Jupiter Medical Center

Michelle J. Wienke

Patient Experience Advocate

Even after all that we have collectively been through within the last 6 years with a Global pandemic, the ways that we approach suffering humans have not shifted much.

I have a curved arrow straight to Patient Experience, which has been my wheelhouse for the better part of the last 25+ years, whether officially or unofficially. Having difficult conversations in a way that makes them meaningful is my forte.

I returned to school as a full-time adult student, post September 11 and completed my Associates, Bachelors and Masters in Mental Health Counseling, while working full time in healthcare and raising two children as a single mother.

During this time, I was able to work in both Palliative and Hospice Care as well as the Organ Donation world, while working full time as a discharge planner in a busy level 1 Trauma center. I also dabbled in long-term and short-term care, home health and hospital CNA work to gain knowledge and support my children and myself. Over this decade I learned how to take information and deliver it in a way that was both empathetic and valuable.

There are a few nuggets of wisdom that I would like to impart from my background that I hope will help you in your work with suffering humans every day.

They must know you care

It sounds trite, but most humans can see a phony a mile away, particularly if they are in crisis mode. Their ‘Spidey’ senses become much more heightened and they go into hyper-protective mode- of themselves and their loved ones. They absolutely know who really cares or if they are just going through the motions.

“Medical education is often best delivered in small ‘bites’ over time.”

Start where they are

Spend some time with them, one on one, a few at a time or as a group. My preference, even when introduced to a large family, is to talk to them in generalities and then begin to have conversations with the decision makers or the patient themselves if they can. Having the autonomy to make our own decisions about difficult things in healthcare is a GIFT. Please allow people to make their own decisions whenever safe and possible. I encourage people to have those difficult conversations with their families ahead of time-make your choices known, they can change over time, but if the critical people know, they should assist in advocating to get everything this person wants, in reason. Everyone there knows this person, but not everyone may or should be privy to their wishes or making decisions for them.

Get to know your audience

These humans in front of you who are uniquely themselves, where they live-city, rural, education level, anyone in healthcare, faith importance and their connection to the person they may be losing. This will assist you in having those difficult conversations with much more ease, as you are talking to the right people and in the right way.

Simple best practices

Sitting alongside someone, looking them in the eye and perhaps a light touch on the arm, are all signals of collaboration, care and concern for the loved ones in crisis. Sometimes they will need a big hug from you and that is ok too.

Watch for queues

They are not grasping the message. Do they look confused, are they exhausted, have they had water and something to eat, are they aggressive-shouting, demanding, posturing. These are defense mechanisms to signal you to slow down as they may be on “overload”.

Breaking your difficult conversation down

Break as many small conversations as they may need to process, accept and align with you is important. “Eat the elephant one bite at a time”. Do not give the larger picture if all that they can focus on is one small piece of the conversation. Give their minds and hearts time to absorb.

Give them space

Physical space, but also mental space-suggest they go for a walk, get something to eat, get a snack or coffee. This shows that you care about them as a person. Establish contact information for them to reach you and then give them some space.

Let them know that you are an “open door” for them and no questions is stupid. They can approach you at any time. Medical education is often best delivered in small “bites” over time.

Meet in a quiet area, free of distractions, if possible. Unless you are speaking with the patient, try to have other crucial conversations away from the patient in bed, as this can be upsetting for them to hear and a family member, once educated, may be better suited to deliver news and have you assist. Even in working with families of patients who had been pronounced, I would ask them to step out of the room for any further conversation. It is a sign of respect for the person in bed, who is no longer in the physical world.

And lastly, speaking of the person in bed, prior to working with anyone in crisis, I picture the person that I love most, who is non-medical in this position-the chair, the bed, etc. It helps to center that the way in which I handle this conversation, which depending on how it is delivered, can shatter someone forever or give them a memory of being cared for and loved, as all humans should be. The meaningful connections that I established with many of “my families” continue to this day. My role in enabling their loved one to have a comfortable transition and the support that I provided to the family made for lasting connections, some over the last 20 years. It is a wonderful touchstone to be in contact with these lovely humans.