breaking bad news ----
TRANSCRIPT
-----BREAKING BAD NEWS-----
Dr. Shaharyar Ahmad BhattiMBBS, MCPS, DPP, MRCGP (INT’L)
“I would rather feel compassion than know the meaning of it”
Thomas Aquinas
WHAT IS A BAD NEWS?
It is any information which is likely to alter drastically a patients’ view of the future
Emotional responses to a bad news
Denial
Despair
Anger
Bargaining
Depression
Acceptance
WHY IS IT DIFFICULT?
It usually means that biomedical measures cannot help, and thus it undermines the clinicians familiar role of the healer
The clinician is upset The patient will be upset too, and can respond
unexpectedly The patient may require emotional support which may
be beyond what the clinician can give The patient may blame the clinician, and indeed there
may be an element of medical mishap to complicate matters
TELL THE PATIENT?No way????? The patients:- Usually know more than anyone has guessed May imagine things to be worse than they are Welcome clear information even about the worse news Welcome liberty to speak as they wish about their
illness and their future rather than join in a charade of deception decided be others
Differ in how much they can take at a time
HOW DO WE KNOW HOW MUCH A PATIENT WANTS TO KNOW?
Two ways:BUCKMAN (Canada)“If this condition turns out to be something serious are you the type of person
who likes to know exactly what is going on.” SANSON-FISHER (Australia)Explicit catagorisation by direct questions in succession“If you would like to know, I will tell you…..”1. What the diagnosis is?2. What the treatment will be?3. What sort of symptoms you will have?4. What examination and test will be necessary?5. What can be done for any physical discomfort or pain you may have?6. What the outcome may be?
THE INTERVIEW
OPENING
Sooner then later
Patient should have someone with him / her
Everyone introduced
The doctor explains his status and extent of his involvement
THE INTERVIEWEXPLORING Find out if anything new has happened since last meeting What does the patient know and how does he react to it? WARNING SHOT_______ very important Allow time / pause to let the warning sink in Discover how much the patients want to know Then place the facts ________ better in small chunks with pauses Be prepared to stop at any point & resume later. Plan and support Provide some positive information and hope tempered with
realism.
THE INTERVIEW
CLOSING
Recap / Summarize
Find out what the patient has understood so far
Safety net
Agree on the next appointment and for what purpose
Provide written information
Goodbye
What not to do?
Jargon and technical language
Euphemisms
Evasion
Conflicting information
Percentages and statistics
Obfuscation
“Every thing is going to be fine”