Delivering “Bad News”

 At some time or another, a physician will have to deliver “bad news” to a patient, to family members, and loved ones. It is never easy. However, there are some steps you can take as a physician to lessen the blow.

  1. Prepare yourself to feel badly. Remember that when you deliver “bad news,” the people hearing it will feel worse afterwards. Feeling worse is a normal reaction and is a normal part of the grieving process. Feeling bad needs to happen so do not try to diminish it.
  2. Give the recipient time to prepare. Reviewing the situation provides time and sets the context for your news. Allowing a person to prepare helps with acceptance and may reduce the pain, if only a little.
  3. Be clear and unequivocal. It is always best to say, “You have cancer, “ rather than, “you have a tumor.” Being direct does not allow the patient to wonder or misinterpret what you are saying. It also keeps the persons from having thoughts of denial. But you also have to be gentle with you words and tone.
  4. Pause. Give the person, family, and loved ones time to react. Some may cry, some will get angry, and some will refuse to believe what you have told them. Do not address their reactions At this point your responsibility is to allow their feelings; you cannot change them. Be present as a way to express your understanding and concern.
  5. Ask for questions. If questions do arise, answer them honestly and concisely.
  6. Always provide hope. Even in the worst of situations, hope is vital to maintain a quality of life and to prevent despair. Even though a situation may appear hopeless, patients always fall into one of two categories, those who survive and those who do not. No one can accurately predict which category a patient will fall into.
  7. Express your commitment of support. Always let the patient, their family, and loved ones know they can count on you for support. Support comes in many forms - listening to their concerns, answering their questions, and making the patient as comfortable as possible by relieving pain and suffering.
  8. Give a plan. Tell the patient, family, and loved ones to:
  • Write down questions. Many times the shock of “bad news” causes people to forget their questions. Tell them you will address them at the next scheduled visit or that you will telephone them in the next few days.
  • Tell their family and loved ones. Keeping “bad news” from family and loved ones is not wise. People may harbor resentment for not being able to express their support and it prevents damaged or strained relationships the chance to heal.
  • Prepare for the next steps. Next steps could be further tests, treatment or both. This can be a very trying time for the patient, the family, and loved ones. Discussing the next steps can be beneficial for gathering support, which will be crucial to maintain hope and the quality of life.

9.   Provide care with compassion. This is the most important action you can do. Not being afraid to show you care is extremely comforting to the patient, family, and loved ones. Each of the previous steps demonstrates in a tangible way that you care and are concerned with the well being of all of those involved. I am certain that the world would be a much better place with a little more care and compassion. Why not give a good example? Most importantly, pray for help and guidance.

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