Cadmore media player playing audio Conflict: Anthony L. Back, MD, discusses dealing with conflict in caring for the seriously ill.
Audio Player
Accessibility
Using forms mode, you can utilize keyboard shortcuts to make usability more efficient.
Space bar will play and pause the audio. Pressing escape will close all displays and pressing it again will jump to the end of the player.
You can press A to open the Keyboard Shortcut Dialog which also provides an audio description of the player and all of its features.
Transcript
Result Count
of
Search
Segments
Result Count
of
Search
Name:
Conflict: Anthony L. Back, MD, discusses dealing with conflict in caring for the seriously ill.
Description:
Conflict: Anthony L. Back, MD, discusses dealing with conflict in caring for the seriously ill.
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/b5065361-929c-4d25-973d-4133909409e4/thumbnails/b5065361-929c-4d25-973d-4133909409e4.jpg?sv=2019-02-02&sr=c&sig=eLEkT1oXP1hENvE%2Ff%2F46NINCoP4FHWjQtpYensdOvDQ%3D&st=2025-05-09T11%3A13%3A31Z&se=2025-05-09T15%3A18%3A31Z&sp=r
Duration:
T00H14M50S
Embed URL:
https://stream.cadmore.media/player/b5065361-929c-4d25-973d-4133909409e4
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/b5065361-929c-4d25-973d-4133909409e4/6830482.mp3?sv=2019-02-02&sr=c&sig=My7Lx8UAMcRzRUdv4ivngTg0M%2Fd%2FXTVuTq%2BS%2F248r8U%3D&st=2025-05-09T11%3A13%3A31Z&se=2025-05-09T13%3A18%3A31Z&sp=r
Upload Date:
2022-02-28T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
>> I'm Joan Stephenson, editor of JAMA's Medical News and Perspectives section. Today I have the pleasure of speaking with Dr. Tony Bock about an important issue discussed in JAMAevidence's Care at the Close of Life about dealing with conflict in caring for the seriously ill. Dr. Bock, why don't you introduce yourself to our listeners? >> Thank you, Joan. My name is Tony Bock. I'm a medical oncologist and palliative care physician at the University of Washington and Fred Hutchinson Cancer Research Center in Seattle, Washington.
>> What are some of the common examples of conflict in end-of-life care, and why do these conflicts occur? >> There are four kinds of conflicts that clinicians commonly encounter. I think the most common one is a clinician conflicting with a family member. The second one I think is a clinician conflicting with another clinician or colleague. The third one is a clinician who's trying to deal with a conflict between family members that relates to a patient's care. And then the final one is the clinician conflicting with a patient. And interestingly, I think the clinician conflicting directly with a patient is maybe the least common.
There aren't that many studies that directly address this, but certainly when I talk to my colleagues, what they come to me the most because they feel stuck is a family member. >> What behaviors should clinicians avoid when dealing with conflict? >> You know, the kinds of things that turn out not to be very useful are, unfortunately, some of the things that people just do without really thinking. They just react and this is what happens, and a few things come to mind. One is, they kind of downplay that the conflict is really happening. And problem with that is, downplaying it usually makes it worse because the other person doesn't think you're listening to them.
A second thing is assuming that you've got all the data and that you know the whole story. You know, the problem with that is, you miss the chance to really see a bigger picture or see another perspective. Another thing is going into this kind of defensive mode where you continually try and convince the other person that you have the right answer, and of course that often turns into just a back and forth of, you know, he said this, she said that, and it doesn't actually help with resolution. Then, one thing that relates to communication in particular is going ahead as if it's just a matter of rational thinking.
When, you know, in the heat of the moment many of these conversations are strewn through with emotions. And emotions have a huge role to play in how to make decisions and how to get people through a conflict. And then the final thing is ignoring your own strong feeling because your own strong feeling, you know, you may not want them to, but if you don't acknowledge them at least internally to yourself, they tend to leak into the conversation in ways that actually don't serve you in helping work through the conflict. So, those are some of the most common pitfalls.
>> What communication tools can clinicians use for addressing conflict? >> There are a few things. One is active listening; you know, full attention to the speaker. For example, you might listen carefully and say, what I'm hearing you say is, dot, dot, dot, as a way of really making the point that you've got it. And when you say what I'm hearing you say is you should use their exact words, all right? Another thing, self-disclosure. Revealing something about your perspective without blame and, you know, without judging them.
So, you might say, you know, I'm worried that even the best medical care may not achieve what you're hoping for. Another thing is empathizing. This is recognizing the emotional data that's in the conversation, not as a way of blaming people for being emotional, but just recognizing where they are, and most people really appreciate that. So, example, you know, I can see this is a big issue for you and that you really care a lot about what's happening to your loved one. Lastly, I think there's an important role for brainstorming.
You know, let's try and come up with a few ideas about how to deal with this, and then let's talk about the pros and cons of them. The most common reason that brainstorming doesn't work is that people go from the first suggestion right into whether or not it's a good solution or not. And, you know, for brainstorming to work, you have to generate a few ideas, so it's important to hold back for a minute and say, okay, now we're finished brainstorming, let's go back and look at these and sort through them. And by giving some signpost to the person you're talking with, you know, that makes the brainstorming and the conversation that much more effective.
>> I think it might be helpful if you could describe an example of a common conflict in end-of-life care and the type of steps you would take to handle it. >> Yeah, so, here's one that happens commonly. It's the relative from out of town who comes in unhappy about the situation, right? So, in my oncology clinic, I'm talking to a gentleman with metastatic colon cancer who's on third-line therapy that's not really working anymore. He comes to clinic with his sister who's flown in from out of state.
She launches into this thing about, you know, you've got to do something else, there must be something more, you must be doing something wrong, et cetera, et cetera, right? And so, what's the stepwise approach to this? One, notice the conflict. Well, in this case it's pretty obvious. Two is kind of prepare yourself, which is, for me, a kind of taking a step back, realizing that her agitation is not really about me, it's really about her brother and what she's trying to do in terms of how to help him, protect him, do what she feels like she needs to do in terms of being a good sister.
And so, then, the third step is for me to find a starting point for our conversation that is neutral, meaning not judgmental from my point of view. So, rather than me saying, "Gosh, why are you so pissed off about this? He's had this colon cancer for a couple of years and I've never seen you before," which, you know, might be a common reaction. I would take a deep breath and say, "Boy, it sounds like we should make sure we're both on the same page about the information and the medical details of the situation." And by saying that, what I'm calling attention to is not how upset she is, because I don't want to make her self-conscious or make her mad that I'm calling her, but bring her to what I think is a useful starting point, which is let's make sure we have shared understanding about the situation because the reality is, is that, you know, I always hope that patients talk to their family members when they come in, but it doesn't always happen.
And most family members and patients, I think these are tough conversations to have on their own, and so the most common thing is, they want to have them when they come into clinic. So, then, you know, responding in a way that recognized the emotion. So, one of my responses might be to acknowledge the emotional charge by saying, "Gosh, it sounds like you're really concerned about your brother. You must care about him a lot." It might be obvious, but on the other hand, my saying it just slows down everything a little bit in the conversation, gives her a chance to breathe, shows her that I understand why she's there.
You know, she's there because she cares about him. And then six, you know, look for options that meet the needs of both parties. In this case, I'm not even sure if I know what she's most upset about, so as I go through the medical information, you know, I'd be looking for what's a part that's really setting her off, right? Is it the prognosis? Is it the fact that he hasn't told her? Is it the fact that she feels a little guilty because she hasn't been there? You know, how can I find a way for us to productively move forward.
So, that would be kind of my stepwise recommendation about this. >> The subject of treatment trials is mentioned in the chapter, and I wonder if you can tell us how they're used. >> So commonly, conflicts between clinicians and patients or family members revolve around-- I want to have this treatment. You know, the patient or family member saying, "I want to have this treatment," and the clinician saying, "Gosh, you know, I'm not sure if it's really going to be worthwhile." Or, more unhelpfully, "No, you can't have this treatment." Right? There are all these battles around treatments.
So, if the battle is around a treatment and that seems a little intractable, one thing you as a clinician can do is offer a trial of the treatment and an offer to do the treatment trial with some agreement between you, the clinician, and the patient or family member about what constitutes benefit. So, you know, in my business in oncology, very commonly we have these discussions around chemotherapy for advanced-stage cancers. You know, when someone's past first- or second-line therapy and a patient may really be clinging to hope, a physician may be saying, I'm not sure about this one.
And here I'm going to say the example would be something where it wouldn't be out of the standard of practice or care to try another regimen of chemotherapy and the patient is not at a physical point where giving chemotherapy really seems deleterious. Like, for me, performance status less than 50 percent, I would say, "You know what? Chemotherapy can do more harm than good, and this is one of those times." So, my example here in terms of a treatment trial would be somebody who's still got adequate performance status, I haven't tried this regimen but, you know, I'm not sure if this is really going to be a beneficial thing to him.
So, then I'd say in proposing the treatment trial, and this is in the chapter in defining the purpose of the trial, you know, let's give this chemotherapy a clear chance to see if it's going to work, but let's make sure to re-evaluate it. So, you know, I'm setting up milestones and, you know, some definition of the treatment successes that we can both agree on. So, I'll say, you know, let's try a couple of cycles of this chemotherapy and let's do another scan in six weeks and let's look at that and use that to help us decide if it's really working because if it's really working, the cancer should shrink.
If it's not working, it means it's not helping, and then I think I propose we should stop, and I'd say, "Does that seem okay to you?" So, I'm explicitly checking their reactions because for the treatment trial to work and to help me as a clinician move through the sequence of this illness, the other party, the patient or family needs to feel like they understand why we're doing the trial, they understand what success is and they don't get wrapped up in the treatment means as the only source of hope, right?
I'm saying the treatment has a really specific medical purpose, if it doesn't shrink the cancer, it actually isn't helping, and we need to talk about hope in a broader way. And I document this so that as the nurses who also care for this patient work with him, but they all aim the patient and the family towards, you know, a discussion at six weeks. And so, everybody knows what to expect, and that when if we have the follow-up scan in six weeks and the scan doesn't show something, doesn't show improvement of the cancer, then it's pretty easy for me to say, "You know what?
Remember we talked about if it shows this, we do this and if it shows that, we do that? Well, here it is, and this is what it tells us." And so, that requires -- this whole process of doing a treatment trial requires a certain amount of transparency on the clinician's part. But, doing that I have found to be incredibly useful because patients and families feel like they're getting a fair shake. They don't feel like you're making a value judgment about them. You can make the parameters of the medical judgment really clear, and it really helps them come to terms with what's happening to them.
>> What should a clinician do when a conflict cannot be resolved? >> This happens all the time, and there are situations where you as a clinician can do all this stuff that I'm talking about and there's still a conflict. And so, what do you do in that situation? Well, you know, my first recommendation is to bring a third-party into the encounter to listen to both sides and do a little negotiation or mediation or whatever. And the exact person to bring in kind of varies depending on the resources at your local institution.
It might be a palliative care consultation, it might be an ethics consultation, it might be a nurse manager, it might be a quality manager, but it's somebody who is able to come into what's often a charged situation and explicitly talk to both sides in a parallel way so that the patient and family feel like they're getting heard and that there's another neutral person involved because if the conflict has gotten to the point where it's not been able to be resolved, there are usually, you know, a lot of strong feelings on both sides.
So, that's the first recommendation. The second recommendation is what I call harm reduction strategy. And Dr. Bob Arnold and I kind of borrowed this concept from other fields, but the idea is, you know, if someone is, for example, dead set on having CPR and is just unwilling to be budged, you and the rest of the medical team may get to the point where you decide it's better to stop arguing about CPR and just say, "We're going to do it," and prepare the team that that is, in fact, the only way that you see out of this, that the patient and family really want it, really value it, and then the CPR should be performed in a way that's medically reasonable but not over the top.
Meaning, in a practical way, you would do a couple of rounds of CPR but not keep the code running for two hours, right? You would find some medically reasonable point at which you'd say, you know, we've tried it and we're done, and that would be reducing harm in the prospect of the patient and family by stopping the intractable conflict. There's some that might argue that that creates a harm, you know, for the staff that has to deal with this. And I think that is true, one factor, and yet I also think that this is where we, in serving patients and families, have to come to terms with that ourselves and I have found that if a clinician takes a leadership role in explaining what's happening to the staff and other clinicians, that most of the time they will totally get it and can deal with this in a way that doesn't create gigantic moral distress.
>> Is there anything else you would like to tell our listeners about dealing with conflict and caring for the seriously ill? >> The last thing I'd like to say is that people, clinicians I should say, often feel like conflict means that they failed in some way. You know, that they're a bad clinician because if they were a good clinician, you know, everyone would love them all the time and conflicts would never occur. Well, I mean, the reality is with the complexity of medicine now, I think conflicts are almost inevitable, and I think to have this ability to step back and kind of take a meta-perspective, if you're able to do that, there are lots of ways in which the little conflicts you see around you all the time can actually lead to better care, can lead to better relationships with your staff and colleagues because, really, the person that you really trust the most in the long run is often someone where you can talk about a disagreement and not have the disagreement devolve into something that means you won't have a working relationship.
So, you know, high trust often means you can have a disagreement and sort it out. So, I would say that dealing with conflict in a productive way has a tremendous upside and value to your own practice and practice satisfaction. >> Thank you, Dr. Bock, for this overview of dealing with conflict in caring for the seriously ill. For additional information about this topic, JAMAevidence subscribers can consult Chapter 4 of Care at the Close of Life. This has been Joan Stephenson of JAMA talking with Dr. Anthony Bock for JAMAevidence.
Segment:0 .
>> I'm Joan Stephenson, editor of JAMA's Medical News and Perspectives section. Today I have the pleasure of speaking with Dr. Tony Bock about an important issue discussed in JAMAevidence's Care at the Close of Life about dealing with conflict in caring for the seriously ill. Dr. Bock, why don't you introduce yourself to our listeners? >> Thank you, Joan. My name is Tony Bock. I'm a medical oncologist and palliative care physician at the University of Washington and Fred Hutchinson Cancer Research Center in Seattle, Washington.
>> What are some of the common examples of conflict in end-of-life care, and why do these conflicts occur? >> There are four kinds of conflicts that clinicians commonly encounter. I think the most common one is a clinician conflicting with a family member. The second one I think is a clinician conflicting with another clinician or colleague. The third one is a clinician who's trying to deal with a conflict between family members that relates to a patient's care. And then the final one is the clinician conflicting with a patient. And interestingly, I think the clinician conflicting directly with a patient is maybe the least common.
There aren't that many studies that directly address this, but certainly when I talk to my colleagues, what they come to me the most because they feel stuck is a family member. >> What behaviors should clinicians avoid when dealing with conflict? >> You know, the kinds of things that turn out not to be very useful are, unfortunately, some of the things that people just do without really thinking. They just react and this is what happens, and a few things come to mind. One is, they kind of downplay that the conflict is really happening. And problem with that is, downplaying it usually makes it worse because the other person doesn't think you're listening to them.
A second thing is assuming that you've got all the data and that you know the whole story. You know, the problem with that is, you miss the chance to really see a bigger picture or see another perspective. Another thing is going into this kind of defensive mode where you continually try and convince the other person that you have the right answer, and of course that often turns into just a back and forth of, you know, he said this, she said that, and it doesn't actually help with resolution. Then, one thing that relates to communication in particular is going ahead as if it's just a matter of rational thinking.
When, you know, in the heat of the moment many of these conversations are strewn through with emotions. And emotions have a huge role to play in how to make decisions and how to get people through a conflict. And then the final thing is ignoring your own strong feeling because your own strong feeling, you know, you may not want them to, but if you don't acknowledge them at least internally to yourself, they tend to leak into the conversation in ways that actually don't serve you in helping work through the conflict. So, those are some of the most common pitfalls.
>> What communication tools can clinicians use for addressing conflict? >> There are a few things. One is active listening; you know, full attention to the speaker. For example, you might listen carefully and say, what I'm hearing you say is, dot, dot, dot, as a way of really making the point that you've got it. And when you say what I'm hearing you say is you should use their exact words, all right? Another thing, self-disclosure. Revealing something about your perspective without blame and, you know, without judging them.
So, you might say, you know, I'm worried that even the best medical care may not achieve what you're hoping for. Another thing is empathizing. This is recognizing the emotional data that's in the conversation, not as a way of blaming people for being emotional, but just recognizing where they are, and most people really appreciate that. So, example, you know, I can see this is a big issue for you and that you really care a lot about what's happening to your loved one. Lastly, I think there's an important role for brainstorming.
You know, let's try and come up with a few ideas about how to deal with this, and then let's talk about the pros and cons of them. The most common reason that brainstorming doesn't work is that people go from the first suggestion right into whether or not it's a good solution or not. And, you know, for brainstorming to work, you have to generate a few ideas, so it's important to hold back for a minute and say, okay, now we're finished brainstorming, let's go back and look at these and sort through them. And by giving some signpost to the person you're talking with, you know, that makes the brainstorming and the conversation that much more effective.
>> I think it might be helpful if you could describe an example of a common conflict in end-of-life care and the type of steps you would take to handle it. >> Yeah, so, here's one that happens commonly. It's the relative from out of town who comes in unhappy about the situation, right? So, in my oncology clinic, I'm talking to a gentleman with metastatic colon cancer who's on third-line therapy that's not really working anymore. He comes to clinic with his sister who's flown in from out of state.
She launches into this thing about, you know, you've got to do something else, there must be something more, you must be doing something wrong, et cetera, et cetera, right? And so, what's the stepwise approach to this? One, notice the conflict. Well, in this case it's pretty obvious. Two is kind of prepare yourself, which is, for me, a kind of taking a step back, realizing that her agitation is not really about me, it's really about her brother and what she's trying to do in terms of how to help him, protect him, do what she feels like she needs to do in terms of being a good sister.
And so, then, the third step is for me to find a starting point for our conversation that is neutral, meaning not judgmental from my point of view. So, rather than me saying, "Gosh, why are you so pissed off about this? He's had this colon cancer for a couple of years and I've never seen you before," which, you know, might be a common reaction. I would take a deep breath and say, "Boy, it sounds like we should make sure we're both on the same page about the information and the medical details of the situation." And by saying that, what I'm calling attention to is not how upset she is, because I don't want to make her self-conscious or make her mad that I'm calling her, but bring her to what I think is a useful starting point, which is let's make sure we have shared understanding about the situation because the reality is, is that, you know, I always hope that patients talk to their family members when they come in, but it doesn't always happen.
And most family members and patients, I think these are tough conversations to have on their own, and so the most common thing is, they want to have them when they come into clinic. So, then, you know, responding in a way that recognized the emotion. So, one of my responses might be to acknowledge the emotional charge by saying, "Gosh, it sounds like you're really concerned about your brother. You must care about him a lot." It might be obvious, but on the other hand, my saying it just slows down everything a little bit in the conversation, gives her a chance to breathe, shows her that I understand why she's there.
You know, she's there because she cares about him. And then six, you know, look for options that meet the needs of both parties. In this case, I'm not even sure if I know what she's most upset about, so as I go through the medical information, you know, I'd be looking for what's a part that's really setting her off, right? Is it the prognosis? Is it the fact that he hasn't told her? Is it the fact that she feels a little guilty because she hasn't been there? You know, how can I find a way for us to productively move forward.
So, that would be kind of my stepwise recommendation about this. >> The subject of treatment trials is mentioned in the chapter, and I wonder if you can tell us how they're used. >> So commonly, conflicts between clinicians and patients or family members revolve around-- I want to have this treatment. You know, the patient or family member saying, "I want to have this treatment," and the clinician saying, "Gosh, you know, I'm not sure if it's really going to be worthwhile." Or, more unhelpfully, "No, you can't have this treatment." Right? There are all these battles around treatments.
So, if the battle is around a treatment and that seems a little intractable, one thing you as a clinician can do is offer a trial of the treatment and an offer to do the treatment trial with some agreement between you, the clinician, and the patient or family member about what constitutes benefit. So, you know, in my business in oncology, very commonly we have these discussions around chemotherapy for advanced-stage cancers. You know, when someone's past first- or second-line therapy and a patient may really be clinging to hope, a physician may be saying, I'm not sure about this one.
And here I'm going to say the example would be something where it wouldn't be out of the standard of practice or care to try another regimen of chemotherapy and the patient is not at a physical point where giving chemotherapy really seems deleterious. Like, for me, performance status less than 50 percent, I would say, "You know what? Chemotherapy can do more harm than good, and this is one of those times." So, my example here in terms of a treatment trial would be somebody who's still got adequate performance status, I haven't tried this regimen but, you know, I'm not sure if this is really going to be a beneficial thing to him.
So, then I'd say in proposing the treatment trial, and this is in the chapter in defining the purpose of the trial, you know, let's give this chemotherapy a clear chance to see if it's going to work, but let's make sure to re-evaluate it. So, you know, I'm setting up milestones and, you know, some definition of the treatment successes that we can both agree on. So, I'll say, you know, let's try a couple of cycles of this chemotherapy and let's do another scan in six weeks and let's look at that and use that to help us decide if it's really working because if it's really working, the cancer should shrink.
If it's not working, it means it's not helping, and then I think I propose we should stop, and I'd say, "Does that seem okay to you?" So, I'm explicitly checking their reactions because for the treatment trial to work and to help me as a clinician move through the sequence of this illness, the other party, the patient or family needs to feel like they understand why we're doing the trial, they understand what success is and they don't get wrapped up in the treatment means as the only source of hope, right?
I'm saying the treatment has a really specific medical purpose, if it doesn't shrink the cancer, it actually isn't helping, and we need to talk about hope in a broader way. And I document this so that as the nurses who also care for this patient work with him, but they all aim the patient and the family towards, you know, a discussion at six weeks. And so, everybody knows what to expect, and that when if we have the follow-up scan in six weeks and the scan doesn't show something, doesn't show improvement of the cancer, then it's pretty easy for me to say, "You know what?
Remember we talked about if it shows this, we do this and if it shows that, we do that? Well, here it is, and this is what it tells us." And so, that requires -- this whole process of doing a treatment trial requires a certain amount of transparency on the clinician's part. But, doing that I have found to be incredibly useful because patients and families feel like they're getting a fair shake. They don't feel like you're making a value judgment about them. You can make the parameters of the medical judgment really clear, and it really helps them come to terms with what's happening to them.
>> What should a clinician do when a conflict cannot be resolved? >> This happens all the time, and there are situations where you as a clinician can do all this stuff that I'm talking about and there's still a conflict. And so, what do you do in that situation? Well, you know, my first recommendation is to bring a third-party into the encounter to listen to both sides and do a little negotiation or mediation or whatever. And the exact person to bring in kind of varies depending on the resources at your local institution.
It might be a palliative care consultation, it might be an ethics consultation, it might be a nurse manager, it might be a quality manager, but it's somebody who is able to come into what's often a charged situation and explicitly talk to both sides in a parallel way so that the patient and family feel like they're getting heard and that there's another neutral person involved because if the conflict has gotten to the point where it's not been able to be resolved, there are usually, you know, a lot of strong feelings on both sides.
So, that's the first recommendation. The second recommendation is what I call harm reduction strategy. And Dr. Bob Arnold and I kind of borrowed this concept from other fields, but the idea is, you know, if someone is, for example, dead set on having CPR and is just unwilling to be budged, you and the rest of the medical team may get to the point where you decide it's better to stop arguing about CPR and just say, "We're going to do it," and prepare the team that that is, in fact, the only way that you see out of this, that the patient and family really want it, really value it, and then the CPR should be performed in a way that's medically reasonable but not over the top.
Meaning, in a practical way, you would do a couple of rounds of CPR but not keep the code running for two hours, right? You would find some medically reasonable point at which you'd say, you know, we've tried it and we're done, and that would be reducing harm in the prospect of the patient and family by stopping the intractable conflict. There's some that might argue that that creates a harm, you know, for the staff that has to deal with this. And I think that is true, one factor, and yet I also think that this is where we, in serving patients and families, have to come to terms with that ourselves and I have found that if a clinician takes a leadership role in explaining what's happening to the staff and other clinicians, that most of the time they will totally get it and can deal with this in a way that doesn't create gigantic moral distress.
>> Is there anything else you would like to tell our listeners about dealing with conflict and caring for the seriously ill? >> The last thing I'd like to say is that people, clinicians I should say, often feel like conflict means that they failed in some way. You know, that they're a bad clinician because if they were a good clinician, you know, everyone would love them all the time and conflicts would never occur. Well, I mean, the reality is with the complexity of medicine now, I think conflicts are almost inevitable, and I think to have this ability to step back and kind of take a meta-perspective, if you're able to do that, there are lots of ways in which the little conflicts you see around you all the time can actually lead to better care, can lead to better relationships with your staff and colleagues because, really, the person that you really trust the most in the long run is often someone where you can talk about a disagreement and not have the disagreement devolve into something that means you won't have a working relationship.
So, you know, high trust often means you can have a disagreement and sort it out. So, I would say that dealing with conflict in a productive way has a tremendous upside and value to your own practice and practice satisfaction. >> Thank you, Dr. Bock, for this overview of dealing with conflict in caring for the seriously ill. For additional information about this topic, JAMAevidence subscribers can consult Chapter 4 of Care at the Close of Life. This has been Joan Stephenson of JAMA talking with Dr. Anthony Bock for JAMAevidence.
Form Title Download
Media
Transcript
Form Title Bookmark
Entire Media
Segment(s)
Custom Clip
Start At:
End At:
Form Title Share
Entire Media
Segment(s)
Custom Clip
Start At:
End At:
Form Title Accessibility
The cadmore media player is a professional video and audio player experience designed to deliver media as well as relevant transcript, segmentation, and metadata. On the screen is a traditional html audio player with buttons such as play, pause, forward, captioning, language and play speed selection and more. Adjacent to the audio player are generally tabs, one of which shows a scrolling transcript of the audio and the other shows any segmentation of the media, sometimes referred to as chapters. At the top of the audio player is a menu bar containing an Explore button and Tools button. The Explore button allows you to dig deeper into the audio by opening up an explore dialog which contains an about tab which contains rich metadata about the media, a segments tab which contains further information about the audio, and a related tab which contains links to other media related to this media. The tools button opens a menu with options for sharing the media on social media, creating bookmarking links, creating embed codes for your website, generating citations, and more.
Keyboard Shortcuts
Keyboard shortcuts only work while you are in forms mode. By entering forms mode, you will be able to quickly access portions of the media player with single key commands.
Spacebar: Play/Pause Toggle
E: Explore Menu,
O: Tools Menu
T: Transcript Tab,
S: Segments Tab
F: Forward 15,
R: Rewind 15
L: Languages,
P: Playspeed
M: Mute Toggle,
V: Volume Bar
N: Video Only Toggle,
B: Full Screen Toggle
C: Captions Toggle
Escape: Closes dialogs and menus
Z: Next Transcript Chapter
X: Previous Transcript Chapter
Q: Next Transcript Paragraph
W: Previous Transcript Paragraph
Form Title Embed Media
Entire Media
Segment(s)
Custom Clip
Start At:
End At:
Embed Size
-
You Size - Responsive
-
We Size - Responsive
-
Picture Overlay Popup
-
400 x 225
-
512 x 288
-
400 x 700
-
768 x 1024
-
1024 x 512
-
1280 x 608
Form Title Cite
No citation provided.
Info
Segments
Related
Thumbnails
Accessibility
Using forms mode, you can utilize keyboard shortcuts to make usability more efficient.
Space bar will play and pause the media.
You can press A to open the Accessibility Dialog.
This describes many other keyboard shortcuts for media controls.
Exit Clip Mode
The video is currently set-up to show just a clip from 0:00 to video end. You have requested to see a portion of the media outside of the clip.
Click OK to switch to the full media or click if you would like to stay inside the clip. You can always go back to the clip with Tools and Clip Mode