-----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”