Skip to main content

Don't try this at home (New GeriPal video "Take out the trash")

"Don't try this at home," said Steve Pantilat, the director of our palliative care fellowship to the new palliative care fellows.  It's July, and the new fellows are learning communication skills.  "Communication skills that work well for breaking bad news and family meetings rarely work well at home."

He's absolutely right.  I have occasionally attempted to use some communication techniques I learned in palliative care training at home with my wife, with disastrous results.  In my case, I usually try these techniques when I'm trying to get out of trouble for something (like not paying attention).

I created this video, called "take out the trash" for all of the spouses and partners who have endured when we talk like we are running a family meeting at home.  We love you!

For the "communication experts" out there - see if you can spot "Ask-Tell-Ask," NURSE (Naming-Understanding-Respecting-Supporting-Exploring), and the "teach back" method.

(Click here to go to youtube if no video pops up below.)

I have to credit the inspiration.  My wife showed me this hilarious video of an orthopedic surgeon talking to an anesthesiologist.

by: Alex Smith


Thank you thank you thank you for these Alex. You forgot to mention 'therapeutic silence' in yours as well.
I will say that there have been many techniques that I have picked up/been taught in palliative care which are helpful at home; but they're most team dynamics ones. The most useful by far has been informing my wife: I am going to tell you this because I need to vent or think out loud not because I am asking you to fix this for me. This helps to prevent 'why don't you do this...why don't you do this...' responses to my venting. Heck, this is a bedside technique that I was taught: meet emotion with emotion.

What's most hilarious about the ortho-anesthesia one is the computer-language mispronunciation of asystole. Initially I thought it was a deliberate joke to have the orthopedic surgeon pronounce it that way. Works really well.
Patrice Villars said…
This post wins for THE FUNNIEST post ever!! I wonder if families feel as frustrated with us sometimes as the wife in the video who just wants him to shut up and take out the trash! Hilarious. Thanks, Alex.
jtulsky said…
Very funny Alex. The best communication techniques will not rescue anyone when they are simply a jerk!
ella bowman @ iu geriatrics said…
These are AWESOME! I am LOL so hard I am crying. Can't wait to share these with my geriatrics and PC colleagues! Thanks so much for sharing!
Sometimes just meeting someone's request is the best "technique." Have you taken out the trash yet Alex?
Eric Widera said…
It often helps to hope for the best but plan for the worst. I too hope that the trash will be taken out, but let's think about what happens if this doesn't happen. What would you want done in this case?
Bear in the striped shirt said…
Haha! In your defense, you have never been as bad as the bear in the video.
Dan Matlock said…
Alex, this is just hilarious.

I would love to see a series of exaggerated communication techniques.
Dan Matlock said…
Alex, this is just hilarious.

I would love to see a series of exaggerated communication techniques.
Dan Matlock said…
Alex, this is just hilarious.

I would love to see a series of exaggerated communication techniques.
Shelly said…
OMG! the hospice staff was about to call 911 for me, I was laughing so hard! Yep, will send this on to cooworkers and my sister, who HATES any type of "therapy voice"
For some reason I missed this blog post the first time around. I saw it posted on Venus Watson's Facebook page (Thank you echo chamber effect!). I just watched time for the first time and my wife was with me, and she totally nodded and agreed.

I had seen the EMT-Nursing Home video using this animation tool a few months ago but had been struggling to figure out a way to use it to show some humorous sides of palliative care. Thanks for inspiring me Alex. Must get my creative juices flowing again.
Hey Dan,

Are your three posts of the same thing emphasizing the adult learning theory of hearing something a few times before internalizing it? And three times to exaggerate it!

Alex Smith said…
Thanks everyone for the comments. Was so fun to make! Many thanks to my dear wife, the bear in the striped shirt for helping.

A few responses:
-Drew Rosielle and James Tulsky (via email) point out that these communication techniques often ARE helpful in the home. I grant that's an extent. I think spouses or partners are sensitive about the re-creation of the work environment at home. The home should be the home.

-Patrice, good point about these techniques sometimes falling flat with patients and families. I think for the most part, they work incredibly well, and are core skills for people practicing Geriatrics and Palliative Care. Analogous to a resident knowing how to perform a lumbar puncture. As Susan Block said in that Atul Gawande New Yorker article, these are necessary skills for difficult converations that can be taught and learned, like any procedure. But the other critical component is knowing to be flexible, and adapting to the situation. Communication is infinately complex, proceeds on multiple levels concurrently and over time (as people process conversations). That complexity part of why this field is so fun and interesting. Sometimes, however, these techniques just fall flat, sound condescending, or can seem evasive. You have to meet the patient or family where they are, and sometimes that's a straight up answer to a question, not a probe. At home, take out the trash means take out the trash; at work, sometimes the answer to a question about prognosis is the prognosis, not a follow up question.

-My favorite comment was an email from Susan Block, "Very funny. We trained you well."

-Dan, love the series idea (from your series of comments), please make one! It's easier than you think, and so fun!

- Eric, re the comedic potential of "hope for the best, prepare for the worst," yes! I incorporated into an extended version (along with "therapeutic silence" - thanks Drew) and emailed to you, let me know what you think.

-Christian, thanks for pointing out that some may have missed it, I just tweeted again, saying this is a new video post for those who may have missed it.

-Shelly and Ella, thanks for the props, and for spreading the word! So far, we've had over 500 views on this page and over 500 views on Youtube. Let's make this go viral!
Amy said…
Going to use this in my grand rounds presentation on communication in medicine. I too hate when my husband uses the psychology crap on me at home...

Popular posts from this blog

Lost in Translation: Google’s Translation of Palliative Care to ‘Do-Nothing Care’

by: Cynthia X. Pan, MD, FACP, AGSF (@Cxpan5X)

My colleagues often ask me: “Why are Chinese patients so resistant to hospice and palliative care?” “Why are they so unrealistic?” “Don’t they understand that death is part of life?” “Is it true that with Chinese patients you cannot discuss advance directives?”

As a Chinese speaking geriatrician and palliative care physician practicing in Flushing, NY, I have cared for countless Chinese patients with serious illnesses or at end of life.  Invariably, when Chinese patients or families see me, they ask me if I speak Chinese. When I reply “I do” in Mandarin, the relief and instant trust I see on their faces make my day meaningful and worthwhile.

At my hospital, the patient population is about 30% Asian, with the majority of these being Chinese. Most of these patients require language interpretation.  It becomes an interesting challenge and opportunity, as we often need to discuss advance directives, goals of care, and end of life care options…

Delirium: A podcast with Sharon Inouye

In this week's GeriPal podcast we discuss delirium, with a focus on prevention. We are joined by internationally acclaimed delirium researcher Sharon Inouye, MD, MPH. Dr Inouye is Professor of Medicine at Harvard Medical School and Director of the Aging Brain Center in the Institute for Aging Research at Hebrew SeniorLife.

Dr. Inouye's research focuses on delirium and functional decline in hospitalized older patients, resulting in more than 200 peer-reviewed original articles to date. She has developed and validated a widely used tool to identify delirium called the Confusion Assessment Method (CAM), and she founded the Hospital Elder Life Program (HELP) to prevent delirium in hospitalized patients.

We are also joined by guest host Lindsey Haddock, MD, a geriatrics fellow at UCSF who asks a great question about how to implement a HELP program, or aspects of the program, in a hospital with limited resources.  

You can also find us on Youtube!

Listen to GeriPal Podcasts on:

Are Palliative Care Providers Better Prognosticators? A Podcast with Bob Gramling

Estimating prognosis is hard and clinicians get very little training on how to do it.  Maybe that is one of the reasons that clinicians are more likely to be optimistic and tend to overestimate patient survival by a factor of between 3 and 5.  The question is, aren't we better as palliative care clinicians than others in estimating prognosis?  This is part of our training and we do it daily.   We got to be better, right? 

Well, on todays podcast we have Bob Gramling from the Holly and Bob Miller Chair of Palliative Medicine at the University of Vermont to talk about his paper in Journal of Pain and Symptom Management (JPSM) titled “Palliative Care Clinician Overestimation of Survival in Advanced Cancer: Disparities and Association with End of Life Care”.

Big findings from this JPSM paper include that we, like all other clinicians, are an optimistic bunch and that it actually does impact outcomes.   In particular, the people whose survival was overestimated by a palliative care c…