After having my first experience with delivering bad news, I realized just how important it is to learn the best technique and method. Of course, every patient and their reactions may be different. However, physicians are people too, and one of the hardest tasks is giving patients bad news. So I thought I would share some ways to deliver difficult information. The SPIKES method is often used, and the American Academy of Family Physicians also offer great strategies.
- Prepare. It is so important that you are familiar with relevant clinical information regarding diagnosis. Make sure there will be no interruptions and turn off your phone and/or leave your pager with a colleague. Prepare yourself emotionally.
- Be honest and simple while communicating well. Do not minimize the truth; state facts in a compassionate manner. Try to use layman’s terms when explaining information. Avoid the urge to talk to overcome your own discomfort. Proceed at the patient’s pace. Be aware that the patient will not retain much of what is said after the initial bad news. Write things down, use sketches or diagrams, and repeat key information.
- Exhibit empathy. Use touch where appropriate. It is also appropriate to say “I’m sorry” or “I don’t know.” Crying may be appropriate, but be reflective—are your tears from empathy with your patient or are they a reflection of your own personal issues?
- Listen and allow time for questions. A patient’s concerns may not be the same as yours. Listen and take note of what he or she is most concerned about.
- Be supportive and validate emotions. Inquire about what the patient’s needs are. Patients need to know you are there for them. You are not there to tell them what to do. You are there to guide them and help make decisions. Also, assure the patient you will be available. At the conclusion of each visit, summarize and make follow-up plans.
I hope this is helpful as you learn how to deliver bad news.