All of us at one point in our lives have received bad news. As a doctor, delivering bad news to patients is one of the most difficult and unavoidable responsibilities in the practice of medicine. Studies have shown patients and their families remember the way bad news is delivered—the exact words you used, how you looked, the gestures you made, and whether you seemed to genuinely care—for the rest of their lives. However, bad news is always in the eye of the beholder, and no one can determine the exact impact it will have on a patient’s expectations or understanding. So, how can you help your patients and their families move forward during such a difficult time in their lives? How can you prepare emotionally to give bad news?
Prepare Yourself to Feel Badly
Do not give bad news over the phone. Arrange for some privacy, have your patient bring a friend or family member with them, and always deliver bad news in person. Do not rush into delivering the news, but rather, allow your patient time to prepare themselves. Most importantly, maintain eye contact or gently stoke your patient’s arm (if the patient is comfortable with this) as a way of establishing rapport.
There’s no way out of it. No matter how you deliver bad news to your patients, they will always feel worse after hearing it. You have to recognize this as a normal process, or else it will just make things harder for you. Working hard to make your patients feel good about bad news is not only counterproductive, but it can also take a toll on your relationship with the patient.
Deliver Bad News in a Clear and Calm Manner
Do not try to sugarcoat the diagnosis. Avoid euphemisms and medical jargon, and use terms such as “cancer” or “death.” Delivering bad news clearly and unequivocally is surprisingly powerful. Best case scenario, it delays your patient’s understanding of the situation, and, worst case scenario, it promotes their denial of it. It is best if both you and your patient are sitting. This sends the message that you have time for them and are willing to address any questions or concerns they might have. Be prepared with a box of tissues just in case, and turn your pager to silent mode so there are no interruptions.
Observe and Address the Patient’s Reaction
After a patient receives bad news, they always have some kind of reaction. Some are shocked, some are angry, and some may be in denial. At this point, your job is to respond to their reaction and help them through it. Use an empathetic response, such as, “I know this is hard to hear,” or “I also wish the news was better.” Allow silence and tears from your patient or their family members, as some need time to process. Once your patient’s reaction has run its course, ask them if they have any questions regarding their prognosis and possible treatment options.
Never Destroy Hope!
Never destroy a patient’s hope for a good outcome. They will suffer far more on the way to whatever bad news may be in store for them than if they had the chance to approach it with hope. It is every individual’s natural tendency to continue to hope in the face of terrible odds, so, discuss new knowledge and treatment discoveries. Even though death often cannot be prevented, effective communication during such difficult times can help families to begin the healing process.
Empathize and Provide Support to the Patient
Let your patient and their family know you care. As long as you have delivered the news clearly, it is ok to feel pain and break for tears. Stress to your patient that you genuinely care about what happens to them and that you will be available to them. Knowing there is someone committed to supporting them throughout the course of their illness is extremely relieving.
Summarize and Prepare a Follow-up Plan
Take a moment and make sure both your patient and their family understand what you have told them. Make sure they have a support system and assure them you will be available for any follow-up questions they might have. Whether by phone or in person, you should talk with your patient again within the same week. Share your action plan and any information (websites or referrals to community organizations) that might be of use to them. Schedule follow-up meetings and close with one statement in particular: “I will be with you every step of the way.”
Many individuals often believe this topic only applies to doctors, however, every healthcare professional need to understand this basic process. It is important, because you may unknowingly be giving bad news. The way you deliver bad news plays a crucial role in how your patients and their families cope with grief and process loss. As a doctor, you accept death as a reality, but you must also help patients and their families deal with this acceptance as well.
Still, you may do all the right things (e.g., a private room, empathetic response, follow-up plan, etc.), but that element of sorrow cannot be avoided. Going back to the main question, “How can you prepare emotionally to give bad news?” The answer lies in preparing by getting ready to do your job well. If you are able to do a good job delivering bad news, you have helped both your patients and their families move forward towards acceptance. Every job has its ups and downs. In medicine, there are limitations, and not all patients can be cured. But no matter how sad and difficult it may be to deliver bad news to your patients, always remember that, above all, you have the ability to heal and preserve hope.