Have you ever said this to anyone? Do you really mean it? What does it really mean? It means please give me the news, whatever it is, in a straightforward manner with no bullshit. Usually it is used in a situation in which bad news is what’s forthcoming. Is that what people really want? I feel like this phrase is said waaaayyy more often than it is truly meant.

I hear this all the time at the office as well. I have patients tell me that they need to know everything and right away. Sometimes this is a complete trap and it does not go well at all when I “give it to ’em straight.” The trouble is that I still can’t completely figure out how to tell ahead of time.

So, as I am want to do, I decided to do some research. I came across an article in Psychology Today that deals with this subject. Let me summarize it for you.

The article starts out by pointing out that there are as many different types of news we don’t want to hear as there are ways and methods to deliver it. The article basically breaks down the process by a few key questions and answers.

The first question to ask yourself is: Is there any good news you can also give? If the answer is yes, start with the good news. Science tells us that people are pushed to act more by bad news if they hear good news first. Dr Angela Legg, a Pace University psychologist says that she prefers a “sandwich technique, good news first, some bad news, then a concrete solution.” If the answer is no, go ahead with the bad news. If there is no chance of any good news to go with it, just get the bad news over with.

The next question to ask is is there any long-term feedback that could be helpful? If so, make sure you include that feedback when you are giving the news.

The next questions to ask are kind of bunched together. Is if the bad news is based on your own judgement or opinion? Are the reasons for the bad news complicated or are they simple? IS the news serious or are you in an important relationship with the person? Then you have to tell them face to face. That shows more empathy and shows that you are invested in the situation, not just a bearer of words.

These are all great suggestions, but none of them are foolproof. Despite best efforts, the doctor patient communication relationship has taken on a whole new level of strain in the last decade. I have noticed lately that patient empowerment is all the rage in the United States. We have pushed aside the old patriarchy of yore where doctors decided and patients complied. Now all patients want equal partnership, if not complete charge, of making decisions for their healthcare. With the invention of electronic medical records, MyChart, and FollowMyHealth and the like, patients even get their results way before I do. I am in favor of this to an extent. I want patients to be involved in their care, but this thinking has extended too far into more of a patient as a consumer, doctor as a supplier relationship. I am not a supplier in a store that patients can go into and dictate what they want and I charge them a price. That is not how it should work. The Wall Street Journal describes a new business model of medicine which requires a new mantra: The customer is always right. But just as doctors playing God won’t fill the bill, neither will patients playing doctor. Dr. Steven Hatch, author of Snowball in a Blizzard” adds that our healthcare system can champion patient autonomy and facilitate more humane treatment and better care by telling patients our real secret. We just can’t offer the kind of confident predictions that patients expect of us. We go on data, science, predictions, experience. There is power and limitations in simultaneously in everything we do and recommend. We need to find some kind of middle ground. I hope we get there someday.

Dr. Katz