult issues to address that may be confusing or even confrontational. The clinician must navigate the interview in a fashion that leads to resolving the underlying problems, improving patient and doctor satisfaction, and arriving at a mutually agreed-upon plan of care. Through this video learning series, Communication 101.5, clinicians can watch as a leading expert in the field offers methods to address these interaction difficulties in a fashion that leads to consensus and resolution. 

After reviewing this program, you will be able to:
● Understand complex underlying interpersonal dynamics leading to confrontative encounters
● Understand the patient's perspective
● Learn how to offer empathy, negotiate and set boundaries to achieve the intended results
● Apply methods to address both patient and doctor concerns
● Maximize the likelihood of establishing patient and doctor satisfaction and a mutually agreed plan of care
● Help the patient leave the office trusting and satisfied with the plan of care

This video program provides 4-8 minute videos that encapsulate the clinical challenges and their resolution. Included are eight seemingly complex interviews occurring during a clinic visit. The doctor uses specific methods and techniques to resolve the obstacles, improve the patient-doctor interaction and result in a mutually agreed-upon care plan. Each video demonstration also provides a time-coded point-by-point description of the dialogue, giving the interpretation of the underlying issues and interview techniques that allow the doctor to negotiate through the sequence of events.

Suggestions for the Use of Communication 101.5
1. Please go to the review key segments for each case presentation using time codes.
2. Select any of the eight clinical scenarios and click "Video length X: XX to view each clinic visit in its entirety
3. Review or make notes of the challenge you observed that the clinician needs to address. Observe how he manages it: What was said and why?
4. Find the row of the specific action related to this challenge and click the time code to view the noted interview segment again.
5. Read the interpretation to understand why the specific action was taken.

The clinical topics included in this series include:
1. Patient Requesting Opioids – The doctor would like to prescribe a neuromodulator to treat a patient with chronic abdominal pain. However, the patient requests opioids. The goal is to set up a management plan without using opioids.

2. Patient Requesting Antibiotics for "SIBO" – The patient convinced she has SIBO (small intestine bacterial overgrowth) and wants to go on another course of antibiotics. The breath H2 tests are negative and recent treatments with antibiotics were ineffective. The doctor needs to refocus the patient's beliefs toward choosing treatments other than antibiotics.

3. Patient Wanting Tests to Exclude Cancer - The doctor needs to address the patient's repeated requests for further testing to rule out cancer when clinically the studies are not indicated. The doctor needs to engage with the patient in a manner where she will be open to hearing a different perspective.

4. Patient Seeing Doctors for Non-credible Diagnoses – The patient presents with abdominal pain and diarrhea. She has been to alternative medicine providers, patient websites and google and is convinced she has multiple diagnoses: Lyme disease, mast-cell activation disease, median arcuate ligament syndrome (MALS), gastroparesis (mildly abnormal GE), and porphyria and wants treatment. The doctor needs to engage the patient in a manner that allows her to give up her false beliefs and work on more established treatment strategies

5. Teenager with Overinvolved Mother - The doctor sees a teenage patient while her mother is present. The mother keeps interrupting and tries to manage the discussion. The doctor needs to find a way to obtain information directly from the patient while respecting the mother's interests.

6. Patient Refusing Neuromodulators - The patient is reluctant to take a neuromodulator (antidepressant) because of the internalized stigma of her being seen to have a psychiatric problem. The doctor needs to clarify this medication's value from a physiological perspective, thereby avoiding the stigma and acquiring the patient's acceptance of the treatment.

7. Achieving Collaborative Care – The patient presents to the doctor with high expectations. She reports how previous doctors are initially interested in working with her, but after the studies are normal, they become disengaged. She wants the doctor to help her where others have failed. The doctor needs to help the patient understand and agree to a collaborative care model with shared responsibility.

8. Patient Reluctant to Discuss History of Trauma - The doctor elicits a history of early life trauma, the consequences of which may be influencing her current GI symptoms. However, the patient does not feel comfortable discussing this topic. The doctor needs to address the possible association of her symptoms to these experiences and suggest further exploration and treatment in a fashion that would be acceptable to the patient.

9. IBS-D patient with a newborn and an overinvolved spouse: Laura and Diane are spouses who recently adopted a newborn, Susie. Their adjustment to becoming parents is complicated by Laura, Susie’s primary caretaker developing IBS-D. This has forced her to leave her work as a teacher, and their relationship has become more complicated and distressing. How does the provider address both Laura’s symptoms and the new interpersonal difficulties?

Notice: The medications mentioned in this video are used to illustrate clinical encounters. They are neither endorsed nor have specific approval by DrossmanCare, the Rome Foundation or the Food and Drug Administration for use in the diseases discussed.

Faculty

The faculty includes a key opinion leader in Neurogastroenterology and Disorders of Gut-Brain Interaction and a patient advocate. Both are certified facilitators in the DrossmanCare/Rome Foundation Communication Skills Program.
Douglas A. Drossman, MD
Professor Emeritus of Medicine and Psychiatry
University of North Carolina at Chapel Hill, NC
President Emeritus and Chief of Operations of the Rome Foundation
President, Center for Education and Practice of
Biopsychosocial Care (DrossmanCare) and Drossman Gastroenterology

Dr. Drossman is Professor Emeritus of Medicine and Psychiatry in Gastroenterology at the University of North Carolina School of Medicine. He is President Emeritus and Chief of Operations of the Rome Foundation and is President of the Center for Education and Practice of Biopsychosocial Care (DrossmanCare) and Drossman Gastroenterology. He is an internationally recognized scientist, clinician, and educator in DGBIs and communication skills training. Dr. Drossman develops workshops and training programs in communication skills and sees patients with complex DGBIs in his gastroenterology practice. The clinical case scenarios were developed from actual patients seen in his practice

Johannah Ruddy M.Ed.
Executive Director of the Rome Foundation
Secretary-Treasurer of the Center for Education and Practice of Biopsychosocial Care (DrossmanCare)

Ms. Ruddy is a patient advocate with a background in education working with non-profit organizations. As Executive Director of the Rome Foundation, she coordinates operations and educational programs. As Secretary-Treasurer of DrossmanCare, Ms. Ruddy facilitates workshops in patient-centered care and is a simulated patient in videos on communication skills. Ms. Ruddy can articulate her experiences in a way that educates doctors and motivates patients to self-actuate and assume responsibility in their care. Ms. Ruddy uses these skills to demonstrate the patient's perspective for these videos.

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