Tips on giving bad news to patients
Patients want to know their doctor cares
Physicians often have to give bad and distressing news to patients. The screening tests have found cancer. An ultrasound shows that a pregnancy is not progressing normally. A planned treatment regimen is not having the desired result.
How the information is communicated is just as important as the information itself, says Frank Boehm, MD, FACOG, director of maternal/fetal medicine at Vanderbilt University Medical Center in Nashville, TN, and the author of the book, Doctors Cry, Too (Hay House Inc.; 2001).
Here are some tips for communicating bad news to patients and their loved ones:
1. Find an appropriate setting. Make sure you can find a place where the patient and/or family members can be alone and comfortable. "You don’t want to do this in a hallway or a place where people will find it distracting," Boehm advises. "It can be in a hospital conference room or a doctor’s office. But, you need to tell your staff not to interrupt you, and you need to turn your cell phone and beeper off.
2. Be focused. Patients will have a difficult time hearing and processing what you are saying, anyway, so any other distractions will complicate the problem. Boehm advises sitting next to the patient — not standing over them or sitting behind a desk — and speaking to them face to face.
3. Make sure the patient is dressed. Patients who are not clothed feel vulnerable and inferior. Make sure the patient is able to be fully dressed and comfortable.
4. Begin forthrightly. Choose words carefully. Be up front with the patient without being callous. Saying, "Unfortunately, I have some bad news" at the beginning of the conversation lets the person know what to expect. Don’t, however, be overly blunt, he adds. "You don’t just say, You’ve got cancer; you have six months to live.’"
Above all, use words the patient can understand, not clinical terms or phrases that you might be more comfortable with.
5. Afterward, ask them to repeat what they’ve heard. "Once you’ve taken them to that point and presented the information, you need to stop and say something like, I know this is upsetting to you, but I need you to tell me what you heard me say," advises Boehm. "Ask them to repeat what they’ve heard. Don’t ask if they have any questions because, at that point, the answer will be no."
6. Give patients permission to ask questions now and later. Once the physician is sure the patient understands the information that has been presented, he or she should tell the patient they can ask any question they want, and that they can write down questions later at home and call, or ask during the next visit.
7. Leave room for hope. Even if the patient’s prognosis is very bad, there should always be room for some hope — even if it’s not for recovery. "You should always leave room for hope, even if the news is that the patient has an illness that they likely won’t recover from. There are no absolutes. We don’t know everything," he says. "And, sometimes, patients just need to know that we will be with them, that we are going to help them through this situation, and that we aren’t going to just give them this news that destroys their lives and abandon them, sending them on their way."
8. Say, I’m sorry.’ It’s important for physicians to share some of their own feelings with the patient, he concludes. "I usually recommend saying, "I am very sorry this has happened,’" he says. "Patients need to know that we have emotions and we do care about what is happening to them." Often, doctors feel that they will add to the patients’ distress if they express a negative emotion, or that they will be perceived as lacking in strength or confidence, he says. But, in his experience, patients need to know that their doctors feel badly sometimes and care about what happens to the people they care for.
Physicians often have to give bad and distressing news to patients. The screening tests have found cancer. An ultrasound shows that a pregnancy is not progressing normally. A planned treatment regimen is not having the desired result.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content