Ok what the heck does that mean? I am going to tell you what it means to me. I have had to give a lot of bad news lately. I have also had to receive a lot of bad news myself lately with all my cancer battle stuff.
Most of the news I have had to give has been heartbreaking because the scenario was scarily familiar: women who hadn’t had regular care in many years and finally made their way to me. I had to be the one to drop the verbal bomb on them about something that was probably either preventable or vastly more treatable with earlier detection and treatment that could have come with routine, regular care.
So, what is the best way to go about giving bad news? I feel like this is something that we are never really taught in a meaningful way in medical school. I have not seen any significant study proven data that describe exactly how to do it. Most of the techniques that I use have come from my own experiences as a patient and the experiences that I have with my patients.
The first thing I would like to emphasize is that you really need to put the time in to know your patient. You need to know much more than the details of their history and their diagnosis. You need to take the time to know them as a person. You need to have an appreciation of their life situation and the availability, if any, of any family or friend support. You have to at least have an idea of what they are ready to handle and digest in terms of information about their diagnosis. Not every person is the same. Not every person is ready to hear the complete blunt truth all at once. Some need to hear things in phases and parts. Some need to hear it all at once. You need to figure out which is which.
Please, do not attempt to commiserate with the patient by saying things like ” I totally know how you feel…or I completely understand what you are going through.” There is a 99 percent chance that that is not true, unless you literally have gone through the exact same thing. It almost is kind of an insult to the patient and minimizes what they are going through without you meaning to. It is much better to say something like…”Of course I can’t possibly fully understand what you are going through, but I am going to do my best to help you get through it. or…”.I know this news is hitting you very hard right now, but I want you to take a minute to take it in and let me help you figure out what direction to go next.”
It is essential to get the patient actively involved in their care. This sounds obvious, but you would be amazed at how often a patient gets almost immediately lost in the shuffle of the “team process” without actually being able to be the captain of their own team. This is absolutely crucial. This is the very first stage of empowerment for the patient that has to be initiated as soon as possible. This is the beginning of the way to help them see their way through their diagnosis. I am always puzzled at doctors that are wary of patients that are knowledgeable and want to be involved in their care. I personally feel that this is the ultimate blessing and one of the best probability indicators of success and survival. We physicians should never be unnerved by this. We as physicians need to realize that our roles are as team members and advisors with experience, never patriarchal dictators of patient care regardless of patient input.
Just some food for thought guys.
Dr. Katz
