Speaking clearly, showing your emotions, saying “I don’t
know...”
Students in the surgery clerkship learn some techniques for
talking with patients and their families when the story may
not have a happy ending
There are several steps and techniques that surgeon Lisa Colletti,
M.D., provides her students in teaching them how to break bad
news to patients and their families. This is the first year
the exercise has been made part of students' surgery clerkships.
preparation
- Know the medical and personal details of the patient.
- Have all of the relevant information available.
- Prepare yourself for what you will say.
- Have a nurse present, if necessary.
- If possible, the person delivering the bad news should have
had atleast some prior contact with the patient.
- Assess/ask who the patient would like to have with them.
- Have other relatives or friends available, if appropriate.
introduction
- Introduce yourself properly.
- Spend a few minutes establishing rapport.
- Ask for information from the patient to assess their knowledge
of the situation.
achieving understanding
- Speak clearly and use non-medical terminology.
- Write down any technical terms, if necessary.
- Find out what the patient's views are.
- Assess the patient's understanding of the situation/diagnosis
just given.
pacing and shared control
- Allow pauses; silences can be appropriate and useful.
- Try to lead the patient to the diagnosis.
- Let the patient take some of the lead; involve him or her
in the management decisions.
- Allow the patient to ask questions.
responding to emotions
- Touch the patient, if appropriate.
- Reassure the patient that it's OK to cry or express emotion.
- Maintain eye contact. Be aware of non-verbal cues; try to
use appropriate body language.
- Show your emotion. Express sympathy, compassion.
- Listen to the patient. Allow him or her to express emotions,
fears, etc.
honesty
- Offer both the worst and best scenarios.
- If appropriate, leave the patient with some hope.
- Take responsibility for mistakes.
- Do not be afraid to say things like "sorry" or
"I don't know." It is more useful to be honest when
the situation is not clear or the possible outcomes are not
known.
support
- Highlight any positive things, e.g., pain relief.
- Offer your continued support and advice.
- Have a plan for the future (if possible).
- Ask about available support systems to the patient.
closure
- Summarize at the end of the discussion.
- Finish with any positive issues, if possible.
- Close the discussion by inviting questions.
- Don't leave the patient alone at the end of the discussion.
Make sure the patient has arrangements to go home and/or support
of family or friends available to them.
- Set a time and date for the next meeting. Make sure to give
the patient a phone number for reaching you.
Source: "Breaking Bad News" Simulated Patient Instructor
Interview, Department of Surgery, U-M Medical School
Also:
The Ethics
of the Unwelcome: Teaching about End-of-Life Issues
Integrating
ethics into residency programs: Michigan helps lead the way
Experimental
treatments and hospice care: a new "best of both worlds"
opportunity for the terminally ill
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