Breaking Bad News
- Junior doctors often find breaking bad news to patients and/or relatives very daunting, however we are often far more anxious about these discussions that the patient is!
- Remember, usually our news will not be unexpected and often it is a relief to patients and families to have an honest discussion with a doctor about their illness.
- The following is a broad overview giving some practical advice for approaching these discussions.
- Prepare yourself
- Are you feeling hungry, tired, stressed? Is there anything you could do to make yourself more comfortable? Do you have all the information you need: e.g. background, diagnosis, prognosis? Remember you don’t need to have all the answers, just enough information to explain things clearly.
- Prepare the patient/relatives
- If possible ask them to bring someone with them to the meeting. This can act as an initial warning shot before you even meet.
- Gain consent
- If you are speaking to relatives, always seek consent from the patient first.
- Prepare the environment
- A quiet room where possible and you should ideally be sitting where you can see everyone. Do you need anything else with you ( notes/scans etc.)
- Ensure that you have told someone where you are and what you are doing and if possible get someone to hold your bleep to avoid being disturbed.
- Introduce yourself and find out who everyone is
- Start by asking them what they understand about what has happened up until now. Building a rapport is incredibly helpful.
- Introduce the concept of bad news gently and let things settle a little bit before moving on. This is referred to a the ‘warning shot’.
- e.g. ‘I have asked to meet you today as the results are back and sadly it isn’t good news…’
- Use simple language to explain things, avoid jargon and try not to waffle.
- Be honest and straightforward, explaining what the news may mean for the patient or their loved one.
- If you are giving a prognosis, broad estimations can be very helpful to allow people to make plans.
- Use categories such as hours to days, days to short weeks, weeks to short months etc.
- Ask what the patient’s wishes are/might have been and if the patient is end of life remember to ask about religion and spirituality.
- Answer any questions honestly (it’s OK to say you don’t know!) and offer to speak to other family members later if they want you to.
- Explain that it can sometimes be difficult to take everything in at once and sometimes writing things down or taking home some written information can be helpful.
- Document your conversation as soon as possible to ensure it is accurate, including who was there and what questions you were asked.
- Ensure that you follow up on the discussion e.g. if you have promised to speak to other family members do so as soon as possible.
- Make sure you are OK!
- These discussions can be very difficult at times. If you are upset then try pause, make a cup of tea and take a break. Talking to other doctors about how the discussion went and how you’re feeling can be hugely helpful.
- Consider a referral to the specialist palliative care team.
Perfect revision for medical students, finals, OSCEs and MRCP PACES
Click here to download free teaching notes on Breaking Bad News