Telling Bad News: Should the Doctor "Say It Flat Out"?
In my previous blog threads, the issue of a physician telling the patient "bad news" has been rather fully discussed (see links below to those threads). It always was and always will be a challenge for any physician to communicate this diagnosis since often the doctor doesn't know how much and how quickly the patient can understand and accept the information. It also means that the doctor has to find the right words to be informative, supportive and yet empathetic to what the patient may be about to experience. In the attached video clip from the John Wayne movie "The Shootist", the doctor played by James Stewart finds this challenge as he must tell the "bad news" word to John Wayne who comes for a consultation. The confrontation of the news by both parties is beautifully played out in this segment of this movie, which, by the way, has been an educational worthy segment for medical students to review. It shows how the patient helped the doctor with the doctor's first challenge with the words "say it flat out". What the doctor should say after the diagnosis is revealed is the second challenge in doctor-patient communication. If you were the patient, would you be a John Wayne and have your doctor "say it flat out"? ..Maurice.
Previous "Telling Bad News" blog thread links:
Video Clip: Downloaded from Turner Classic Movies website.
posted by Maurice Bernstein, M.D. @ 10:47:00 PM
3 comments
3 Comments:
Personally, I would like the truth. Is it harder for the doctor, or for the patient, to tell bad news? The truth will come out anyway, in how one feels, especially if it is cancer. I would want to know how long I have to live, even if days, so I can spend quality time as I choose. That said, many people can't take bad news, and it may cause such anguish, it leads to suicide, or being so depressed they won't follow up with treatment. Each individual is different, and a good doctor will gauge what is the best approach to take on that basis.
Kim, if you mean is it harder for the doctor to tell bad news than the patient to accept the bad news, I always consider it will be harder for the patient to accept. After all, it is the doctor who will be moving on in his or her life but it is the patient who must personally deal with that news and the "moving on" may not be readily apparent to the patient.
Therefore, what the doctor says and does after providing the patient with the bad news may be more important to the patient's well-being than how the news is delivered.
I would be interested in reading from my visitors who have been given bad news how they appraised their doctor's followup words and deeds. ..Maurice.
Kim wrote the following, posted on the copy of my blog on Medpedia and I am reproducing it here with my response. Kim wrote:
\I put an article in my Medpedia Lymphoma and Chronic Lymphocytic Leukemia patient communities about grief and loss Oncologists may feel, with the death of cancer patients. If that feeling is there after a patient's death, perhaps it will be present at the time of having to tell "bad news". If the bad news leads to a shortened life of the patient, perhaps this will affect ability or desire for giving bad news. I wonder if this also occurs in other medical specialties? What if surgery is a failure, and a surgeon must tell the patient this? Do doctors move on, as if they are mechanics? I suppose the medical training is supposed to deal with "feelings".
My response is that doctors are trained to deal with and try to understand the feelings of their patients but how they deal with their own feelings is a different matter. Yes, the doctor does have to "move on" but moving on doesn't mean that the doctor's experience is forever forgotten. ..Maurice.
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