Bioethics Discussion Blog: Telling Bad News and Not Walking the Walk

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Thursday, March 22, 2007

Telling Bad News and Not Walking the Walk

Not Walking the Walk

By Maurice Bernstein, M.D.

The doctor
Sits there looking into your eyes
He has told you
The bad news.

It came out swiftly
He told bad news to many, but
He wonders
How will you respond?

The doctor
Has never been told the same bad news
He wonders
How will he understand?

I have discussed the need for the physician to have empathy with the patient’s story. Empathy requires that the physician have had some similar experience in life so that there is a true understanding of the patient’s burden. That means that the physician has walked the walk. Patients, I think, can sense when the physician is simply only talking the talk. The talk becomes generic and may gloss over the very concerns that the patient has developed in response to the news. What should a physician do who has to tell the patient the bad news without personally having experienced a similar burden? After the physician tells the patient bad news, what should the patient expect next? What has been your experience with a physician telling you or your loved one the bad news? ..Maurice.

3 Comments:

At Friday, March 23, 2007 11:48:00 AM, Anonymous Moof said...

That's a tough one. We can't expect our physicians to have experienced every manner of illness or loss themselves ... however, I do believe that, warranted or not, realistic or not, all patients hope for empathy.

A simple admission may be all that's necessary ... "I can't imagine what this news must mean to you ..." ... perhaps followed with a question, like "Tell me how this is making you feel" ...

Too many physicians only treat half of the patient, sad as it is. Certainly, a lack of empathy (not having experienced it themselves) and a certain amount of "bad news fatigue" or "numbness" - ("I'm sick of having to tell people this sort of news") - contribute to a reticence to becoming too empathetic.

And really, if they're going to be effective, they need to not become too "empathetic."

This reminds me of something I just read elsewhere. See this post on Dr. Emer's blog: How Doctors Should Think ...

 
At Friday, March 23, 2007 1:33:00 PM, Blogger Maurice Bernstein, M.D. said...

Moof, I went to Dr. Emer's blog and read the posting. There is no doubt that the way doctors think is the essential function in the making of a diagnosis and proper treatment. Itis important that we see to it that the way doctors think is done in the best and most productive way. Coincidentally, on this very topic, in a couple of weeks I am going to help facilitate a 7 week course for 2nd year medical students who next semester will be going on to their clerkships on the medical or surgical wards at the teaching hospital. The course, called "Integrated Cases" has the goal of helping the students learn how doctors should think as they workup their patients. I think I will discuss the issue of how doctors think and what goes into productive and effective thinking on a separate thread.

In this present post, my aim was to try again to emphasize that beyond "thinking out the problem", it was important to consider how doctors should "feel". Because how a doctor "feels" about the patient's symptoms can affect not only how bad news can be delivered in the most supportive way but also the feelings about the patient and the patient's story has much to do with the thinking out of the problem. For example, the doctor's feelings may affect how the doctor gives attention and how the doctors listens to the patient and how much weight the doctor will give to the individual symptoms. So feeling is important. But also is the process of thinking the problem out.

As far as being "too empathetic" Moof, I doubt that will happen if we keep the current criteria for empathy. Since "too empathetic" actually becomes "sympathetic" and it is being "too sympathetic" that can lead to poor thinking and poor decision-making. ..Maurice.

 
At Friday, March 23, 2007 3:48:00 PM, Anonymous Anonymous said...

I don't really agree with the concept that "no one can possibly understand what I'm going through unless they've walked in my shoes."

While it's true the physician might not viscerally understand what it's like, for instance, to be someone with cancer, he/she can learn a lot by simply listening with an open mind to the patients themselves.

I'm on a cancer message board, and I think it would be educational for physicians to lurk from time to time. We discuss it all - the good, the bad and the ugly. People know they'll be listened to and that they won't be judged for being fearful or angry or frustrated or however they happen to feel.

Empathy isn't a white coat you put on when the occasion calls for it. It's something you gain over time, by forming a relationship with your patients, listening to their stories and respecting their experiences.

 

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