Perfect Phrases for Healthcare Professionals by Masashi Rotte & Bernard Lopez M.D

Author:Masashi Rotte & Bernard Lopez, M.D.
Language: eng
Format: epub
Publisher: McGraw Hill LLC
Published: 2012-09-15T00:00:00+00:00

CHAPTER 4

Perfect Phrases for Breaking Bad News to Patients and Their Families

Breaking bad news to patients or their loved ones can be a source of extreme stress for healthcare professionals. We are not always prepared for these difficult interactions in medical or nursing school. We might be concerned that our patients will not take the news well and that it could destroy all the hope they have. We can imagine that the patients or their loved ones will be angry with us. Finally, we may feel that we have failed in our job by not securing good outcomes for our patients.

How well these difficult conversations go depends on many factors. A pre-existing relationship between the healthcare provider and the patient can be comforting for all parties involved. Studies have shown that family members named the attitude of the doctor delivering the bad news, the doctor’s ability to answer questions, and a private setting for the conversation as very important.

Unfortunately, it can be very hard to meet all of these goals for communication. Not all healthcare professionals know their patients very well. Some patients may be new to your practice, or they may have been just admitted to the hospital and you are meeting them for the first time. The fast pace of modern medicine does not always allow the time or place to sit down quietly and have long conversations. In addition, it is nearly impossible to anticipate how patients or their families will react to bad news.

In these instances, we have to do our best to deliver bad news professionally and with as much compassion as we can. Having a structure or “game plan” in place ahead of time can be beneficial.

Prepare to Give the News

Try to arrange for a private and quiet place to have the discussion.

Maintain a professional appearance—straighten your tie or white coat, check your hair in a mirror, and take off bloody clothing.

Put your beeper or cell phone on vibrate.

Ensure that you have a complete understanding of the prognosis or diagnosis you are about to present.

Bring a social worker, chaplain, or nurse if you think it will help facilitate communication.

In an academic setting, the attending physician should be present to either supervise the resident or to allow the resident to observe how to deliver the bad news.

Open the Discussion

Clearly identify yourself, your role in the patient’s care, and why you are there.

Introduce yourself to everyone present and find out how they are related to the patient.

Sit down at eye level.

Break the News

Lead off with a very brief summary of the patient’s clinical history.

Give the patient or loved ones a warning statement—”I’m sorry but I have some bad news.”

Break the news using plain language—“The cancer has spread and has become much more serious” or “The car crash was very severe, and he died from his injuries.”

Pause to give the patient or loved ones time to absorb the information, grieve, or simply cry.

Offer to answer any questions.

Close the Interaction

Briefly let the patient or loved ones know what

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