breaking bad news - not so bad?

Hey all,

just wondering if someone could share some tips with breaking bad news in a situation where the news may not be bad.
With breaking bad news we are encouraged to give a warning shot e.g. unfortunately the results aren't good/ im afraid I have some bad news etc etc

How do you tackle this in a situation where the news may not be bad e.g. a diagnosis of downs syndrome or disability etc without potentially offending the patient.
The only thing I can think of is 'The results may not be what you have hoped for ' but at the same no one really 'hopes' for these things as such.

Any advice with how to approach this?
.

Many thanks in advance.

Reply 1

nexttime

Original post by MedMed12

Well you don't always have to give a warning shot right. These things are suggestions, not rules to always be followed. Just start by seeing what they understand and go from there.

Spoiler

Reply 2

MedMed12

Original post by nexttime

Well you don't always have to give a warning shot right. These things are suggestions, not rules to always be followed. Just start by seeing what they understand and go from there.

Spoiler

I agree with what you're saying. Most people would find the news devastating but it was raised during a tutorial that some individuals may have friends/family members with a disability or downs syndrome for example and they do not find the diagnosis as upsetting as most people so stating 'im sorry its bad news' may be taken the wrong way. Maybe we went too deeply into it.
The reason for my example was because they tend to be more common osce stations .

Reply 3

nexttime

Original post by MedMed12

Well.. ok, but that's pretty unusual! Down's is absolutely life changing for both the person and the parents - i think treating it as something minor is very unwise!

Honestly IRL I don't like the warning shot that much. Instead I like the 'so do you know what we were looking for' and then whether or not they do you say 'yes we were looking for Down's syndrome' and that acts as the warning shot and go from there.

Reply 4

squeakysquirrel

Original post by MedMed12

Hi - I work in bowel cancer and it is my job to tell people that they have it. There is no manual that will tell you exactly what to do because every case is different.

There are courses that you can go on but they never prepare you for real life.

Before telling people I try to amass information about them ( this is not always possible) - so job, family situation, language, religion etc.

And my basic lines are: it is really good that you came today .... pause..... because we have found something that looks a bit suspicious .... pause....we have taken biopsies and will send them off to the laboratory..... do you have any symptoms.... pause.

It seems strange but you cannot talk too much and you need to pause a lot for the information to sink in.

Once it has I launch into a "what we do now". Patients need something to cling onto - so I give them timelines as to what is going to happen next. I always always always always and I cannot stress this highly enough... not to look at DR GOOGLE.

Then I tell them what they can do to help themselves - not keep things from family, eat well, exercise. They have my phone number . I could go on but it is. And I will always tell them that we will not lie - a lot of patients think we keep things from them. If it is bad I will say. You cannot give false hope, but equally you need to have them in a positive mood. Hope this helps.

Reply 5

purplefrog

Keep the language neutral

"I have some news..." - can be enough of a warning shot with a pause... no need to say "good/bad/significant/concerning news" etc.
"The tests looked at [descriptive statements e.g., patterns of DNA, markers of proteins for conditions X/Y/Z]... and we found that you have Z"... and once again, pause for a while and read the patient before deciding how then to proceed...

Reply 6

Ghotay

Original post by nexttime

Honestly IRL I don't like the warning shot that much. Instead I like the 'so do you know what we were looking for' and then whether or not they do you say 'yes we were looking for Down's syndrome' and that acts as the warning shot and go from there.

Absolutely on board with this.

You really don't need to overthink it. I think if you start with too much of a spiel at the beginning you are really just assuming how the patient will feel about the news. You are a clinician and a professional. Just take the conversation seriously, be engaged, and respond appropriately to their emotions/questions.

"Do you know what tests results you are here for today". Gauge their knowledge/expectations. Then tell them the results, and respond appropriately. If they're upset: "Sorry, this must be very difficult for you to hear" etc. But you'd do that anyway, you're not a robot.

Seriously, don't overthink it

Reply 7

Helenia

My (now) husband was diagnosed with Hodgkin's lymphoma when I was an FY1. The appointment opened with "We called you back early because I'm afraid your biopsy looks highly likely to be a lymphoma. " I was taken aback at the lack of preparation/warning shot, he (non-medic) was absolutely unbothered. It's good to do a bit of groundwork but in real practice you don't have to follow the OSCE structure rigidly.

Reply 8

nexttime

Original post by Helenia

I saw a 'So I'm glad to tell you you don't have cancer, so great news [about 3 more sentences about follow up] Ok bye'
Patient starts walking out door.
'Oh hang on wait, I got the wrong patient. You do have cancer! Silly me'.

Patient somehow still took it well.

But yeah OP, top tip: don't do that.

(edited 5 years ago)

Reply 9

Ghotay

Original post by nexttime

Although realistically there is probably no good way to manage that situation after having made that mistake. That doctor was lucky it happened with a good patient