Many people think doctors are coldhearted and curt. While there may be some that fit the criteria, the majority of physicians truly care about helping others and the lives entrusted to our hands. While we try to save and lengthen lives, sometimes this simply is not possible. One of the hardest tasks that a clinician must do, for many of is, is giving patients bad news.
It amazes me that patients are so varied in their response to this information. Some of them quite expected it and are fully prepared to face the outcome. Others are so shocked that they disbelieve the data. Some may stand steadfast in the face of the worst while others break down on great anguish. There is no wrong or right response and no way to predict how a patient will respond. The best start is to know that delivering bad news to a patient is going to change their life. They will have schedules to change and plans to make. They will be uncertain how they will tell their loved ones. We need to be open to any response and not minimize it. Not all people can be strong and to tell them to do so may trivialize what they are experiencing.
How to give bad news:
- Be empathetic: Patients need our empathy in all circumstances, not just when they are facing bad outcomes. However, they are in need of a higher dose of it when facing difficult medical circumstances.
- Be honest: Some doctors like to minimize the truth. While, it may be easier for them, the patients deserve the full and complete truth, no matter how bad it is. If they are getting worse, tell them. We cannot save everyone and those who are facing death should know so that they can make preparations, whatever that may be.
- Be simple: Explaining test results sometimes can be difficult. I find myself occasionally falling into medical terminology that others may not know. Make sure the patients understand what you have explained or disclosed. Give them websites that they can glean more information after they go home. They are often shocked and unable to listen to everything you tell them.
- Let them ask questions: Make sure you answer them. They should be fully apprised of their medical situation. If they don't ask any questions on their own, ask them if they have any.
- Listen: A patient's concern may not be the same as yours. A patient may be more concerned about their hair falling out from chemotherapy than their distant metastases. If you listen, you will know what they are most concerned about and this should be addressed. Let them express their emotions.
- Don't trivialize them: People often tell others just stay strong or have stronger patients. Well, those words may be easy to say when you are not the one suffering. If you spend any time on social media, you will witness a whole array of pithy sayings being circulated on how to handle suffering. Don't be one of them. You are a doctor, not a source for inspirational quotes.
- Be supportive: Patients need to know you are there for them. You are not there to tell them what to do. You are there to guide them and help make decisions. You may not like or agree with their decisions, but it is theirs to make.
Watching the movies, it seems like doctors are often telling patients they have "six months to live," but this is far from the truth. Most often, we simply do not know how long a patient will live. And any doctor that has practiced for any length of time will share stories of patients whose survival has amazed us. No matter how bad the news, we need to give our patients some hope. And, we must not dash the hope our patients hold within themselves.