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29 November 2018

When doctors deliver bad news

Bad news can be a challenge for both patient and doctor.

Receiving bad news is tough, especially when it comes from your doctor. Although different, delivering bad news to patients can be difficult for the doctor as well.

Doctors have to navigate between delivering bad news, providing medical information in a way that the patient can clearly understand, empathising and giving the patient some hope.

Dr Steven Pantilat, co-founder of the Palliative Care Program at the University of California-San Francisco Medical Center, in an interview with Medical News Today, said, "This is not easy. Nobody likes doing it. No matter how well you deliver bad news, it's still bad. You can't make it somehow OK for the patient, but it's important not to make it worse.”

Different doctors relay information in different ways. Some are able to do it in an empathetic manner, whereas others prefer to keep it professional and straightforward.

Breaking the news

When a patient receives bad news, they are usually offered information and advice as to what the next steps are. Dr Pantilat states that doctors often ramble on to bypass the uncomfortable silences, using medical jargon that the patient does not understand.

Clinical audiologist and Health24 expert Dr Kara Hoffman says, "When people come to me, it is often because they are already concerned about possible hearing loss, so they are almost geared up for bad news. It is, however, never easy to break the news, and parents vary in their responses."

The initial shock of the bad news may prevent patients from hearing or understanding anything else that is said after that. It is therefore important that doctors provide patients with some time to process the information, maybe even set up another appointment to discuss the next steps.

Dr Hoffman adds, "I usually show them the results, explain what this means in real life and what the repercussions of doing nothing about it are. Once I have explained the results, and we have shed some tears, I usually follow their lead with answering any burning questions they may have, then I give them tissues and wait for them to make the first move. Sometimes they are in denial, and choose to take in the information and get back to me, while others want to do something about it immediately."

Having a doctor who is direct and open with a patient is the best option. Sugar coating the subject just complicates things and confuses the patient. Giving the patient hope can be a good or a bad thing, depending on the circumstances.

According to Health 24's Cyberdoc, Dr Heidi Van Deventer, "I have found that patients prefer to know the truth. They do not like it when one hides information to "spare their feelings", even if it is bad news... They like to know the facts and the treatment options available. Communication is extremely important. So take out more time than usual to talk to your patient and don't rush". 

Communication skills

Studies have found that lacking the appropriate skill on how to speak to patients when delivering bad news can have a negative impact on the lives of patients and their families, often leading to dissatisfaction.

Speaking to radiation oncologist Dr Elizabeth Murray, she says that she tries to break the bad news into little bits and hopes that the patient has questions for her. Should their condition be fatal she tries to not give them a specific time and uses words like a few weeks or months or years, as "None of us is God and really knows". She goes further to say that "I always say something positive about what we can do whether treatment (is) aimed at cure or control or comfort and symptomatic relief etc".

Doctors do receive communication skills training as part of their studies and are taught how to assess and address situations in an objective fashion. What is taught in theory may, however, not be applied in practice and can fall by the wayside in real-life situations.

Image credit: iStock

 
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