{"id":259,"date":"2012-12-10T13:13:39","date_gmt":"2012-12-10T21:13:39","guid":{"rendered":"https:\/\/phcprimarycare.org\/?p=259"},"modified":"2014-02-19T13:38:13","modified_gmt":"2014-02-19T21:38:13","slug":"communicating-bad-news-an-art-and-a-science","status":"publish","type":"post","link":"https:\/\/phcprimarycare.org\/?p=259","title":{"rendered":"Communicating bad news \u2013 an art and a science"},"content":{"rendered":"

(Thanks to Doug Wilson, MD, president of the Napa County Medical Society, for the idea for this post.)<\/em><\/p>\n

One of our hardest jobs as physicians is delivering bad news. It is emotionally draining, time-consuming, and uncomfortable. Most of us received very little training in medical school on how to deliver bad news. And it really does require some training. While many physicians are intuitive by nature, delivering bad news honestly, candidly, gently, directly, empathetically, and supportively does not come easily for most of us.<\/p>\n

For many physicians, we tend towards one of two extremes. On the one hand, we sometimes try to shelter patients from bad news by presenting information through rose-colored glasses. \u201cYou\u2019re going to be OK.\u201d \u201cWe have some new treatment options that are showing a lot of promise.\u201d \u201cYou\u2019re doing great.\u201d Phrases like these \u2013 when spoken to patients with incurable serious disease, who are often looking for any kind of miracle \u2013 are meant to reduce worry and allay fear, but they can be misconstrued. The short-term gain such statements provide can make the grim reality, which cannot be avoided forever, even more painful. If we falsely raise hope when there is no valid reason to expect a good outcome, we are not doing our patients any favors.<\/p>\n

On the other hand, we also sometimes go to the other extreme of being too blunt, to the point of seeming callous. When first delivering some very bad news, it does not help to say, \u201cThere is nothing we can do.\u201d \u201cThere is no hope for improvement.\u201d To extinguish any sense of hope, to state without hesitation that the game is over, can make patients and their families feel abandoned, uncared for.<\/p>\n

So how do we balance contending priorities? To be most effective, physicians need to be consummate jugglers. We need to be able to deliver bad news compassionately and caringly. We need to let our patients know that we understand their concerns, fears, and emotions. We need to let them know we will stand by them and help as they embark on their new and perilous journey.<\/p>\n

While good communication is essential in all clinical realms, it is particularly important when talking about the delicate matter of end-of-life care. Even the term end-of-life<\/em> is an ominous phrase. It can evoke the worst fears that humans experience. Patients and families, when facing the prospect of life\u2019s impending end, often and understandably want to delay the inevitable. They may ask their physicians to \u201cDo everything.\u201d Their motivation in asking for \u201ceverything\u201d is understandable. But that plea often reflects a flawed awareness of what \u201ceverything\u201d means. Patients and families are often unclear on just how painful and ineffective some interventions can be. Their plea is a call for help, and it requires the physician to spend time communicating, realistically and compassionately, with the patient and their family about what lies ahead.<\/p>\n

No, our job is not easy. But then, none of us asked for easy when we decided to enter this profession.<\/p>\n

The Journal of Clinical Oncology<\/em> recently published an interesting perspective piece on this topic. You can find it at this link: http:\/\/jco.ascopubs.org\/content\/30\/27\/3421.full<\/a>.<\/p>\n

\u00a0Richard Fleming, MD<\/p>\n","protected":false},"excerpt":{"rendered":"

(Thanks to Doug Wilson, MD, president of the Napa County Medical Society, for the idea for this post.) One of our hardest jobs as physicians is delivering bad news. It is emotionally draining, time-consuming, and uncomfortable. 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