Improving Serious Illness Communication By Developing Formulations
episode
GeriPal - A Geriatrics and Palliative Medicine Podcast
20 min
4 speakers
8 chapters
transcribed 8 hours ago
Transcript
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Transcript generated automatically by AI and may contain errors.
What is a clinical formulation and why is it important for serious‑illness communication?
Welcome to the Jerry Pal Podcast. This is Eric Widera. This is Alex Smith. And today we have a special guest with us today, Danielle Shamas, who is a psychiatrist and a palliative care doctor, and just gave a wonderful talk to our fellows on an interesting topic, which we will get to. But maybe before that, Dani, we usually ask our guests to give Alex a song that he should sing.
I'm going to go with Free Fallin' by Tom Petty.
Free
Fallin'. Great song.
And America, too. She's a good girl. Crazy about Elvis. Loves horses. And her boyfriend, too. It's a long day. Living in Christine.
I said, don't even miss her. I'm a bad boy. Breaking her heart. I said, I'm free. I'm free, boy.
Danny and I both have our lighters going right now up in the sky.
Good song choice.
So we just had a really interesting morning core curriculum talk on formulation. Alex, have you ever heard of formulation before?
I don't know. Drug formulation?
Apparently not drug formulation because that's what I was thinking initially. Danny, what is a formulation and why should we use it in palliative care and geriatrics?
So a psychological formulation in the therapy world is what you think is the core underlying issue in someone's psyche that's getting in their way or tripping them up, right? So similar to, you know, heart failure or…
How does Dani Chammas define a formulation in palliative‑care settings?
in internal medicine. If someone comes in with chest pain, you don't think about treating the chest pain. You think, what is causing this? What's underneath? And that guides your treatment. In the therapy world, it's the same with communication. You don't just look at what the patient's saying or doing. You think, what is the formulation? What is the root behind this that's causing this? And that guides how you treat it.
So what's the formulation for Trump? Yeah.
How
long do we have today,
Alex? There could be a lot of different reasons people say things that they do. How do you know what's the underlying reason that they're saying something? Like, why did Alex just bring up Trump?
Yeah. So it's a good question. And in general, you know, you don't pick one specific thing a person did, but sort of a guiding formulation. But I will say it takes four years of psych residency to even start feeling comfortable doing formulations. And then people keep doing this in therapy and practice for years over their career. This is why therapists like tend to only get better with time. So it's a hard thing to do. And I guess I'm not advocating that everybody in palliative care immediately know how to formulate, but I am advocating that they – slow it down to take the step to wonder what is the root behind the behavior. And
what's an example?
Let's say the behavior you're seeing is that you're in a family meeting and the family is stuck. They do not want to make a decision. You're trying to get a goal as a carer and they just can't. There could be different reasons. There's not one thing you do for a stuck family meeting.
If
my psychological formulation is, oh my gosh, this family is so overwhelmed by the responsibility of this choice, they are petrified of doing the wrong thing, that they're going to have to live with that burden forever. then my communication tool is going to be something that takes away that responsibility from them. I might give them my strong recommendation. I might stop presenting it as a choice and just say this is what we should do. But if my formulation is that their psyche is really stuck on a feeling like they think that their loved one is just you know another person to the doctors that the doctors are pushing their agenda and that they don't see them as an individual and that they're trying to like force me one way or the other things are going to go south if i start giving them strong recommendations right so based on my formulation that the real core issue is am i seeing their father as a person
that's
the place where i might start saying tell me about your dad tell me what he would want if he was here right i'm going to pick different tools from my toolkit
just
like you'd pick a different nausea med for a different if you had a different cause of nausea or a different chest pain med if you had a different cause for chest pain right
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Chapters
8 chapters
1
What is a clinical formulation and why is it important for serious‑illness communication?
0:00–2:26
2
How does Dani Chammas define a formulation in palliative‑care settings?
2:26–5:26
3
Why should clinicians pause and ask “What’s the root cause of this behavior?” before responding?
5:26–8:44
4
What does a real‑world family‑meeting case look like and how can a formulation guide the response?
8:44–11:40
5
How can clinicians practice formulation skills on the spot during team debriefs?
11:40–14:46
6
What are the key steps for making your thought process explicit when communicating with families?
14:46–17:51
7
How can palliative‑care providers get feedback and coaching on their formulation technique?
17:51–20:03
8
What resources (readings, videos, mentors) does the team recommend for mastering formulations?
20:03–20:50
Speakers
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