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.