AETCOM
(Attitude, Ethics,
Communication)
Presented by: 176-200
WHAT IS AETCOM?
AETCOM is defined as an integrated approach to teaching
and learning that aims to develop appropriate attitudes,
uphold ethical principles and enhance communication
skill in medical students so they can function effectively
and compassionately as a doctors in society.
FOUR PILLARS OF AETCOM:
1. AUTONOMY
2. BENEFICENCE
3.NON-MALFICENCE
4.JUSTICE
DEALING WITH DEATH
(From AETCOM MODULE 4.8)
COMPETENCY 1
Identify conflicts of interest in
patient care and professional
relationships and describe the
correct response to this conflicts.
COMPETENCY 2
Demonstrate empathy to patient
and family with a terminal illness
in a stimulated environment.
CASE SUMMARY
A 18 year old boy brought to casualty in
altered consciousness after accident with
road divider during bike ride. Doctors noticed
head injury with multiple fractures and pale
conjuctiva with severe blood loss. Doctor
started treatment immediately but unable to
save his life. Communicate the bad news of
death to his mother.
POINTS FOR DISCUSSION
1. How should doctor deal with
emotions of patient’s family
facing death.
2. What are the emotions
faced by doctors when
confronting death in patient?
S (SETTING UP THE INTERVIEW)
• Ensure privacy (quiet room,
away from crowds) P (PERCEPTION)
• Sit down at eye level
• Include support person for • Ask: What do you understand
mother if needed. about your son’s condition?
• Switch off your phone to avoid • Assess her understanding of
distraction the situation before delivering
the news.
‘SPIKES’ PROTOCOL
‘SPIKES’ PROTOCOL
I (INVITATION)
• Ask for permission: Would you
like me to explain what
happened?
• This respects autonomy and
prepares mother mentally.
K
• Give the news in simple and
(KNOWLEDGE)
clear language.
• Avoid medical jargon: “ We
did everything we could, but
unfortunate, he could not
survive the injures.
‘SPIKES’ PROTOCOL
E ( EMOTIONS WITH
• Allow space for grief, silence, and
EMPATHY)
tears
• Respond empathetically: I am so
sorry for your loss. I can’t imagine
how difficult this must be for you.”
S (STRATEGY AND SUMMARY)
• Offer support : We will guide you through the
next steps”
• Provide contact for emotional or psychological
counselling.
• Help in completing legal or formal
requirements.
DO’S DON’TS
• Chose the right setting • Don’t deliver news over the phone
• Prepare yourself • Don’t be rushed or dismissive
emotionally • Don’t use medical terms or
• Use the patient’s name euphemisms
• Use simple, clear language • Don’t give false hopes
• Allow time to grieve • Don’t blame or shift responsibilities
• Show empathy • Don’t show emotional deattachment
• Answer questions honestly • Don’t leave immediately after giving
• Provide support the news
• Use spike protocol • Don’t argue or get deffensive
• Document the conversation • Don’t disclose sensitive information
publically
DO’S AND DON’TS
SOME IMPORTANT POINTS
• Show respect and dignity towards
deceased and their relatives
• Maintain composure,
compassion, and patience
• Avoid being defensive or blaming
others
• Recognise and acknowledge the
emotional burden on the doctor
too.
CONCLUSION
• Breaking bad news is one the most emotionally charged and
ethically challenging task a doctor performs. It not only
involves delivering information but also directly impacts the
emotional well-being of patients family and doctor patient
relationship .
• Hence, the SPIKES protocol provide the structured, step wise
approach to this process, combining clinical professionalism
with human compassion. It teaches medical professional to be
empathetic, ethical and emotionally intelligence which is at the
core of AETCOM.
• For future doctors mastering the SPIKES protocol is not merely
an academic requirement but a lifelong skill that upholds the
values of empathy, ethics and humanity in medicine. It reminds
THANK YOU FOR YOUR
ATTENTION
