Delivering bad news is a part of medicine. It has been something that I have had to witness as a medical student and now take a part in as a resident physician. Meeting with families to discuss goals of care or delivering a poor prognosis over the phone to those who cannot visit their loved ones. Quite recently we were given a lecture regarding how to deliver bad news to our patients and their families which I thought was helpful.
One of the best ways to start the conversation is by setting the space. For example, if appropriate, in a quiet room where everyone can sit together and discuss. If it has to be over technology making sure that all connections are adequately working and everyone who would like to participate is available.
The next step is to make sure everyone has the same level of understanding regarding what is currently going on with the patient. For example, asking everyone to explain how up-to-date they are with the patient’s condition and how their view the prognosis. During this stage of the conversation and just generally it should be noted that using language that everyone is familiar with can allow for everyone to connect on the same level of understanding. I generally avoid using too many medical terms or rather breaking down concepts either visually or verbally for everyone in the room.
Lastly, it is important to have the help of a palliative care team who can help provide the support that patients and their families need. They are full of resources and are able to provide the support that is exactly the level of compassionate care that any family needs. I have also had the privilege of being a part of many meetings led by our palliative team that has helped me tremendously when delivering bad news.
There is much more to this topic and I have just brushed the surface, but given that I have had to deliver sad news quite often during my intensive care unit rotation in the context of the pandemic, I thought it was appropriate to share what I have learned with you all.