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Communicating Bad News

Author: delhiwal, Posted on Tuesday, July 13 @ 16:37:37 IST by RxPG  

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PLAB Part 2

Many medical students and residents dread the prospect of having to give patients and their family members bad news. In order to protect themselves from the anticipated reaction, many will therefore distance themselves from the situation, leaving the families to cope on their own and depriving them of support just when that support is most needed. But if you learn how to communicate unwelcome news to your patients, it can bring you closer to them. Here are some suggestions to help you communicate more effectively in these stressful situations:

1. Ask how much patients prefer to know about their conditions before results are known. A good opener may be to inquire into their fears about "worst case scenarios" in order to gain insight into what they fear most and how they would want to be treated if the worst possible outcome was to happen.

2. Ask other staff about the situation if you are new to that service. Nurses, the attending physician, or the family doctor can provide background and help you deal with patients in the manner in which they prefer.

3. Take it slowly. Provide information in small amounts, watching to see how it is received and waiting for patients to digest one piece before moving on to the next.

4. Choose the place and the time. Hallways are not private enough and are noisy, and visiting hours may not be the best moments to convey bad news to either patients or to their family members.

5. Honor the basics of good communication. Eye contact, body posture—these can non-verbally convey either "I'm here for you" or "I'm just the messenger" attitudes.

6. Avoid saying that you know how your patients are feeling, which is unlikely to be believed and therefore resented. But do state the situation accurately. Minimizing the seriousness of the situation only delays the inevitable, when they learn and deal with the realities of the situation. Allowing some silent time is often helpful, giving patients or family members the chance to grasp what they have just heard.

7. Encourage patients to express their fears. This helps them begin the process of adjusting to what must be faced and shows sympathy more than just saying that you are sympathetic.

8. Inform patients and family members about services that may be available to help them through what's ahead.

9. Leave some room for hope. Nothing is one hundred percent certain and each patient's illness is experienced uniquely. Quality of life may be a topic to raise, as many treatments can maximize this even when prolonging life is unlikely.

10. Summarize before leaving to make sure that the key aspects of the situation have been heard.

11. Remain available. Patients may have more questions after they have had some time to digest the news. Tell them that you will be happy to speak with them further when they feel ready to do so.

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