Managing the Challenging Questions - Sarah Thompson Gill Foster Librarian at SWYP Foundation Trust

Managing the Challenging Questions

           Sarah Thompson
      Librarian at SWYP Foundation Trust

                Gill Foster
        Clinical Librarian at 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 #3
I 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 #6
I'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 #8
Daughter 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.

Conclusion
   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

Any Questions?

           ?
sarah.thompson@swyt.nhs.uk