Doctors Telling “Bad News”: But There Is More To Tell
Shrinkette links to a blog-posting by a neurologist who talks about giving “bad news”, having to tell a patient that the diagnosis is a malignant brain tumor. The author tells about what to consider when telling the “bad news”:
"You have to have some sense of your own feelings, but mostly you must be vigilant to the signs of feelings of others, the signs that someone else is either tuned in or out. If you can't explain things in nonmedical terms, you don't understand them well enough yourself and you should have come better prepared. You also must know when to quit, when to pause to let the information sink in, when to quit for now and come back later.
I've had people thank me for telling them what they were going to die of. It's uncomfortable to be in that position. I know they're thanking me for my honesty, for spending time to explain, answer their questions. But it's hard to say, "You're welcome" after being the bearer of bad news."
However, as I explained in my comment on Shrinkette’s blog, the physician must follow the “bad news” with essential “good news”. I wrote:
It is not enough to give the "bad news". It is even more important to give the "good news" too. "Good news?" "What good news?" you might ask. It's the news that some physicians fail to follow up with, telling the patient "I am going to continue to take care of you and try to make sure that your upcoming days are as comfortable as possible." The patients need the feeling that with the bad news, the doctor-patient relationship that led to this point is not over. They want to know that the doctor is not now relatively abandoning them. On the other hand, it is understandable why some physicians want to "pull back" after giving their diagnosis and prognosis. They may feel that they have not much else to offer and if they continue close contact they will only be, uncomfortably, following the course of their "failure".
So doctors should be encouraged to follow the "bad" with the "good" and render, with help as necessary, the comfort care that always should follow this kind of "bad news".
If you are a physician, what do you say after giving the "bad news"? ..Maurice.
posted by Maurice Bernstein, M.D. @ 1:13:00 PM
3 comments
3 Comments:
Great post. I liked the use of "upcoming days" as opposed to "final days" or "last few months". It states that there is a future, even if it is a shortened future. It's the sense that the patient is still alive and is still entitled to care; it gives them validation as a human being. I am not usually the one to give "bad news" but I will certainly use the principle of following the negative with the positive.
As somewhat the "originator" of this whole line of dialog, I agree with what you've said. Even with all of this, it's a strange position to be in for people said to be in the "healing arts", but of course just illustrates the breadth and many meanings of "healing."
My most common scenario of bad news has tended to be in patients with ALS, frequently as a second or third opinion. One of my principles is to never take away all hope, yet at the same time be honest and frank. And I make sure I schedule followup visits fairly soon; many have come to me feeling abandoned by their original neurologist, who didn't seem to want to schedule further visits "unless needed."
I wholeheartedly agree with you!
To feel like the rug has been pulled out from under and then to feel abandoned by your physician would be awful. That is exactly the time the physician needs to be a source of comfort and continuity.
It is comforting to know that there are doctors out there that do just that.
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