By Hannah Hughes, DMD

I still remember the powerful relief of graduation day. I was ready to shelve my books, put on scrubs, and start working with patients; the continuing education (CE) Connecticut required of me to renew my license was the last thing on my mind. But, as my first year of work progressed, I began to ask some questions. How was I going to motivate myself to go back to the classroom? How do I find and then pick CE courses? Can I justify spending money on CE courses while I still have student loans looming? Since that first year, I have arrived at some preliminary answers.

My work itself provided both the motivation to return to the classroom, and the topics to be prioritized. After residency, I relished my newfound freedom from the classroom, until gaps in my knowledge began to become apparent. Whether a coworker brought up a topic I needed to know more about, or a patient had a question that I could not answer, there arose a need to broaden my knowledge. I started to make a list of these incidents, and this list became an inventory of subjects to be addressed through CE.

I next took on locating and choosing CE courses, and eventually discovered three sources for relevant CE. I began with an exhaustive search of local schools' websites to see if any offered CE in dentistry; many did. Outside academia, I found many town and state dental associations offered CE. Finally, one of my colleagues recommended looking at social media groups. I turned to Facebook, and was surprised by how many profession-specific groups there were. Even the less helpful groups were filled with other health professionals looking for advice, not only helping me find CE, but also helping me feel like a part of a broader medical community.

Even after solving these problems, I still thought I should wait before spending more on education. Then, I remembered that during my third year of medical school, I had met a dentist who was four years out of school. He told me he had made a promise to spend 10% of his yearly income on CE while working. I admired his plan at the time, but only after beginning work did I realize the importance of his commitment to staying focused and bettering his education. I resolved to set goals and make plans for my CE. Since Connecticut's CE requirements are counted in hours for dentists and many professionals, I tracked and planned my CE in hours rather than dollars. Setting a goal for my CE, and visualizing this goal by tracking my hours on a spreadsheet, helped me think about CE productively rather than with fear for my finances.

I’m still experimenting with CE to find what works for me. I still ask for advice from colleagues and check internet forums. With so many CE classes offered, finding effective ones still requires research. And, sometimes, I still need a break from the classroom for a few months. I just make sure to keep my goals in mind and to remember that my patients are counting on me!

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By Kate Schiff, MHS, PA-C

One challenge all medical practitioners face is how to deliver bad news to their patients. During my five years as a PA, I have been the beneficiary of excellent advice on how to do this. But, from time to time, I have wondered whether there may be something I could do to better comfort and communicate with patients during these difficult moments.

For guidance, I turned to Dr. Gerard Fumo, medical oncologist and hematolgist at Midstate Medical Center. “Sit down, sit close, don’t rush, remove distractions and don’t allow interruptions. Watch your patient closely as you talk. Make sure you are not losing them,” Fumo advises. “Pause if necessary, let them absorb what you are saying. Frequently people stop processing when they get bad news…don’t be uncomfortable with a little silence. This is where you can ‘read’ the situation – is your patient coping well or decompensating? You will proceed differently based on how you read the situation.” The ability to read the situation is critical, and patients will notice when their provider fails to do so even if the patient appears distracted by their diagnosis. When labor and delivery nurse Amy Murlowski received news that she had a progressive, degenerative spinal disorder, she explains she wished her spine specialist had “simply acknowledge[d] the shock and discomfort” Amy was in due to both the diagnosis and her level of pain at the time.

Patients watch their medical providers closely, and read their demeanor for clues to the diagnosis. Breast cancer survivor Kimberly Jones* describes her first doctor's visit after a breast biopsy: “When the initial biopsy came in, she checked [the biopsy site] and never looked at me. We have a history of friendly banter usually with each other…I already knew it was bad.” She recalls feeling alarmed and offended by the sudden loss of friendliness and withdrawal. Later, when pathology revealed her cancer to be worse than what she had initially understood it to be, Kimberly resisted returning to the office to discuss her treatment and prognosis. “I said call me, I can read your body language so not looking at me doesn’t work for me. She said ‘well I don’t like to give bad news’…in my heart I want to say I’m glad she has not been desensitized, but in my head I’m like my God it's your job to inform me of everything…”

While tact and body language are extremely important, the greatest nuance lies in knowing the right amount of information to give the patient. To gauge the proper amount, Dr. Fumo suggests observing how comfortable the patient is with the conversation. “You don’t always have to give all the bad news in one meeting. Some individuals just can’t cope with it and others don’t do well with bad news that just seems to be getting worse and worse. Many times bad news can be given in stages.” He also cautions health care professionals to be aware of the influence of accompanying friends and family. “It’s great to make sure that family and friends are getting what they need from the conversation, but your first obligation is to your patient. Even as you address family’s questions, always keep an eye on your patient and make certain your patient is comfortable with how things are going. Stay at the pace of your patient, not the family or friends.”

My hope is that this essay will provide some useful tools, insight, and reassurance for a distressing medical moment. In conclusion, I offer one last pearl from Dr Fumo: “Be sincere and empathetic. Patients sense whether you are just giving them standard recommendations…or whether you’re giving them individual care and guidance based on medical information. Earn their trust and guide them with your heart and instinct; you have the knowledge.”

*Name changed at patient's request.

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To leave a response to this post, please email Ellen Ravens-Seger.