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Q: Why did you change your name from Oncotalk to VitalTalk?

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It turned out that another group had trademarked the term ‘oncotalk’, and so when we decided to start a nonprofit, we had move on from that name—and changing made sense because we’re going beyond oncology now.

Q: Why did you start a nonprofit?

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We want to rapidly scale our dissemination because we see communication as the key clinical skill needed for palliative care to take off in the US—we’ll never have enough fellowship trained physicians to meet the needs for primary and secondary palliative care. No single existing institution has the number of faculty that can do this training that we need.

Q: Couldn’t you do a face-to-face course closer to me?

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We’re in the process of pulling together a network of VitalTalk faculty—people that we’ve trained and who we know can teach this material in a way that is compelling, engaging, and rigorous—to make our work more available.

Q: I’ve heard a little about your facilitation methods—can I find it here on the website?

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In the teacher section here, you’ll find our original writings on facilitation. To get our newest stuff, join the VitalTalk faculty program! You’ll have access to faculty-only resources and we’ll keep you abreast of what’s happening.

Q: I was talking to a patient yesterday who just seemed unwilling to talk about the fact that he was dying, and it was urgent for him to make a decision about code status—what do you do in that situation?

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Your question makes me curious about what made you patient unwilling—was it fear, or beliefs, or a commitment to others? When you’re in a tough situation (and those situations are some of the hardest ones we face), it can help to take a step back and ask yourself, ‘what is going on here?—what is he saying and how can I unpack it?’ The thing we often see is that well-meaning clinicians repeat what they’ve been saying (just louder), and get stuck in a rut—often wallpapered with their assumptions. So make sure you examine your own assumptions about why the patient seems unwilling, and the clinical situation. And if other clinicians are pressing you, consider whether they are distressed and are turning to you to ‘fix’ something…

Q: Given the limited time we have with patients, how can we first recognize the patient’s culture and then give bad news in a culturally sensitive way?

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I don’t do a formal cultural assessment before I give difficult news—but what i do is to ask people what they have taken away from what the other doctors have told them—the way they explain and how they explain tells me quite a bit about their level of education, medical savvy, how they think about their illness. Then, if I detect a major cultural disconnect i’d say ‘what sort of advice or guidance would help you today?’ That usually allows me to avoid putting my foot in my mouth. Pauline Chen wrote a great article here, and the best cultural sussing questions, by Arthur Kleinman, are here.

Q: I see that my patients get upset but feel pressed for time—what do I do then?

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Hey thanks for being honest—and dedicated. It’s great that you can read an emotional cues that signal getting upset. So when you see a patient get upset, it’s normal to feel worried that you won’t get everything done that you hoped. The usual impulse is to try to talk faster, so you can try to get it all in. But while that seems efficient, you’re probably wasting time—because your patient isn’t hearing what you say. So pause for a moment, acknowledge the upset (for example, “I can see you’re worried about this”), and see what the patient says. Invest in a moment of empathy—it often pays off in the patient telling you what she really needs.

Q: How do I find a VitalTalk course that is for clinicians? I’ve got to work on my own skills first!

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We have big plans for the next year, and you’ll see our courses for clinicians take off. So sign up for our newsletter—we won’t share your email with anyone—and be the first to know.

Q: I was watching someone give bad news—and they did a terrible job. It was really hard to sit and watch. But I didn’t want to do anything that might embarrass my colleague.

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Try this: “could I add something?” It’s a polite way of getting a word in edgewise—and then you can add a little breathing room in the conversation (a common pitfall is for a clinician to talk a little too much). We wrote a paper about this here.

Q: I was talking to a patient about code status, which I thought went quite well. But later I found out the patient had been really tearful after I left—and I felt terrible about it.

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Could you take a step back and ask, what would a kind third person say? I might say, it’s common for people to be sad after a code status discussion—so her sadness after you left might just be a normal reaction. Could you think back through your conversation, and see if there is a moment when you weren’t sure it was going well? Try to reconstruct a portion of your conversation (in retrospect, did you start to see the sadness coming on?), and pick one skill you’d like to try next time (if you did see the beginning of the sadness, could you acknowledge it?). Check our resources on responding to emotions here.