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Breaking bad news: "The doctor patient relationship is a unique one"

Bericht Ăźber den vertrauensvollen Umgang mit HIV-Patienten:

Scientific American Magazine, im Internet hier einzusehen!

Breaking Bad News

By Nathalia Holt | June 25, 2012 |

In an exam room in his modern clinic in Berlin, Dr. Heiko Jessen takes his patient’s hand; “I don’t have good news for you” he begins, giving what he calls a warning shot before delivering the bad news. He looks into the young man’s eyes, “Your HIV test came back positive.” The patient, Joseph, a twenty-three year old American living in Germany, asks a few questions and then breaks down in tears. Jessen rubs his back, his quiet embrace giving him space for the larger emotional release.

The doctor patient relationship is a unique one, a precarious balance of trust and influence. Physicians must ultimately find a compassionate way to give their patients difficult news. Yet, this is not so easy. A study published in February found that physicians struggle with honesty, with over half admitting that they’ve been inappropriately optimistic when diagnosing their patients. Physicians have difficulty giving their patients the open, honest dialogue they need.

To address this, medical schools are adding courses in patient communication. Two decades ago, only a minority of schools taught communication skills, today, almost all of them do, including mock-patient workshops, where students can directly test their ability to talk with patients about complicated issues. One of the first of these courses was at Humboldt University in Berlin, Germany. This course, termed ‘breaking bad news,’ started in 2000 as a tiny group of only six students practicing role-playing. A decade later, the course has become a mandatory part of the curriculum and a model for physician communication classes worldwide.

Jessen, who has wide experience in giving poor diagnoses, has been part of the ‘breaking bad news’ course since the beginning. He teaches an especially popular session, where he brings in patients with whom he has had to make particularly difficult diagnoses, allowing students to directly speak to the patient. These conversations get to the heart of which parts of the diagnosis are most difficult for patients and what communication tactics are ultimately effective.

This evening, Jessen has brought Joseph, the young American man he diagnosed as HIV positive, seven years earlier. The setting is intimate, ten students gather about Jessen and his patient. The atmosphere is casual as Joseph begins to tell his story, the students gradually warming up, asking questions. Jessen is there to direct the course but mostly he lets the patient speak, preferring the informal nature of the session. To his surprise, Joseph becomes emotional. Although it has been almost a decade since his diagnosis, the patient begins to break down in front of the class, tears mixing into his difficult story and his memory of what it was like to be told he was HIV positive.

He met Jessen when he was just twenty years old at a club in Berlin. Like many of Jessen’s patients, their relationship encompasses trust and friendship, a bond that makes the difficult business of breaking bad news easier for the patient. In fact, Jessen argues that getting a difficult diagnosis is far easier from a family doctor, a person who has built a relationship with their patient and will be there for the long run, rather than a specialist.

Studies indicate that empathy plays a significant role in the clinical outcome for patients, further underlining the importance of the patient-doctor relationship. Physicians have a connection with their patients unlike any other profession. Doctors touch their patients, both physically laying hands on their heart and head, but also emotionally, representing a safe place to speak about hidden fears. A poor diagnosis involves intricate communication skills: the ability to explain as well as listen, to lead the patient into complex decision-making, and to involve those people the patient is closest to. Predictably, physicians trained in these communication skills are far less likely to suffer from ‘burn-out’ and psychiatric distress.

As Joseph speaks to the medical students he realizes that he has not entirely accepted his own difficult diagnosis. Despite the support and resources he’s received, the difficulty of his disease still weighs on him. Bad news may forever change the doctor-patient relationship but, at its core, giving patients the honesty and empathy they need is as critical to a diagnosis as any PCR test.

Copyright: Scientific American Magazine (TM)

Originalartikel im Internet hier einzusehen

Dermatologische Klinik der Ruhr-Universität und European Skin Cancer Foundation verleihen Poster-Preise

Beim DSTIG Jubiläumskongress 2012 wurden zwei Poster gekürt, die aus internationalen Zusammenarbeiten resultierten und während des STI-Kongresses im Rahmen der Posterausstellung präsentiert wurden. Die Dermatologische Klinik der Ruhr-Universität und die European Skin Cancer Foundation stifteten das Preisgeld (500,00 €).

Fotos: Professor Detlef Petzoldt, Ehrenpräsident der DSTIG, ßberreicht die Poster-Preis-Urkunden an Harriet Langanke (links) und Judith Coenenberg (rechts), die den Preis stellvertretend fßr ihren äthiopischen Kollegen Dr. Amir Adem annimmt.

  Posterpreis der Dermatologischen Klinik der Ruhr-Universität Bochum

Harriet Langanke, GSSG Köln erhielt für die Arbeit "Target Group Clients: Time Patterns in the Use of Internet Forums of Sex Workers’ Clients in Germany" den Poster-Preis der Dermatologischen Klinik der Ruhr-Universität. Die ausgezeichnete Studie entstand in Zusammenarbeit mit ihren Kollegen Sven-Axel Månsson (University of Malmö, Schweden) und Michael W. Ross (University of Texas, Houston, USA).

Bitte klicken Sie auf das Bild des Posters, um es zu vergrößern (PDF).

  Posterpreis der European Skin Cancer Foundation (ESCF)

Dr. Amir Adem (Ayder Referral Hospital, Mekelle University, Äthiopien) erhielt für das Poster zu "HIV, ART, and the problem of Treatment Failure Detection in Ethiopia" den Poster-Preis der ESCF. Die Datenauswertung entstand in Zusammenarbeit mit Sintayehu Abebe, Norbert Brockmeyer, Anja Potthoff, Adriane Skaletz‐Rorowski, und Judith Coenenberg.
In der Medizinischen Welt, Ausgabe 2/2012, ist ein Hintergrundartikel zu dieser Kooperation erschienen: HIV Behandlung in Äthiopien HIER als PDF

Bitte klicken Sie auf das Bild des Posters, um es zu vergrößern (PDF).

Hier finden Sie das gesamte JDDG Abstract-Band mit allen Poster-Abstracts (PDF).

Wir gratulieren den PreisträgerInnen und bedanken uns sehr herzlich bei den Stiftern der Preise fßr Ihre Unterstßtzung!

Petzoldt-Preis 2012 erhalten Dr. K. Haar und Dr. Y. DelerĂŠ

Im Rahmen des Jubiläumskongresses wurde am 15. Juni bei der Abendveranstaltung im Beate Uhse Museum der Detlef Petzoldt-Preis verliehen.

Die Gewinnerinnen Haar und Deleré, beide Mitarbeiterinnen des Robert Koch-Instituts in Berlin, nahmen die Auszeichnung von Professor Detlef Petzoldt persönlich entgegen. Die vier unabhängigen Gutachter hatten die Forschungsarbeiten als besonders herausragend bewertet und entschieden sich für eine Aufteilung des Preisgeldes (2500,- €) zu gleichen Teilen.

Hier kÜnnen Sie die Arbeiten der Preisträgerinnen 2012 online abrufen:

Dr. Karin Haar:
"Low Sensitivity of Pooled Chlamydia Testing in a Sample of the Young German General Population"

http://www.davidpublishing.com/journals_show_abstract.html?4497-0

Dr. Yvonne DelerĂŠ:
Cervicovaginal Self-Sampling Is a Reliable Method for Determination of Prevalence of Human Papillomavirus Genotypes in Women Aged 20 to 30 Years (J. Clin. Microbiol. 2011, 49(10):3519)

http://jcm.asm.org/content/49/10/3519.full.pdf+html?sid=938f6b1c-c1ec-4709-b367-fb4dd9ed0dca

Wir gratulieren den Preisträgerinnen sehr herzlich zu der erfolgreichen Bewerbung!

Prof. Petzoldt verliest die Namen der Preisträgerinnen. Dr. Karin Haar (links) und Dr. Yvonne DelerÊ erhalten die Auszeichnungen.