One of the most difficult situations a health care provider has to face is delivering bad news to a patient and his family, and there’s no single right way to do it. It can be a terribly uncomfortable situation, especially for those unprepared to deal with the questions and resulting emotions of the patient and family. As a result, many physicians attempt to disassociate themselves with the situation and wind up behaving in an unnaturally stiff and formal manner.
When dealing with a potentially fatal outcome, the best way to approach the subject is to prepare the family in advance, using plain English. Discuss treatment options and possible outcomes early, so they will have time to adjust to the news and ask questions before the prognosis is in.
Delivering bad news will always be painful, but your attitude and approach can make all the difference in the way the family receives it. First, consider the setting. On medical shows like Grey’s Anatomy, doctors often deliver even the worst news in a very public setting, like a waiting area full of people. A much better choice would be a private room with plenty of comfortable seating, where the family does not feel as if they are on display. Grief is private and should be treated with dignity.
Deliver the information in plain English and fully explain any medical terms. Don’t try to sugarcoat it. If the patient is dead or is going to die, say so…as gently as possible, without euphemisms. Don’t just blurt it out; give them a few seconds to brace with a leading sentence, like “I’m afraid the news is not good.”
If there are to be complicated procedures, ask the patient how much detail he wants to hear. Some people will want only the bottom line, and not the minutiae of treatment. Giving the patient only as much as he is ready to deal with allows him to absorb it more readily. Technical details can wait.
Before you attempt to deliver any news, try to anticipate potential questions and have answers prepared. Unfortunately, sometimes the answer is “I don’t know.” It’s helpful to have related knowledge handy, like statistical information about what percentage of patients survive the same situation and what challenges the family will face.
Be sympathetic, but be careful about getting too emotional. No matter how strongly you feel, keep your own emotions in check. The patient needs to see you as a professional in order to maintain his confidence. Kindness, empathy and understanding make wonderful bedside manners, but a burst of emotion can be alarming for both family and patient.
Allow sufficient time for them to ask questions. Be prepared to offer a comprehensive game plan and discuss the course of treatment if they are ready to hear it. A positive plan of action is a great way to alleviate feelings of helplessness and despair. Try not to mislead them with false hope, but offer some solid advice for the future and assurances that you will do everything that can be done.
Another scenario to consider is when the patient is a child. The best way to approach this situation is to remove the parents from the room and tell them privately before breaking the news to the child. They may wish to do it themselves, or may want to discuss a plan of approach that best addresses their child’s emotional needs.
Remember, in any scenario, the objective is to make the patient and his family or caregivers understand what is happening and prepare them for what is to come. The more simple the language and straightforward the approach, the more likely you will succeed.