Stop, Talk, Roll

Stop, Talk, Roll
Ken Orvidas, New York Times "When the Patient is Racist". July 25, 2013 http://nyti.ms/236dXMe

Stop, Talk, Roll: How to Deal with Tough Communication Exchanges in the Medical Workplace

Throughout the course of your career, there will be a range of situations in the hospital or clinical setting that will make you uncomfortable. These disconcerting situations can run the full spectrum and involve interns, residents, attendings, nurses, healthcare staff, administrators, patients and the families of patients. 

These incidences can occur at anytime and can happen to anyone. Some examples of situations that you might find yourself in during rotation include:

  • Experience mistreatment firsthand by being called a racial slur by a patient or member of the medical staff.
  • Witness any healthcare professional who makes a sexist comment to another health care professional and seeing that person become uncomfortable or embarrassed.
  • Observe an attending and resident making jokes related to gender identity or gender stereotypes in a group in front of other residents.
  • Being the target of pointed, belittling, sarcastic comments such as, “What’s the matter with you? – You should know this already! Or “What’s wrong with you – you call yourself a doctor?” or “You’re not trying hard enough” and “Just get out of my OR.”
  • Feeling ignored, as if you are being isolated from the rest of the team and not being engaged by others.

Physicians, as leaders, must have the words and communication skills to interact, interpret, and navigate these uncomfortable, and potentially distressing situations where they feel disrespected or discriminated against.

In meeting this goal, Stop, Talk, Roll (STR) is a communication guidance tool that has been designed to provide suggested phrases and approaches for medical students and residents to addressing particular scenarios and diffuse tense communication exchanges with a wide range of stakeholders. STR training and guidance will be provided to medical students, residents and medical staff this coming fall.

STR also provides pathways for seeking out help and support to navigate the scenarios, which include seeking out support from your residency program leadership, including: chief residents, program directors and associate program directors.

Access Stop, Talk, Roll Guide for Medical Students Here
Access Stop, Talk, Roll Guide for Residents Here
What to do with inappropriate behavior? Stop, Talk, Roll; full text below graphic

What to do with inappropriate behavior?
Stop: Stop the conversation and immediately consult with your supervising resident or attending.
Talk: Talk through a tough patient encounter with a supervising resident or attending.
Roll: After your shift is over, roll on out and get support through: GUSOM peer mentors, Student Affairs, Office of Diversity & Inclusion, Clerkship Harassement Team Members (http://bit.ly/1Tx4g5f), Counseling & Psychiatric Service (CAPS)

Step 1: Stop; full text below graphic

Step 1: Stop
What to do, what to say.
Scenario 1: Patients
Stop the conversation and immediately consult with your attending. “Thank you, I appreciate your concern. would like to discuss your care/case with the supervising physician to ensure that you receive the appropriate care from the right people.” “I am not comfortable with your comments. I am going to consult with the supervising physician to ensure you receive the appropriate care by the right people.”
Keep an appropriate distance in case the situation escalates. “I want the best care for you, so please let me know if you have any concerns. I’m going to consult with another physician and refer him/her on to you.” “If there are any concerns you have about your care, I can get the supervising physician and we can discuss together.”
Assess the Situation. Assess the patient for source of hostility/frustration: 1) Angry/frustrated patient 2) Substance altered/intoxicated patient 3) patient who is acting innately slanderous. “Is there something that is concerning/bothering you? I’d like to better understand what is troubling you so we can get you the care you need.”

Scenario 2: Team Healthcare Member
Depending on the nature of what was said, consider waiting 24-48 hours. This allows reflection in order to decide on the right words that should be used to address the comment and persons that need to be involved. It also allows for a moment to calm down and cool off if the statement was inflammatory. You do not want to retaliate in anger and fuel the situation. This may be a good time to consult Office of Student Affairs, Office of Diversity and Inclusion, MSLAC Coordinator Team and/or Ombudsperson for advice and feedback.

Step 2: Talk; full text below graphic

Step 2: Talk
What to do, what to say.
Scenario 1: Patients
As a medical student, politely remove yourself from the presence of the patient and immediately consult with the supervising resident or attending who has the responsibility to address the patient directly. “I’m not sure what happened, but I need to talk through this scenario with you — I’m feeling shaken, scared, upset.”
If possible, after consulting with your resident/attending, observe how s/he diffuses the situation so that you may know how to approach a similar situation in the future whether in clerkship and residency. “I need a sounding board right now, I feel torn up about this and not sure if there was a better way to handle this. It would be good to talk this through with you.”
Scenario 2: Team Healthcare Member
Seek Private Conversation. “Dr. X, I wanted to reflect briefly about a comment that you made yesterday that created some concern for me. Respectfully, you mentioned ‘….’ I was feeling that this statement could have been interpreted as offensive to [this group of people]. I really enjoy being a member of your team and am excited by the work we are doing. However, this comment made me uncomfortable.” Allow for the person to react and give their side of the story. Do not raise your voice and watch your tone.

Step 3: Roll; full text below graphic

Step 3: Roll
What to do, what to say.
Scenario 1: Patients
Reach out to school of medicine staff or peers for immediate, confidential, and safe support. Appointments are easy to make and can be made the same day or week of, depending on your need to talk to SOM staff and peers soon! Appointments can also range from quick, informal 15-minute check-ins to an hour as needed in order to process, troubleshoot and support you, depending on what you need. “Thanks for your help — I’d like to process what happened to me during my clerkship and get some support.” “I’m still feeling offended and hurt by the situation and thought it would be a good idea to talk through how I might respond if the situation were to happen again.”
Scenario 2: Team Healthcare Member
Judge the situation moving forward. [Resolved] If you feel that the situation ended well, you should continue on the clerkship as normal. [Unresolved] If you feel that the situation did not end well and are concerned about the work environment moving forward, you should consider approaching the Office of Student Affairs & the Office of Diversity and Inclusion. It’s important for you to address the situation because there will be many situations that you will experience as a future physician, and your response can determine perceptions of professionalism, ethics and collaboration.