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You may feel more comfortable by first finding out what the patient knows about his or her condition. You might ask questions such as, “Have you been worried about your illness or symptoms?”
Next, you might spend a few moments finding out how much the patient really wants to know. Depending on their cultural background, personal history, or medical status, people may have different expectations and preferences for what they should be told. You might ask the patient if he or she wants to hear the prognosis, for example, or would prefer not to know.
If a patient’s family has reservations about having the patient know the prognosis, you might ask them about their concerns. Legally, of course, you are obligated to tell the patient; however, you may negotiate some elements with the family. If you cannot resolve it, an ethics consultation may be helpful.
When you are ready to share the bad news, try to be as straightforward as possible, without speaking in a monotone or delivering a monologue.
Be positive, but avoid the natural temptation to minimize the seriousness of the diagnosis. Communications experts suggest that you not start by saying,
“I’m sorry . . .” Instead, try saying, “I feel bad to have to tell you . . .” After you have explained the bad news, you can express genuine sadness while reassuring the patient that you and others will be there to help.
Of course, people will respond differently to bad news; shock, anger, sorrow, despair, denial, blame, disbelief, and guilt all are common reactions. In some cases, people may simply have to leave the office. Try to give the patient and family time—and privacy—to react.
A good way to end this visit is to establish a plan for next steps. This may include gathering more information, ordering more tests, or preparing advance directives. Reassure the patient and family that you are not going to abandon them, regardless of referrals to other health care providers. Let them know how they can reach you—and be sure to respond when they call.
In follow-up appointments or conversations, give the patient an opportunity to talk again about the situation. Ask if he or she has more questions or needs help talking with family members or others about the diagnosis. Assess the patient’s level of emotional distress and consider a referral to a mental health provider.
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The Language of Bad News: Phrases That Help
These phrases can help you to be straightforward, yet compassionate: