tag:blogger.com,1999:blog-46308820808950144362024-03-17T20:00:31.411-07:00VITALtalkVITALtalkhttp://www.blogger.com/profile/08730670279040888864noreply@blogger.comBlogger33125tag:blogger.com,1999:blog-4630882080895014436.post-44869356664846449052014-10-12T09:02:00.005-07:002014-10-12T09:03:37.800-07:00Going beyond the question list<div class="MsoPlainText">
<a href="http://2.bp.blogspot.com/-X10SU9ejL2w/VDqkuxr18zI/AAAAAAAAAUQ/frrPbGMh2bg/s1600/Bloghands.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-X10SU9ejL2w/VDqkuxr18zI/AAAAAAAAAUQ/frrPbGMh2bg/s1600/Bloghands.jpg" height="145" width="200" /></a>Dave’s wife* pulled out a list of questions from her
purse. Sitting across from her, I could read her first question upside down, in
a shaky cursive script across the top of the page. Her question: “How much
longer?” She knew that her husband’s situation sucked. Typically, however, she
was more polite. Dave was in the hospital with a bowel obstruction due to
carcinomatosis; we were sitting down for a serious conversation, and the real
topic was dying. <o:p></o:p></div>
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I didn’t let on that I knew her first question. But when I
asked her to read me the whole list, she didn’t include “how much longer?” I
got Dave to talk about what was important now (time with grandkids was at the
top of his list). We talked through her other questions, about carcinomatosis
(bad), more chemo (no), IV nutrition (not helpful). She was trying not to cry.<o:p></o:p></div>
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We had covered a lot, I thought, and from the way she was
staring down at her notebook, I judged that she probably had heard as much as
she could manage. She seemed determined to get through this without crying, and
I didn’t want to push her over the edge—she’d be so embarrassed, it would
interfere with our next conversation.<o:p></o:p></div>
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But then she put her notebook aside, looked right at me,
and said “Okay, how much time do we have?” Her husband nodded. I said that the
time frame was weeks, with a worst-case scenario being two to three weeks, and
a best case scenario being 10 to 12 weeks. She looked down again at her
notebook, her hands shaking. “Ten weeks from now is winter,” she said, shaking
her head. “That’s a terrible time to die.”<o:p></o:p></div>
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This kind of moment happens in cancer care all the time.
The communication researchers call it an “emotion cue.” But what’s misleading
about that label is that the cue is often masked with a statement (e.g., winter
is a terrible time to die). And often we clinicians feel cued to correct the
facts, to say something like, “There’s no good time to die.” When you hear an
emotion and feel compelled to respond with a fact, hit your pause button.<o:p></o:p></div>
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I waited until she had finished shaking her head. She
slumped over in her chair. Then I said: “That wasn’t what you were hoping to
hear, I know. This is a very tough situation.” Her face crumpled. “No,” she
said. She was holding her breath so she didn’t cry. <o:p></o:p></div>
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When I saw her shoulders relax a little, I said, “What
you just heard is a very hard thing to hear.” She sighed, and said. “Well, yes,
but that’s how it is.” In another few moments, I knew, she would be ready to
make some real plans. Dave’s daughter described it later: “She needed to
process, but Dad was dry-eyed. He was expecting this.”<o:p></o:p></div>
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<i>[Originally posted as a guest commentary for <a href="http://connection.asco.org/Commentary/Article/id/4024/When-Lists-Arent-Enough-Talking-About-Dying.aspx" target="_blank">ASCO connection</a>. </i><i>*A few details altered for confidentiality. I'll be sharing more skills at the ASCO <a href="http://pallonc.org/" target="_blank">Palliative Care Symposium</a> later this month.]</i></div>
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VITALtalkhttp://www.blogger.com/profile/08730670279040888864noreply@blogger.com7tag:blogger.com,1999:blog-4630882080895014436.post-16583676812862175432014-03-14T10:53:00.000-07:002014-03-14T10:53:13.449-07:00Liftoff! <div class="separator" style="clear: both; text-align: center;">
</div>
<a href="http://2.bp.blogspot.com/-ER16oPFmGQU/UyM9hJM4CuI/AAAAAAAAAOc/xLvdrf4prwA/s1600/vitaltalk_site2.jpg" imageanchor="1" style="clear: left; display: inline !important; margin-bottom: 1em; margin-right: 1em; text-align: center;"><img border="0" src="http://2.bp.blogspot.com/-ER16oPFmGQU/UyM9hJM4CuI/AAAAAAAAAOc/xLvdrf4prwA/s1600/vitaltalk_site2.jpg" height="268" width="320" /></a><br />
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif; font-size: large;">We've launched a new website: <a href="http://www.vitaltalk.org/">www.vitaltalk.org</a></span><br />
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">If you've ever had trouble finding an oncotalk, intensivetalk, or toughtalk resource--your problems are over. We've reorganized our site, consolidated all our old stuff, and wrapped in a new user interface. As one physician told us yesterday: 'it's awesome'. </span><br />
<a href="http://2.bp.blogspot.com/-fLsZNzgM9NA/UyM9hEhhojI/AAAAAAAAAOw/yozF5mnFhbM/s1600/vitaltalk_site1.jpg" imageanchor="1" style="clear: left; display: inline !important; margin-bottom: 1em; margin-right: 1em; text-align: center;"><img border="0" src="http://2.bp.blogspot.com/-fLsZNzgM9NA/UyM9hEhhojI/AAAAAAAAAOw/yozF5mnFhbM/s1600/vitaltalk_site1.jpg" height="268" width="320" /></a><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; font-size: large;">What you'll find</span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">You can stop by on your way into a patient's room for a 1-page talking map. When you have more time, dive in and scale up your skills for the next visit: we've got video, chapters, articles, and powerpoint talks, all ready for downloading. </span><br />
<br />
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">There's more: you can ask us a question through our curated Q&A hotline, or find our <a href="https://itunes.apple.com/app/id639969220" target="_blank">iOS app</a>, or peruse a spellbinding set of <a href="http://www.vitaltalk.org/disrupt" target="_blank">video reflections</a> by some of the most fantastic thinkers on serious illness that we know.</span><br />
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">You'll see these resources evolve too as we continue to innovate--and we have a lot planned.</span><br />
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><br /></span>
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Stay ahead of the curve: sign up on the website for our new monthly newsletter, or send us an email at hello@vitaltalk.org. And since we're a nonprofit in the social enterprise space--we won't give your email to anybody. Go to our site--then go talk to a patient in a way that makes a difference.</span><br />
<br />VITALtalkhttp://www.blogger.com/profile/08730670279040888864noreply@blogger.com4tag:blogger.com,1999:blog-4630882080895014436.post-6316135225359515792014-03-13T14:54:00.001-07:002014-03-14T10:20:21.859-07:00Vitaltalk goes to AAHPM San Diego!<span style="font-family: Arial, Helvetica, sans-serif;">We're in San Diego, and i'm still blinking from the sunlight. Vitaltalk rolled a new curriculum for palliative care clinicians, in a special day-long preconference collaboration with the American Academy of Hospice & Palliative Medicine: Advanced Communication Skills for Difficult Situations. </span><br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-Wcm_gXk2dfM/UyI4vgKATZI/AAAAAAAAAOM/0V6f_GA2TVg/s1600/P1000188.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-Wcm_gXk2dfM/UyI4vgKATZI/AAAAAAAAAOM/0V6f_GA2TVg/s1600/P1000188.jpg" height="200" width="166" /></a></div>
<span style="font-family: Arial, Helvetica, sans-serif;">For Bob, James, &; me, it was a special treat to work with a talented group of Vitaltalk faculty facilitators--Renee Boss, Lynn Bunch, Mary Buss, Kristen Chasteen, Elise Carey, Gordon Wood--with their help we did the largest small group course with simulated patients we've ever done. And we need to give a special shout-out to Julie Bruno, AAHPM Director of Education, whose vision made this collaboration happen!</span><br />
<div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div>
<span style="font-family: Arial, Helvetica, sans-serif;">The heart of our 1-day course for palliative care clinicians are two new talking maps: PAUSE for 'early' goals of care conversations; and REMAP for 'late' goals of care conversations. As Palliative Care moves upstream, it's critical for this level of communication expertise to become the standard--and while we have learned that this level of quality entails some complexity, we've also learned that we can do it--and now we're scaling it up. The participants had some great ideas for the future; one said 'i'd love for our oncology colleagues to have something like this!'.</span></div>
<div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div>
<span style="font-family: Arial, Helvetica, sans-serif;">You can find the talking maps now on our new Vitaltalk <a href="http://www.vitaltalk.org/" target="_blank">website</a>. </span></div>
<div>
<a href="http://2.bp.blogspot.com/-BIF1NcNhHM8/UyImoBZrl1I/AAAAAAAAAN0/nuDuYDw5K8w/s1600/McCraeChart.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/-BIF1NcNhHM8/UyImoBZrl1I/AAAAAAAAAN0/nuDuYDw5K8w/s1600/McCraeChart.jpg" height="640" width="252" /></a><span style="font-family: Arial, Helvetica, sans-serif;">But in meantime, if you're here in san diego feeling a little smaller because of the great work everyone ELSE is doing....</span></div>
<div>
<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
<div>
<span style="font-family: Arial, Helvetica, sans-serif;">Or if you're thinking 'does EVERYONE in this city jog?'...</span></div>
<div>
<br /></div>
<div>
<span style="font-family: Arial, Helvetica, sans-serif;">Or if you're not in san diego feeling oppressed by all the perfect physiques (do we have to share the convention center with a conference of fitness professionals?) and are ready for a little wisdom to POWER up your communication skills...</span></div>
<div>
<br /></div>
<div>
<span style="font-family: Arial, Helvetica, sans-serif;">Enjoy!</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></div>
VITALtalkhttp://www.blogger.com/profile/08730670279040888864noreply@blogger.com4tag:blogger.com,1999:blog-4630882080895014436.post-11533633497287595902013-12-08T09:49:00.001-08:002013-12-08T09:49:17.995-08:00Our view of the JAMA article<div class="MsoNormal">
<span style="font-family: Calibri;">We’ve gotten a few quizzical emails about the
JAMA article showing that a communication skills clinic elective didn’t improve
how patients rated quality of communication. What do we make of it?</span></div>
<div class="MsoNormal">
<span style="font-family: Calibri;"><br /></span></div>
<h3>
<span style="color: #6aa84f; font-family: Calibri;">Don't forget...</span></h3>
<h4>
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><span style="color: #45818e;">The residents and nurse practitioners acquired new skills. </span></span></b><span style="font-family: Calibri; font-weight: normal;">For those who are skeptical that physicians change, this is
evidence to the contrary. Lectures don’t work; carefully facilitated small
groups can enable learners to acquire skills.</span></h4>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><span style="color: #45818e;">This skill acquisition happened with facilitators who were trained
for this project. </span></span></b><span style="font-family: Calibri;">T</span><span style="font-family: Calibri;">hey didn’t have much small
group experience. Our facilitation model doesn’t require years of experience.</span></div>
<div class="MsoNormal">
<span style="color: #6aa84f; font-family: Calibri;"><br /></span></div>
<h4>
<span style="color: #6aa84f; font-family: Calibri;">Then why didn’t it work? Some</span><span style="color: #6aa84f; font-family: Calibri;"> hypotheses:</span></h4>
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><span style="color: #45818e;">Our measurement tools don’t capture the full patient experience.</span> </span></b><span style="font-family: Calibri; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">We used the Quality of Communication and Quality of Dying
measures, the best of what’s out there. But there may be a basic conceptual flaw
– we are asking patients to say that they are “highly satisfied” with a
conversation that may be the most disruptive and difficult they’ve had in their
life, even when done well from the clinicians’ perspective. We don’t have direct
empirical data on this, but this hypothesis might also explain the recent NEJM
study by Weeks et al showing a negative correlation between communication (as
measured by 5 generic questions) and accuracy of prognostic understanding.
Perhaps we need to be asking patients what the conversation covered rather than
whether the doctor did a ‘good’ <a href="" style="mso-comment-date: 20131207T1010; mso-comment-reference: BA_1;">job.</a><o:p></o:p></span><br />
<span style="font-family: Calibri; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><a href="" style="mso-comment-date: 20131207T1010; mso-comment-reference: BA_1;"><br /></a></span>
<div class="MsoNormal">
<br /></div>
<a href="" style="mso-comment-date: 20131207T1012; mso-comment-reference: BA_2;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><span style="color: #45818e;">Measurement
needs to occur sooner after conversations are held.</span></span></b></a><span style="mso-comment-continuation: 2;"><span style="font-family: Calibri; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> The number of questionnaires
returned by patients indicating that they couldn’t rate the clinician because
they had not had a significant conversation, or couldn’t remember the clinician
well enough was sobering. Add that many patients were receiving questionnaires
months after they had met the clinician—and we wonder how well the patients
could really remember what happened.</span></span><br />
<span style="mso-comment-continuation: 2;"><span style="font-family: Calibri; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><br /></span></span>
<div class="MsoNormal">
<br /></div>
<a href="" style="mso-comment-date: 20131207T1035; mso-comment-reference: JT_3;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><span style="color: #45818e;">Intervention
needs to occur when the clinicians really need it</span></span></b></a><span style="mso-comment-continuation: 3;"><span style="font-family: Calibri; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><span style="color: #45818e;">.</span> The clinic </span></span><span style="font-family: Calibri; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">elective was designed to fit in to the residents’ schedule rather
than designed to target times when these conversations were most likely to
happen. We used a clinic block slot because it was feasible. But in retrospect,
figuring out how to embed the intervention in a clinical experience where these
conversations happen a lot would have made the intervention more powerful as
‘just-in-time’ learning.</span><br />
<span style="font-family: Calibri; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><br /></span>
<h4>
<a href="" style="mso-comment-date: 20131207T1037; mso-comment-reference: JT_4;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><span style="color: #45818e;">We should
build on individual baseline skill levels.</span></span></b></a><span style="mso-comment-continuation: 4;"><span style="font-family: Calibri; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> <span style="font-weight: normal;">The baseline self-assessment</span></span></span><span style="font-weight: normal;"><span class="MsoCommentReference"><span style="font-family: Calibri; mso-ansi-font-size: 12.0pt; mso-ascii-theme-font: major-latin; mso-bidi-font-size: 12.0pt; mso-hansi-theme-font: major-latin;"><span style="mso-special-character: comment;"> </span></span></span><span style="font-family: Calibri; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">from the study showed that resident assessments were all over the
place—from quite accurate, to massive self-overrating, to massive
self-underrating. We ought to feed that back and start the learners there.</span></span></h4>
<div>
<span style="font-weight: normal;"><span style="font-family: Calibri; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><br /></span></span></div>
<h3>
<span style="color: #6aa84f; font-family: Calibri;">Findings that made us think...</span></h3>
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><span style="color: #45818e;">Discussing serious stuff might make people sad and upset.</span></span></b><span style="font-family: Calibri; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> This seems almost ridiculous to state, but I think we’ve been
hoping that great communication skills mean that we can skip the sad step—that
might not be true. And maybe the study intervention gave learners the ability
to start the conversation—but not enough skill to deal with the sadness?<o:p></o:p></span><br />
<span style="font-family: Calibri; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><br /></span>
<div class="MsoNormal">
<br /></div>
<b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><span style="color: #45818e;">Sick people might view these conversations differently.</span></span></b><span style="font-family: Calibri; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Note the subset analysis that showed that the patients who rated
their own health poorly rated trained clinicians as significantly better. It’s
a subset—but we wonder if experiencing the reality of one’s own illness
prepares you in some way.<o:p></o:p></span><br />
<span style="font-family: Calibri; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><br /></span>
<div class="MsoNormal">
<br /></div>
<a href="" style="mso-comment-date: 20131207T1014; mso-comment-reference: BA_5;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Calibri; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><span style="color: #45818e;">Are
randomized trials really the best way to test an educational intervention?</span></span></b></a><span style="mso-comment-continuation: 5;"><span style="font-family: Calibri; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> In this study, we treated the
communication skills intervention like a drug—give it to all the residents,
regardless of their skill level, and see if it changes them (which it did), and
if that effect trickles down to the patients (which it did not using these
instruments and these methods). But as an educator, I know that learning has to
be tailored—and we didn’t do that. Maybe we need to target interventions to
performance level? </span></span><br />
<span style="mso-comment-continuation: 5;"><span style="font-family: Calibri; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><br /></span></span>
<h3>
<span style="font-family: Calibri; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><b><span style="color: #6aa84f;">What's next?</span></b></span></h3>
<div class="MsoNormal">
<span style="font-family: Calibri; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Seth Godin defines failure as ‘</span><span style="background: white; color: #333333; font-family: Calibri; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-latin;">a project that doesn't work, an initiative that
teaches you something’, and (borrowing from Nietzsche) declares that ‘failures
that don't kill us make us bolder’. We’re with Seth—and our north star is still
culture change. The way clinicians talk to patients still isn’t good enough,
and it’s still central. We’re sticking to a strategy of innovation and empirical
testing, and we’ll seek collaborators who can think big and deal with reality. </span></div>
<div class="MsoNormal">
<span style="background: white; color: #333333; font-family: Calibri; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-latin;"><br /></span></div>
<div class="MsoNormal">
<span style="background: white; color: #333333; font-family: Calibri; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-latin;">Our next steps are courses for learners at different levels, expanding learning
into the peer social space, and using technology to extend feedback and
community, and looking at how communication is distributed across teams. If you’re
interested—let’s keep talking.</span><span style="font-family: Calibri; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-hansi-theme-font: major-latin;"><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Calibri; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><o:p>(this post is under construction--hyperlinks coming!)</o:p></span></div>
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VITALtalkhttp://www.blogger.com/profile/08730670279040888864noreply@blogger.com2tag:blogger.com,1999:blog-4630882080895014436.post-28919897748764022382013-12-01T08:55:00.001-08:002013-12-01T09:00:47.468-08:00New talking maps for discussing prognosis, & goals of care<div style="margin-bottom: .0001pt; margin: 0in;">
<div class="separator" style="clear: both; text-align: center;">
</div>
<b style="font-family: Arial;">What's a
talking map?</b><br />
<span style="font-weight: normal;"><span style="color: black; font-family: Arial;">In our
recent courses for the American Cancer Society, we used cognitive
maps as learning tools for communication. We're giving them away here, because we hope you'll use them. A good cognitive map, or talking map,
can point the way through a tough conversation, and keep the clinician on track.</span></span><br />
<span style="font-weight: normal;"><span style="color: black; font-family: Arial;"><br /></span></span><span style="color: black; font-family: Arial;"><b>Pointing a way through the evidence.</b></span><br />
<span style="font-weight: normal;"><span style="color: black; font-family: Arial;">The talking maps we used are new--we've been tweaking them for
some time--and they incorporate some new features. They represent a synthesis
of evidence-based practice, and they're short--just 5 letters each. For each
task (discussing prognosis, and discussing goals of care), the 5 letters form a
word that represents a critical meta-theme about that communication task. We're
posting the talking maps in a one-page user-friendly form:</span></span><br />
<ul>
<li><span style="font-family: Arial;"><a href="https://drive.google.com/file/d/0B3pGGRTYd1rkRmpZajVwOWtiRU0/edit?usp=sharing" style="font-weight: normal;" target="_blank">The "ADAPT" talking map for discussing prognosis.</a></span></li>
</ul>
<ul>
<li><span style="font-family: Arial; font-weight: normal;"><a href="https://drive.google.com/file/d/0B3pGGRTYd1rkX1B5RHdYNFphR3c/edit?usp=sharing" target="_blank">The "REMAP" talking map for goals of care.</a> </span></li>
</ul>
<span style="font-weight: normal;"><span style="color: black; font-family: Arial;">There's more: here are pdfs adapted from the brief presentations we
did in our ACS courses--these are intentionally short, because our goal here is
to get to a modeling demo, and then to deliberate practice. (As you know,
<span id="goog_861742111"></span><a href="http://www.blogger.com/"><span id="goog_368529906"></span>lectures don't work<span id="goog_368529907"></span></a><span id="goog_861742112"></span>!)</span></span><br />
<ul>
<li><span style="font-family: Arial;"><a href="https://drive.google.com/file/d/0B3pGGRTYd1rkWGRRLVBqVFhRbGs/edit?usp=sharing" style="font-weight: normal;" target="_blank">Using "ADAPT" for discussing prognosis.</a></span></li>
</ul>
<ul>
<li><span style="font-family: Arial;"><a href="https://drive.google.com/file/d/0B3pGGRTYd1rkN0N5ZTZHdEdlZWs/edit?usp=sharing" style="font-weight: normal;" target="_blank">Using "REMAP" for reevaluating goals of care.</a></span></li>
</ul>
<span style="font-weight: normal;"><span style="color: black; font-family: Arial;">We make these available with a <a href="http://creativecommons.org/licenses/by-nc/4.0/" target="_blank">Creative Commons license</a>--use them
freely, with attribution, edit as you need, in noncommercial settings--because
we see this work as social entrepreneurship. We'd love to hear your feedback.</span></span><br />
<span style="font-weight: normal;"><span style="color: black; font-family: Arial;"><br /></span></span><span style="color: black; font-family: Arial;"><b>What talking maps don't do.</b></span><br />
<span style="font-weight: normal;"><span style="color: black; font-family: Arial;">Talking maps form an important scaffold, but not the only one you
will need. A talking map is akin to a a road map that gives you the freeway
exits and road names; it won't show you the flowers at the side of the road.
And with medical conversations, ignoring the small details to push forward can
give patients & families the sense that you only want to talk about what's
on your agenda. The great medical communicators balance guiding with
responsiveness (you can read the study <a href="http://theoncologist.alphamedpress.org/content/16/3/342.long" target="_blank">here</a>)--it's a back-and-forth balancing
act that blends medical information with empathy. We'll have more about this
here and on our brand-new website--but while you're waiting, check out Bryan Vartabedian's terrific <a href="http://33charts.com/" target="_blank">blog post </a>on communication as the primary skill set of the doctor in the era of social media. </span></span></div>
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<!--EndFragment-->VITALtalkhttp://www.blogger.com/profile/08730670279040888864noreply@blogger.com3tag:blogger.com,1999:blog-4630882080895014436.post-81794573277904633732013-11-12T06:18:00.001-08:002013-11-12T06:20:56.390-08:00<br />
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<a href="http://4.bp.blogspot.com/-mDxK_vu-cPY/UoI3GFLpHFI/AAAAAAAAANM/ZV3r9sJOxuo/s1600/ACS.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="31" src="http://4.bp.blogspot.com/-mDxK_vu-cPY/UoI3GFLpHFI/AAAAAAAAANM/ZV3r9sJOxuo/s200/ACS.png" width="200" /></a></div>
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<b><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;">Inflight with the American Cancer Society</span></b></h2>
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b>We're doing a new gig</b> in collaboration with the American Cancer Society--a series of one-day workshops in Los Angeles, Minneapolis, Miami, Boston. (And we're in the air right now!) This is not CME as usual--it's culture change--we attract clinical role models from top cancer centers, equip them with new tools for talking about prognosis, and goals of care, and send them out to be changemakers. And we're drawing on the talents of an extraordinary group of faculty who are teaching with us: Holly Yang (Scripps), Toby Campbell (University of Wisconsin-Madison), Wendy Anderson (University of California San Francisco), Gordon Wood (Northwestern), and Vicki Jackson (Massachusetts General Hospital).</span></div>
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b>What are we learning?</b> These clinicians are the opposite of resistant--they're eager. They're not burned out--but they're worried about it. They're working in balky systems--and they're holding their own. In our view, they need resilience--and a first step towards that are a set of communication tools that are practical, actionable, and valuable. (In our first workshop, 100% of the clinicians said they would recommend this to a colleague.)</span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>We're always working on two levels</b>--sometimes called 'parallel process'. I've never liked this term--it's always struck me as inside baseball--but the idea is powerful: treat your learners the way you want them to treat patients. So you engage them, activate them, equip them. This is teaching as awakening, feedback as positive change, and metacognition as a pause in everyday practice. I think of these as small acts of courage. I'll add the video player here later, but for now you can watch it <a href="https://www.facebook.com/SmallActOfCourage">here on facebook</a> (& tell me what you think of this experiment).</span></div>
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<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><b>Hey Miami, how about a little bling?</b></span></div>
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VITALtalkhttp://www.blogger.com/profile/08730670279040888864noreply@blogger.com0tag:blogger.com,1999:blog-4630882080895014436.post-30879595519820413162013-09-24T09:04:00.000-07:002013-09-24T09:04:29.889-07:00What more expertise looks likeOur first Pallitalk course is next week--and as we get ready for Aspen, i've been thinking about how we talk about improving our own skills. How could explain better the journey of acquiring expertise? It's central to learning skills--either communication skills, or teaching skills--but hard to explain. Then i found this video--and amazingly, it's all there, in less than 2 minutes. The increasing fluidity, the improvement that is excruciatingly slow--then blindingly fast, the sense at the end that she was born to dance this way. Thanks Karen!<div class="separator" style="clear: both; text-align: center;">
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VITALtalkhttp://www.blogger.com/profile/08730670279040888864noreply@blogger.com4tag:blogger.com,1999:blog-4630882080895014436.post-43239960826836333622013-07-21T16:20:00.002-07:002013-07-21T16:20:24.161-07:00We nurture educators who are outliers.<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><img border="0" height="150" src="http://2.bp.blogspot.com/-G1yvPfXuuec/UexImbtXJ4I/AAAAAAAAAE4/NFoO2Npwacs/s200/istock_000018232445small-c91d3be0e84a16e9f046007bfca536b8fc63e145-s2.jpg" style="margin-left: auto; margin-right: auto;" width="200" /></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><b style="text-align: left;"><span style="font-size: xx-small;">The educators who inspire us are all about cultivating the oddballs.</span></b></td></tr>
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Bob just alerted me the the latest entry of NPR's Monkey See--it quotes Rian Johnson 's tweet "...the great hope is one day some little fat girl in Ohio is going to make a summer movie where skyscrapers don't fall over like dominoes." The blogger Linda Holmes responds, 'eventually i understood...[that] when i am drowning in the familiar, I am comforted in the belief that somewhere there is a kid who will someday do something different.'</div>
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<b>So: break out of the routines that define your comfort zone.</b> As Bob pointed out, this applies to educators too--we're drowning in the familiar: think of the powerpoint slide with too many bullets, the speaker who says, oh i'm going to skip this one. Ugh! </div>
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<b>Here's what we believe: learners & teachers alike are aching for something better.</b> The usual advice for this, unfortunately, isn't all that helpful (be learner-centered blah blah blah). Here's some real advice: pay attention to what's criticism and what's feedback. The quotes are from Holmes; the square brackets are mine.</div>
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<b>She's brilliant on the difference between feedback and criticism.</b> "Feedback is primarily for you; criticism (in the sense of "a movie critic" or "an arts critic" [or substitute: many medical reviewers]) is primarily not. Criticism is part of an ongoing cultural conversation that's designed to make everybody smarter and better and more thoughtful and to advance the art form itself; it's done even when the creator of a piece is long dead. It's not really for you. Feedback, on the other hand, is aimed at you to make you better, and that's the only kind of feedback worth paying attention to. If you can't listen to it and take it in without your hackles rising, you will never become good. Period, boom, g'bye." [Ok: we are working on this...]</div>
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<b>"But! Only listen to it if it's supposed to make you better</b>, not if it's supposed to make you stop. And remember: much of what is presented as criticism or feedback is not about you at all. Some people are just walking around with a mouthful of acid, and they spit it at you because you're there. You will know them by their tendency to spit acid at everyone indiscriminately and by their inability to love anything as much as they hate everything."</div>
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<b>What we think</b>: cultivate your feedback people; they''ll help you push out of your comfort zone to where the magic happens.</div>
VITALtalkhttp://www.blogger.com/profile/08730670279040888864noreply@blogger.com2tag:blogger.com,1999:blog-4630882080895014436.post-78346136722638653582013-07-04T10:00:00.002-07:002013-07-04T10:00:19.720-07:00Using Branch.com to foster dialogueTrying out a new dialogue thing for the blog: Branch.com. See what you think!<br />
<script data-branch-embedid="Nl-HBXaOvWs" src="http://embed-script.branch.com/assets/embed/embed.m.js?body=0" type="text/javascript"></script><br />
<noscript><a href="http://branch.com/b/the-patient-s-perspective-2">The patient's perspective</a></noscript><br />
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VITALtalkhttp://www.blogger.com/profile/08730670279040888864noreply@blogger.com0tag:blogger.com,1999:blog-4630882080895014436.post-22964155693250922192013-06-25T19:43:00.001-07:002013-06-25T19:43:52.561-07:00Registration for Pallitalk is open!<div style="font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 10px;">
<strong><span data-mce-style="font-size: 13pt; font-family: 'Helvetica Neue'; color: #535353;" style="color: #535353; font-family: 'Helvetica Neue'; font-size: 13pt;">Registration is open for Pallitalk Faculty Development in Aspen!</span></strong></div>
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<span data-mce-style="color: #535353; font-family: 'Helvetica Neue'; font-size: 13pt;" style="color: #535353; font-family: 'Helvetica Neue'; font-size: 13pt;"><i><b>A unique train-the-trainer conference</b></i><b>.</b> We're aiming to equip Palliative Care faculty physicians to run small group communication skills training workshops for their fellows. Using evidence-based methods based on expertise acquisition, you will experience the learning model we developed in Oncotalk, then learn the small group facilitation techniques we use. We're aiming this course for physicians who could run a short workshop for their Palliative Care fellowship program. We encourage 2-person teams because the f2f co-mentorship accelerates your development.</span></div>
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<span data-mce-style="font-size: 13.0pt; font-family: 'Helvetica Neue'; color: #535353;" style="color: #535353; font-family: 'Helvetica Neue'; font-size: 13pt;"><strong><i>4 days of learning and networking in Aspen</i></strong>. Pallitalk will take place in the amazing setting of Aspen, Colorado--we're in final negotiations with the hotel but</span><span data-mce-style="font-size: 13.0pt; font-family: 'Helvetica Neue'; color: #535353;" style="color: #535353; font-family: 'Helvetica Neue'; font-size: 13pt;"> wanted to enable you to get the date on your calendars</span><span data-mce-style="font-size: 13.0pt; font-family: 'Helvetica Neue'; color: #535353;" style="color: #535353; font-family: 'Helvetica Neue'; font-size: 13pt;">.</span></div>
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<span data-mce-style="font-size: 13.0pt; font-family: 'Helvetica Neue'; color: #535353;" style="color: #535353; font-family: 'Helvetica Neue'; font-size: 13pt;"><strong><i>We've re-invented faculty development for communication skills. </i></strong>The faculty will include Anthony Back, Bob Arnold, James Tulsky, and Kelly Edwards, who have been working together for over a decade, and others (watch our blog for updates at vitaltalk.blogspot.com). </span></div>
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<span data-mce-style="font-size: 13.0pt; font-family: 'Helvetica Neue'; color: #535353;" style="color: #535353; font-family: 'Helvetica Neue'; font-size: 13pt;"><i><strong>Details</strong>.</i> The $100 ticket fee holds your spot and is nonrefundable. The tuition for the course is due 30 days prior to the course and will be $1000 for the four-day course. This includes lodging, breakfast, lunch and two dinners. </span><span data-mce-style="color: #535353; font-family: 'Helvetica Neue'; font-size: 13pt;" style="color: #535353; font-family: 'Helvetica Neue'; font-size: 13pt;">We're limiting the course to 24 participants, so apply now at:</span></div>
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<span data-mce-style="color: #535353; font-family: 'Helvetica Neue'; font-size: 13pt;" style="color: #535353; font-family: 'Helvetica Neue'; font-size: 13pt;"><a href="http://vitaltalk.eventbrite.com/">vitaltalk.eventbrite.com</a></span></div>
VITALtalkhttp://www.blogger.com/profile/08730670279040888864noreply@blogger.com1tag:blogger.com,1999:blog-4630882080895014436.post-56513344221686767072013-06-03T21:27:00.002-07:002013-06-03T21:43:02.559-07:00Adding improv to your teaching repertoire<a href="http://2.bp.blogspot.com/-b3KOICYBLNU/Ua1qgNIOipI/AAAAAAAAAEc/V9FcbpY9VV0/s1600/do_improvise_front_shopify_large.png" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-right: 1em;"></a><br />
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<a href="http://www.uwhealth.org/findadoctor/Provider.action?id=8053" target="_blank">Toby Campbell MD</a>, who created an Oncotalk spinoff called WiTalk at the University of Wisconsin-Madison, opens his workshops with an improv exercise. Brilliant! At some level, we're all improvising, aren't we? From the perspective of expertise, the improv might be seen as something that happens at the higher levels, as an ingredient in <a href="http://en.wikipedia.org/wiki/Adaptive_expertise" target="_blank">adaptive expertise</a>--what experts do at the edge of what they know exactly. But the improv angle adds an emphasis on working in the moment. After searching for years (!), i've finally found a book i can recommend: <a href="http://thedobook.co/products/do-improvise-less-push-more-pause-better-results-a-new-approach-to-work-and-life" target="_blank">Do Improvise</a> is a terrific read, with the best descriptions of how to run an improv exercise i've read anywhere. </div>
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VITALtalkhttp://www.blogger.com/profile/08730670279040888864noreply@blogger.com0tag:blogger.com,1999:blog-4630882080895014436.post-40924718497305859632013-05-22T12:12:00.001-07:002013-05-22T12:12:13.912-07:00What went well--in New Zealand!We got a nice email from a .nz address! Here's something that went well for this app user: asking "if your wife could <u><b>share</b></u> in this discussion...?" Our comment: the idea of the patient 'sharing' in the discussion is a great way to describe participation in decision making that is collaborative and socially connected--feels like it lowers the pressure for a surrogate decision maker to know exactly what their loved one would have wanted. A nice touch, Fred--and thanks for reaching out from your side of the globe!VITALtalkhttp://www.blogger.com/profile/08730670279040888864noreply@blogger.com0tag:blogger.com,1999:blog-4630882080895014436.post-80274664244151815492013-05-16T09:13:00.002-07:002013-05-16T09:13:59.091-07:00Another shining star!Here's what another Vital Talk app user told us: "When I asked what [my patient] understood...she ended in tears as she got to now--showing me that she knew things were not going well." My comment: this is a great example of how asking what a patient understands--with openness and kindess--can shift the entire direction of your encounter. Nice work, Robyn!<span style="font-family: monospace; font-size: xx-small;"> </span>VITALtalkhttp://www.blogger.com/profile/08730670279040888864noreply@blogger.com1tag:blogger.com,1999:blog-4630882080895014436.post-41191441161628468612013-05-13T20:37:00.002-07:002013-05-13T20:37:35.818-07:00Vital Talk app users rock!Thanks for the terrific feedback on our app! For those wondering about android: we just had enough funding for iOS--but we're interested... And for those wondering if the app makes a difference: our last 'what went well' was from a user who tried acknowledging a patient's worry--and said it was a 'mini-breakthrough'--nice!VITALtalkhttp://www.blogger.com/profile/08730670279040888864noreply@blogger.com3tag:blogger.com,1999:blog-4630882080895014436.post-35993049846951388992013-05-09T08:44:00.000-07:002013-05-09T08:47:28.031-07:00Why an iPhone app through VitalTalk?Those of you who know our work may be wondering why we've started Vital Talk. Here's why. First reason: when we started using the term <a href="http://www.oncotalk.info/" target="_blank">Oncotalk</a>, we didn't realize that another cancer nonprofit had trademarked the term. They graciously have allowed us to continue using Oncotalk on our website, in exchange for not launching new projects under that term. Second reason: i couldn't put the iPhone app on the iTunes store through the University of Washington--they wanted me to license the app to a company.<br />
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<a href="http://4.bp.blogspot.com/-0ZCiGhfsPtc/UYvE79aKdsI/AAAAAAAAAEM/n0MCqVxa6VA/s1600/creativecommons.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="http://4.bp.blogspot.com/-0ZCiGhfsPtc/UYvE79aKdsI/AAAAAAAAAEM/n0MCqVxa6VA/s1600/creativecommons.png" /></a>So we've created Vital Talk as a nonprofit to disseminate our work. Our existing published work, including written materials and videos, will continue to be <a href="http://www.oncotalk.info/" target="_blank">available</a> freely on the web. We distribute it with a <a href="http://creativecommons.org/" target="_blank">Creative Commons</a> license that allows any of you to <a href="http://creativecommons.org/licenses/by-nc/3.0/" target="_blank">use it </a>with attribution, edit it so that it works better for your particular use, and remix it--our goal is to stimulate innovation! (Note that the Creative Commons license does not allow use for a commercial purpose.) We're charging for the iPhone app to cover our costs (user experience design, programming, etc). </div>
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We're not building a business--we're trying to build a <a href="http://www.ted.com/talks/seth_godin_on_the_tribes_we_lead.html" target="_blank">tribe</a> that changes the culture. </div>
VITALtalkhttp://www.blogger.com/profile/08730670279040888864noreply@blogger.com4tag:blogger.com,1999:blog-4630882080895014436.post-38191250581795032022013-05-03T08:10:00.000-07:002013-05-03T08:17:29.796-07:00"What went well" for a VitalTalk app user<span style="background-color: white; font-family: Helvetica Neue, Arial, Helvetica, sans-serif; font-weight: normal;">Here's what Ann did that we want to showcase: "Honest and genuine demeanor on my part and recognition of the fatigue of a patient and family who had been seeing doctors since 7." My comment: often i emphasize tracking emotion, but for noticing fatigue is right in the same vein--incredibly valuable. Terrific work, Ann!</span><br />
<span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif;"><span style="background-color: white; font-weight: normal;"><br /> </span>You can improve your communication skills using our iPhone app, and submit your 'what went well' when you debrief yourself in the app. Spread your learning and change the culture.</span>VITALtalkhttp://www.blogger.com/profile/08730670279040888864noreply@blogger.com5tag:blogger.com,1999:blog-4630882080895014436.post-53579785296241032182013-04-30T04:40:00.002-07:002013-04-30T04:42:01.346-07:00The VitalTalk iPhone app is live!<div class="separator" style="clear: both; text-align: center;">
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This is the first iPhone app designed to improve the communication skills for clinicians who talk to patients about serious news. It's based on 5 simple steps that spell "GUIDE" because that's what giving bad news about now--in the age of communication skills 2.0, clinicians need to do more than just disclose. What patients tell us, in a number of studies, is that they want the clinician to point them in the right direction. And a new study by <a href="http://jco.ascopubs.org/content/early/2013/03/21/JCO.2012.46.7993.full.pdf?ijkey=rgP5YDIIBgjXCcV&keytype=finite" target="_blank">Trevino</a> shows in a new way that communication matters: specifically, therapeutic alliance was associated with less grief and greater willingness to adhere to treatment.<br />
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Search for "Vital Talk" (two words)--and tell us what you think!<br />
Or click <a href="https://itunes.apple.com/app/id639969220" target="_blank">here</a>.<br />
<br />VITALtalkhttp://www.blogger.com/profile/08730670279040888864noreply@blogger.com5tag:blogger.com,1999:blog-4630882080895014436.post-36215234442571526772013-04-23T08:29:00.002-07:002013-04-23T08:29:24.215-07:00The VitalTalk app home screen: first look<a href="http://4.bp.blogspot.com/-voEVpyF56bs/UXanJ4RWpEI/AAAAAAAAADs/ZK9Wl9jYkto/s1600/Screenshot+2.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="http://4.bp.blogspot.com/-voEVpyF56bs/UXanJ4RWpEI/AAAAAAAAADs/ZK9Wl9jYkto/s320/Screenshot+2.png" width="180" /></a><b>What's different about the VitalTalk app? </b><br />It's designed for point-of-care, just-in-time learning that is based on a deliberate practice model. If you haven't heard of deliberate practice, it's how experts get better at what they do--they break down the complex task into small bits, and focus on one bit at a time. That's what our app does. So you'll notice a 'prepare me' button--that enables you to focus on one bit. You'll also notice a 'debrief me' button--that enables you to set a reminder (that appears on your iPhone screen) to think back on what happened, debrief yourself, troubleshoot. We hope you'll try it out--it's a new learning platform for communication skills.<br />
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The VitalTalk app will be in the iTunes store very soon--we'll keep you posted here!<br />
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<br />VITALtalkhttp://www.blogger.com/profile/08730670279040888864noreply@blogger.com0tag:blogger.com,1999:blog-4630882080895014436.post-6020001796916386512013-04-14T17:31:00.002-07:002013-04-14T17:31:41.044-07:00On my way to TED MED...<span style="font-family: inherit;">I've been an advisor on a terrific new project designed to create new kinds of conversations among people--not clinicians, necessarily--that started as a course at the University of Washington, in the Digital Communication Program. <span style="color: #141413;">What emerged from the course was a powerful intention to build an
interactive digital experience for inspiring real dinners hosted by real people
who want to talk about the realities of death -- how they want to die and how
they want to be remembered.<span style="font-family: inherit;"> </span></span><span style="color: #141413;">@deathoverdinner</span></span><!--EndFragment--><!--EndFragment--><div class="separator" style="clear: both; text-align: center;">
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VITALtalkhttp://www.blogger.com/profile/08730670279040888864noreply@blogger.com0tag:blogger.com,1999:blog-4630882080895014436.post-13476872684525879702013-04-10T21:09:00.000-07:002013-04-10T21:09:00.191-07:00The VitalTalk iPhone app is about to launch!<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-ydNp4Y526I8/UWY1rxnLNqI/AAAAAAAAAC4/tlG7P5zq6tI/s1600/Level2.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="http://4.bp.blogspot.com/-ydNp4Y526I8/UWY1rxnLNqI/AAAAAAAAAC4/tlG7P5zq6tI/s320/Level2.jpg" width="173" /></a></div>
Ready for the next wave of learning technology? The VitalTalk iPhone app brings point-of-care learning to communication skills. Zip through a fresh look at serious news (our updated mnemonic: GUIDE). Check out a video demo. Commit to a skill. Set a reminder. Debrief yourself. The VitalTalk app creates a reflective learning space, right when learners need it--before they go in for a difficult conversation, then later when thinking back on what worked consolidates learning. And if you're really stuck--send me an email right from the app. In the iTunes store--very soon.<br />
(Didn't someone say that the last 10% took 90% of the effort?...it sure seems that way.)<br />
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TonyVITALtalkhttp://www.blogger.com/profile/08730670279040888864noreply@blogger.com0tag:blogger.com,1999:blog-4630882080895014436.post-82364713857513211092013-04-01T17:15:00.000-07:002013-04-14T17:17:31.179-07:00Troubleshooting<span style="font-family: inherit;">To report problems with the Vital Talk app, please email tony@vitaltalk.org.</span><br />
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<span style="font-family: inherit;">We'll post issues as we hear about them, and update you on the fixes here!</span>VITALtalkhttp://www.blogger.com/profile/08730670279040888864noreply@blogger.com0tag:blogger.com,1999:blog-4630882080895014436.post-3772299866049332412013-04-01T17:12:00.000-07:002013-04-14T17:13:27.317-07:00Vital Talk app Privacy Policy<!--[if gte mso 9]><xml>
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<span style="font-family: inherit; font-size: x-small;">The Vital Talk Privacy Policy (“Privacy Policy”) governs your use of
the Vital Talk Licensed Application, and it is meant to be read in conjunction
with the Licensed Application End User Agreement available here. Capitalized
terms may be defined herein or in the Licensed Application End User
Agreement. By downloading and using the
Licensed Application, You agree to this Privacy Policy and the Licensed
Application End User License. </span></div>
<div class="MsoNormal">
<span style="font-family: inherit; font-size: x-small;">The Licensed Application includes
an educational interface and informational database intended to help guide you
through crucial patient and patient family conversations.</span></div>
<h1>
<!--[if !supportLists]--><span style="font-family: inherit; font-size: x-small; font-weight: normal;">A. <!--[endif]-->What
information does the Licensed Application obtain and how is it used?</span></h1>
<h1>
<span style="font-size: x-small; font-weight: normal;"><span style="font-family: inherit;">User Provided
Information.</span><span style="font-family: inherit;"> </span><span style="font-family: inherit;">The Licensed
Application obtains information automatically when you download it, such as the
type of mobile device you use, your mobile device unique ID, the IP address of
your mobile device, your mobile operating system, and information about the
functions you use on the Licensed Application. The Licensed Application does
not collect your name, email, or any credit card information.</span></span></h1>
<h1>
<!--[if !supportLists]--><span style="font-family: inherit; font-size: x-small; font-weight: normal;">B. <!--[endif]-->Does
the Licensed Application collect precise real-time location information of the
device?</span></h1>
<h1>
<span style="font-size: x-small; font-weight: normal;"><span style="font-family: inherit; text-indent: 0in;">The
Licensed Application does not collect information about the location of your
mobile device.</span><span style="font-family: inherit; text-indent: 0in;"> </span></span></h1>
<h1>
<!--[if !supportLists]--><span style="font-family: inherit; font-size: x-small; font-weight: normal;">C. <!--[endif]-->Do
third parties have access to information obtained by the Licensed Application?</span></h1>
<h1>
<span style="font-family: inherit; font-weight: normal; text-indent: 0in;"><span style="font-size: x-small;">Yes,
but only in the following ways:</span></span></h1>
<div class="MsoBodyText" style="text-indent: 0in;">
</div>
<ul>
<li><span style="font-family: inherit; font-size: x-small;"><span style="text-indent: -0.25in;">As required by law, such as to comply with a subpoena,
or similar legal process</span><span style="text-indent: -0.25in;"> </span></span></li>
<li><span style="text-indent: -0.25in;"><span style="font-family: inherit; font-size: x-small;">When we believe, in good faith, that disclosure is
necessary to protect our rights, protect your safety or the safety of others,
investigate fraud, or respond to a government request; and</span></span></li>
<li><span style="font-family: inherit; font-size: x-small;"><span style="text-indent: -0.25in;"> </span><span style="text-indent: -0.25in;">To trusted service providers who work on our behalf,
do not have an independent use of the information we disclose to them, and have
agreed to adhere to the rules set forth in this Privacy Policy.</span></span></li>
</ul>
<br />
<h1>
<!--[if !supportLists]--><span style="font-family: inherit; font-size: x-small; font-weight: normal;">D. <!--[endif]-->Automatic
Data Collection and Advertising</span></h1>
<h1>
<span style="font-size: x-small; font-weight: normal;"><span style="font-family: inherit;">We may work with analytics companies to help us understand
how the Licensed Application is being used, such as frequency and duration of
usage.</span><span style="font-family: inherit;"> </span><span style="font-family: inherit;">We do not work with advertisers,
and we will not give or sell your information to third parties for advertising
purposes.</span></span></h1>
<h1>
<!--[if !supportLists]--><span style="font-family: inherit; font-size: x-small; font-weight: normal;">E. <!--[endif]-->What
are my opt-out rights?</span></h1>
<h1>
<span style="font-size: x-small; font-weight: normal;"><span style="font-family: inherit; text-indent: 0in;">There
are an opt-out option for users of the Licensed Application: </span><span style="font-family: inherit; text-indent: 0in;">Uninstall the Licensed Application</span><span style="font-family: inherit; text-indent: 0in;">. You can stop all collection of information by the
Licensed Application easily by uninstalling it. You may use the standard
uninstall process as may be available as part of your mobile device.</span><span style="font-family: inherit; text-indent: 0in;"> </span></span></h1>
<h1>
<!--[if !supportLists]--><span style="font-family: inherit; font-size: x-small; font-weight: normal;">F. <!--[endif]-->Children</span></h1>
<h1>
<span style="font-size: x-small; font-weight: normal;"><span style="font-family: inherit; text-indent: 0in;">The
Licensed Application is not intended to be used by children and we do not
market use of the Licensed Application to children.</span><span style="font-family: inherit; text-indent: 0in;"> </span></span></h1>
<h1>
<!--[if !supportLists]--><span style="font-family: inherit; font-size: x-small; font-weight: normal;">G. <!--[endif]-->Security</span></h1>
<h1>
<span style="font-size: x-small; font-weight: normal;"><span style="font-family: inherit; text-indent: 0in;">We
are concerned about safeguarding the confidentiality of your information.</span><span style="font-family: inherit; text-indent: 0in;"> </span><span style="font-family: inherit; text-indent: 0in;">We provide electronic and procedural
safeguards to protect the information that we process and maintain.</span><span style="font-family: inherit; text-indent: 0in;"> </span><span style="font-family: inherit; text-indent: 0in;">For example, we limit access of this
information to authorized employees and contractors who need to know that
information in order to operate, develop, or improve the Licensed Application.
Please be aware that, although we endeavor to provide reasonable security for
information we process and maintain, no security system can prevent all
potential security breaches.</span><span style="font-family: inherit; text-indent: 0in;"> </span></span></h1>
<h1>
<!--[if !supportLists]--><span style="font-family: inherit; font-size: x-small; font-weight: normal;">H. <!--[endif]-->Changes</span></h1>
<h1>
<span style="font-size: x-small; font-weight: normal;"><span style="font-family: inherit;">This Privacy Policy may be updated from time to time for any
reason.</span><span style="font-family: inherit;"> </span><span style="font-family: inherit;">We will notify you of any
changes to the Privacy Policy at the conclusion of a software upgrade or on our
blog.</span><span style="font-family: inherit;"> </span></span></h1>
<h1>
<!--[if !supportLists]--><span style="font-family: inherit; font-size: x-small; font-weight: normal;">I. <!--[endif]-->Your
Consent</span></h1>
<h1>
<span style="font-size: x-small; font-weight: normal;"><span style="font-family: inherit;">By using the Licensed Application and Services, you agree to
this Privacy Policy and specifically consent to our processing of User Provided
and Automatically Collected Information as set forth in this Privacy Policy now
and as amended.</span><span style="font-family: inherit;"> </span><span style="font-family: inherit;">“Processing” means using
cookies on a mobile or other hand held device or using or touching information
in any way, including without limitation, collecting, storing, deleting, using,
combining and disclosing information, all of which activities will take place
in the United States. If you reside outside of the United States, your
information will be transferred to the United States as well as processed and
stored in the United States under applicable privacy standards.</span><span style="font-family: inherit;"> </span><span style="font-family: inherit;">By using the Licensed Application, you
consent to such transferring and processing in the United States.</span></span></h1>
<h1>
<!--[if !supportLists]--><span style="font-family: inherit; font-size: x-small; font-weight: normal;">J. <!--[endif]-->Contact</span></h1>
<h1>
<span style="font-family: inherit; font-weight: normal;"><span style="font-size: x-small;">If you have any information about this Privacy Policy, feel
free to contact us via email at info@vitaltalk.org</span></span></h1>
<div class="MsoNormal">
<span style="font-family: inherit; font-size: x-small;">Last Updated: 04/12/13</span></div>
<!--EndFragment-->VITALtalkhttp://www.blogger.com/profile/08730670279040888864noreply@blogger.com0tag:blogger.com,1999:blog-4630882080895014436.post-11435329545381560252013-04-01T16:58:00.000-07:002013-04-14T16:59:49.721-07:00Vital Talk app End User License Agreement<!--[if gte mso 9]><xml>
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<div style="background-color: white; line-height: 13.5pt; margin: 0in 0in 13.5pt; text-align: left;">
<span style="color: #333333; font-family: 'Lucida Grande'; font-size: 9pt; line-height: 13.5pt;">The Products transacted through the
Service are licensed, not sold, to You for use only under the terms of this
license, unless a Product is accompanied by a separate license agreement, in
which case the terms of that separate license agreement will govern, subject to
Your prior acceptance of that separate license agreement. The licensor
(“Application Provider”, i.e. Vital Talk) reserves all rights not expressly granted to You. The
Product that is subject to this license is referred to in this license as the
“Licensed Application,” (i.e. the Vital Talk app).</span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; line-height: 13.5pt; margin: 0in 0in 13.5pt;">
<span style="color: #333333; font-family: "Lucida Grande"; font-size: 9.0pt;">a. Scope of License: This license granted to You for the
Licensed Application by Application Provider is limited to a non-transferable
license to use the Licensed Application on any iPhone or iPod touch that You
own or control and as permitted by the Usage Rules set forth in Section 9.b. of
the App Store Terms and Conditions (the “Usage Rules”). This license does not
allow You to use the Licensed Application on any iPod touch or iPhone that You
do not own or control, and You may not distribute or make the Licensed
Application available over a network where it could be used by multiple devices
at the same time. You may not rent, lease, lend, sell, redistribute or
sublicense the Licensed Application. You may not copy (except as expressly
permitted by this license and the Usage Rules), decompile, reverse engineer,
disassemble, attempt to derive the source code of, modify, or create derivative
works of the Licensed Application, any updates, or any part thereof (except as
and only to the extent any foregoing restriction is prohibited by applicable
law or to the extent as may be permitted by the licensing terms governing use
of any open sourced components included with the Licensed Application). Any
attempt to do so is a violation of the rights of the Application Provider and
its licensors. If You breach this restriction, You may be subject to
prosecution and damages. The terms of the license will govern any upgrades
provided by Application Provider that replace and/or supplement the original
Product, unless such upgrade is accompanied by a separate license in which case
the terms of that license will govern.<o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; line-height: 13.5pt; margin: 0in 0in 13.5pt;">
<span style="color: #333333; font-family: "Lucida Grande"; font-size: 9.0pt;">b. Consent to Use of Data: You agree that Application Provider
may collect and use technical data and related information, including but not
limited to technical information about Your device, system and application
software, and peripherals, that is gathered periodically to facilitate the
provision of software updates, product support and other services to You (if
any) related to the Licensed Application. Application Provider may use this
information, as long as it is in a form that does not personally identify You,
to improve its products or to provide services or technologies to You. </span><span style="font-family: "Lucida Grande"; font-size: 9.0pt;">In addition, by using the
Licensed Application, You agree to our Privacy Policy available at
vitaltalk.blogspot.com.<span style="color: #333333;"><o:p></o:p></span></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; line-height: 13.5pt; margin: 0in 0in 13.5pt;">
<span style="color: #333333; font-family: "Lucida Grande"; font-size: 9.0pt;">c. Termination. The license is effective until terminated by You
or Application Provider. Your rights under this license will terminate
automatically without notice from the Application Provider if You fail to
comply with any term(s) of this license. Upon termination of the license, You
shall cease all use of the Licensed Application, and destroy all copies, full
or partial, of the Licensed Application.<o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; line-height: 13.5pt; margin: 0in 0in 13.5pt;">
<span style="color: #333333; font-family: "Lucida Grande"; font-size: 9.0pt;">d. Services; Third Party Materials. The Licensed Application may
enable access to Application Provider’s and third party services and web sites
(collectively and individually, "Services"). Use of the Services may
require Internet access and that You accept additional terms of service.<o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; line-height: 13.5pt; margin: 0in 0in 13.5pt;">
<span style="color: #333333; font-family: "Lucida Grande"; font-size: 9.0pt;">You understand that by using any of the Services, You may
encounter content that may be deemed offensive, indecent, or objectionable,
which content may or may not be identified as having explicit language, and
that the results of any search or entering of a particular URL may
automatically and unintentionally generate links or references to objectionable
material. Nevertheless, You agree to use the Services at Your sole risk and
that the Application Provider shall not have any liability to You for content
that may be found to be offensive, indecent, or objectionable.<o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; line-height: 13.5pt; margin: 0in 0in 13.5pt;">
<span style="color: #333333; font-family: "Lucida Grande"; font-size: 9.0pt;">Certain Services may display, include or make available content,
data, information, applications or materials from third parties (“Third Party
Materials”) or provide links to certain third party web sites. By using the
Services, You acknowledge and agree that the Application Provider is not
responsible for examining or evaluating the content, accuracy, completeness,
timeliness, validity, copyright compliance, legality, decency, quality or any
other aspect of such Third Party Materials or web sites. The Application
Provider does not warrant or endorse and does not assume and will not have any
liability or responsibility to You or any other person for any third-party
Services, Third Party Materials or web sites, or for any other materials,
products, or services of third parties. Third Party Materials and links to
other web sites are provided solely as a convenience to You. Financial
information displayed by any Services is for general informational purposes
only and is not intended to be relied upon as investment advice. Before
executing any securities transaction based upon information obtained through
the Services, You should consult with a financial professional. Location data
provided by any Services is for basic navigational purposes only and is not
intended to be relied upon in situations where precise location information is
needed or where erroneous, inaccurate or incomplete location data may lead to
death, personal injury, property or environmental damage. Neither the
Application Provider, nor any of its content providers, guarantees the
availability, accuracy, completeness, reliability, or timeliness of stock
information or location data displayed by any Services.<o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; line-height: 13.5pt; margin: 0in 0in 13.5pt;">
<span style="color: #333333; font-family: "Lucida Grande"; font-size: 9.0pt;">You agree that any Services contain proprietary content,
information and material that is protected by applicable intellectual property
and other laws, including but not limited to copyright, and that You will not
use such proprietary content, information or materials in any way whatsoever
except for permitted use of the Services. No portion of the Services may be
reproduced in any form or by any means. You agree not to modify, rent, lease,
loan, sell, distribute, or create derivative works based on the Services, in
any manner, and You shall not exploit the Services in any unauthorized way
whatsoever, including but not limited to, by trespass or burdening network
capacity. You further agree not to use the Services in any manner to harass,
abuse, stalk, threaten, defame or otherwise infringe or violate the rights of
any other party, and that the Application Provider is not in any way
responsible for any such use by You, nor for any harassing, threatening,
defamatory, offensive or illegal messages or transmissions that You may receive
as a result of using any of the Services.<o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; line-height: 13.5pt; margin: 0in 0in 13.5pt;">
<span style="color: #333333; font-family: "Lucida Grande"; font-size: 9.0pt;">In addition, third party Services and Third Party Materials that
may be accessed from, displayed on or linked to from the iPhone or iPod touch
are not available in all languages or in all countries. The Application
Provider makes no representation that such Services and Materials are
appropriate or available for use in any particular location. To the extent You
choose to access such Services or Materials, You do so at Your own initiative
and are responsible for compliance with any applicable laws, including but not
limited to applicable local laws. The Application Provider, and its licensors,
reserve the right to change, suspend, remove, or disable access to any Services
at any time without notice. In no event will the Application Provider be liable
for the removal of or disabling of access to any such Services. The Application
Provider may also impose limits on the use of or access to certain Services, in
any case and without notice or liability.<o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; line-height: 13.5pt; margin: 0in 0in 13.5pt;">
<span style="color: #333333; font-family: "Lucida Grande"; font-size: 9.0pt;">e. NO WARRANTY: YOU EXPRESSLY ACKNOWLEDGE AND AGREE THAT USE OF
THE LICENSED APPLICATION IS AT YOUR SOLE RISK AND THAT THE ENTIRE RISK AS TO
SATISFACTORY QUALITY, PERFORMANCE, ACCURACY AND EFFORT IS WITH YOU. TO THE
MAXIMUM EXTENT PERMITTED BY APPLICABLE LAW, THE LICENSED APPLICATION AND ANY
SERVICES PERFORMED OR PROVIDED BY THE LICENSED APPLICATION
("SERVICES") ARE PROVIDED "AS IS" AND “AS AVAILABLE”, WITH
ALL FAULTS AND WITHOUT WARRANTY OF ANY KIND, AND APPLICATION PROVIDER HEREBY
DISCLAIMS ALL WARRANTIES AND CONDITIONS WITH RESPECT TO THE LICENSED
APPLICATION AND ANY SERVICES, EITHER EXPRESS, IMPLIED OR STATUTORY, INCLUDING,
BUT NOT LIMITED TO, THE IMPLIED WARRANTIES AND/OR CONDITIONS OF
MERCHANTABILITY, OF SATISFACTORY QUALITY, OF FITNESS FOR A PARTICULAR PURPOSE,
OF ACCURACY, OF QUIET ENJOYMENT, AND NON-INFRINGEMENT OF THIRD PARTY RIGHTS.
APPLICATION PROVIDER DOES NOT WARRANT AGAINST INTERFERENCE WITH YOUR ENJOYMENT OF
THE LICENSED APPLICATION, THAT THE FUNCTIONS CONTAINED IN, OR SERVICES
PERFORMED OR PROVIDED BY, THE LICENSED APPLICATION WILL MEET YOUR REQUIREMENTS,
THAT THE OPERATION OF THE LICENSED APPLICATION OR SERVICES WILL BE
UNINTERRUPTED OR ERROR-FREE, OR THAT DEFECTS IN THE LICENSED APPLICATION OR
SERVICES WILL BE CORRECTED. NO ORAL OR WRITTEN INFORMATION OR ADVICE GIVEN BY
APPLICATION PROVIDER OR ITS AUTHORIZED REPRESENTATIVE SHALL CREATE A WARRANTY.
SHOULD THE LICENSED APPLICATION OR SERVICES PROVE DEFECTIVE, YOU ASSUME THE
ENTIRE COST OF ALL NECESSARY SERVICING, REPAIR OR CORRECTION. SOME
JURISDICTIONS DO NOT ALLOW THE EXCLUSION OF IMPLIED WARRANTIES OR LIMITATIONS
ON APPLICABLE STATUTORY RIGHTS OF A CONSUMER, SO THE ABOVE EXCLUSION AND
LIMITATIONS MAY NOT APPLY TO YOU.<o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; line-height: 13.5pt; margin: 0in 0in 13.5pt;">
<span style="color: #333333; font-family: "Lucida Grande"; font-size: 9.0pt;">f. Limitation of Liability. TO THE EXTENT NOT PROHIBITED BY LAW,
IN NO EVENT SHALL APPLICATION PROVIDER BE LIABLE FOR PERSONAL INJURY, OR ANY
INCIDENTAL, SPECIAL, INDIRECT OR CONSEQUENTIAL DAMAGES WHATSOEVER, INCLUDING,
WITHOUT LIMITATION, DAMAGES FOR LOSS OF PROFITS, LOSS OF DATA, BUSINESS
INTERRUPTION OR ANY OTHER COMMERCIAL DAMAGES OR LOSSES, ARISING OUT OF OR
RELATED TO YOUR USE OR INABILITY TO USE THE LICENSED APPLICATION, HOWEVER
CAUSED, REGARDLESS OF THE THEORY OF LIABILITY (CONTRACT, TORT OR OTHERWISE) AND
EVEN IF APPLICATION PROVIDER HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH
DAMAGES. SOME JURISDICTIONS DO NOT ALLOW THE LIMITATION OF LIABILITY FOR
PERSONAL INJURY, OR OF INCIDENTAL OR CONSEQUENTIAL DAMAGES, SO THIS LIMITATION
MAY NOT APPLY TO YOU. In no event shall Application Provider’s total liability
to you for all damages (other than as may be required by applicable law in
cases involving personal injury) exceed the amount of fifty dollars ($50.00).
The foregoing limitations will apply even if the above stated remedy fails of
its essential purpose.<o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; line-height: 13.5pt; margin: 0in 0in 13.5pt;">
<span style="color: #333333; font-family: "Lucida Grande"; font-size: 9.0pt;">g. You may not use or otherwise export or re-export the Licensed
Application except as authorized by United States law and the laws of the
jurisdiction in which the Licensed Application was obtained. In particular, but
without limitation, the Licensed Application may not be exported or re-exported
(a) into any U.S. embargoed countries or (b) to anyone on the U.S. Treasury
Department's list of Specially Designated Nationals or the U.S. Department of
Commerce Denied Person’s List or Entity List. By using the Licensed
Application, you represent and warrant that you are not located in any such
country or on any such list. You also agree that you will not use these
products for any purposes prohibited by United States law, including, without
limitation, the development, design, manufacture or production of nuclear,
missiles, or chemical or biological weapons.<o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; line-height: 13.5pt; margin: 0in 0in 13.5pt;">
<span style="color: #333333; font-family: "Lucida Grande"; font-size: 9.0pt;">h. The Licensed Application and related documentation are
"Commercial Items", as that term is defined at 48 C.F.R. §2.101,
consisting of "Commercial Computer Software" and "Commercial
Computer Software Documentation", as such terms are used in 48 C.F.R.
§12.212 or 48 C.F.R. §227.7202, as applicable. Consistent with 48 C.F.R.
§12.212 or 48 C.F.R. §227.7202-1 through 227.7202-4, as applicable, the
Commercial Computer Software and Commercial Computer Software Documentation are
being licensed to U.S. Government end users (a) only as Commercial Items and
(b) with only those rights as are granted to all other end users pursuant to
the terms and conditions herein. Unpublished-rights reserved under the
copyright laws of the United States.<o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; line-height: 13.5pt; margin: 0in 0in 13.5pt;">
<span style="color: #333333; font-family: "Lucida Grande"; font-size: 9.0pt;">i. The laws of the State of Washington, excluding its conflicts
of law rules, govern this license and your use of the Licensed Application.
Your use of the Licensed Application may also be subject to other local, state,
national, or international laws.<o:p></o:p></span></div>
<div style="background: white; line-height: 13.5pt; margin-bottom: 13.5pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<span style="font-family: "Lucida Grande"; font-size: 9.0pt;">j. Medical Advice Disclaimer and
Indemnification. The Licensed
Application contains contents, such as text, graphics, images, information
posted by third party end users, and other material (the “Content”). The Content is not intended to help You, or
anyone else, to offer professional medical advice, You represent and warrant
that you will not use the Content or Services in connection with, or as a
substitute for, professional medical advice, diagnosis, or treatment. You agree to defend and hold the Application
Provider harmless in the event that any third party makes a claim that against
the Application Provider in connection with Your dispensing medical
advice. <o:p></o:p></span></div>
<div style="background: white; line-height: 13.5pt; margin-bottom: 13.5pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<span style="font-family: "Lucida Grande"; font-size: 9.0pt;">k. Dispute Resolution. Upon any dispute or claim
arising under the terms, obligations, or promises hereunder, You agree to first
attempt to resolve the dispute privately with the Application Provider. Should
that fail, You, and us as the Application Provider, agree to submit to binding
arbitration. Arbitration will be before a single arbitrator that You may select
from a list of at least three arbitrators provided by the Application Provider.
Arbitration will be performed under the rules adopted by the American
Arbitration Association at the time a claim is filed with an arbitrator.
Arbitration will take place in Seattle, Washington. An arbitration judgment may
be entered into and enforced by a court of competent jurisdiction, which
judgment may include the costs and attorneys’ fees for the prevailing party at
arbitration.<o:p></o:p></span></div>
<div style="background: white; line-height: 13.5pt; margin-bottom: 13.5pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<span style="font-family: "Lucida Grande"; font-size: 9.0pt;">l. Jurisdiction and Venue. This license is governed
by and construed in accordance with the domestic laws of the State of
Washington without giving effect to any choice of law or conflict of law
provision or rule (whether of the State of Washington or any other
jurisdiction) that would cause the application of the laws of any jurisdiction
other than the State of Washington. Accordingly, you consent to personal jurisdiction
in Washington State, and agree that the venue for any dispute resolution shall
be King County, Washington.<span style="color: #333333;"><o:p></o:p></span></span></div>
<!--EndFragment-->VITALtalkhttp://www.blogger.com/profile/08730670279040888864noreply@blogger.com3tag:blogger.com,1999:blog-4630882080895014436.post-20318406753610685382013-03-01T17:25:00.000-08:002013-04-14T17:25:38.539-07:00Contact us<span style="font-family: inherit;">The best way is email: tony@vitaltalk.org</span>VITALtalkhttp://www.blogger.com/profile/08730670279040888864noreply@blogger.com0tag:blogger.com,1999:blog-4630882080895014436.post-48436840866540687962013-03-01T17:22:00.000-08:002013-04-14T17:23:12.811-07:00About Vital Talk<span style="font-family: inherit;">VitalTalk is a nonprofit with the mission of nurturing healthier connections between patients and clinicians. We're running communication skills courses for clinicians, launching an iPhone app, and hosting an innovation conference--and you can keep up to date with us here. </span>VITALtalkhttp://www.blogger.com/profile/08730670279040888864noreply@blogger.com46