BREAKING BAD NEWS : A Case Study

Informing someone of undesirable news is always a hurdle. It is even harder in a hospital environment involving sick patients and their attendants. Below we discuss critical scenarios and certain approaches one must adopt inorder to avoid any retaliation towards bad news.

Attendants keep on changing - Be open to speak to every new attendant - Answer their concerns - Don't Hesitate to communicate with new attendants of a sick patient - else, they might turn into your trouble makers.

The most important issue in communication is 

NOT WHAT YOU TALK.
IT IS HOW YOU TALK.

  • In every case be sure to inform patients regarding all treatment options

  • Involve them in  the decision-making process

  • Explain to them why a particular option has been chosen; which parameters might have to be monitored and as to what changes will lead to a change in decision

  • Discuss the conservative approach or attitude to surgery

It is also wise to inform your OP Attendants to allow interaction between sick patients and their attendants, whenever they come. It is important to identify patient attendants who may end up creating a problem. Develop a rapport with them; get to know their name and communicate effectively with them and put in an effort to address their concerns.

80% of patients are non-critical and non-troublesome. 20% are either critical or troublesome. Therefore, focus on that 20% and give sufficient time however busy you may be. You may have 100 patients to take care of, but from their perspective, he is the only patient & it is their only work or function to ask for care.

Studies have shown that patients who are more familiar with their doctors, create lesser issues. Patients’ expectations encompass not only the doctor but also from their staff. Therefore, train them to behave appropriately. Find a few intelligent staff or Duty doctors in order to be in constant touch with the sick patient and their attendants. Inform ICU staff or Gateman to allow slight relaxation to visit dying sick patients.

Earn the patient’s TRUST & CONFIDENCE. This will be instrumental in making their stay pleasant.

In the same way, as we blame a sick patient’s poor general condition due to his bad habit & very late presentation to the Doctor; Similarly, when some unexpected things happen patients or their attendants blame it on the deficiency of services or staff behavior. 

If they are happy with the doctor’s attitude, then they usually blame it on God or their karma. Whenever you visit any patient, do greet their attendants with a smile since we are all unaware which case could turn out to be an emergency and have an unanticipated outcome.

Most importantly, regularly update them about the patient’s condition. Be sure to tailor the bad news and explain to them every bad sign or report from time to time.

Breaking the Bad news should preferably be done by a Senior Doctor.

  • When you explain, do show the file and point out the undesirable reports and make sure to explain the events.

  • When needed, show the facts on Google or Literature and explain to them about the prognosis of that particular condition; ex: survival rates of Decompensated cirrhosis with HRS.

Do not face the mob.

  • It is wise to call in a few key attendants to a separate room. And always maintain sufficient medical staff at your side.

  • Speak softly with proper eye contact; If you bend your head down, they will assume that you have made a mistake.

Don't Minimise Severity.

  • While explaining involve staff who are attending them regularly.

Use Simple words.

  • Employ Proper Body language. 

  • Do not speak in a hurry and leave. 

  • Give them time to digest the news. Allow for sufficient pauses and let the conversation be a dialogue - not a monologue.

Advancement in Communicative Skills is the need of the hour. Only 7% of our communication is covered by words. 38% of it is the Tone of Voice and the rest 55%, Body Language.

  • Listen to attendants and give them the opportunity to speak.

  • The Patient himself being able to listen is the best way of communication.

There will be 5 stages of reaction from attendants side:

  1. Shock. Denial. Disbelief.
    Convince them by showing them the reports

  2. Blame. Anger. Aggressive
    Support them, listen to them and be calm

  3. Bargaining. Empathy.
    Try to empathize with them for what has happened and help them to accept the reality 

  4. Depression

  5. Acceptance

Don't leave them at Stage 1 or 2. Try to be with the family silently until they reach at least stage 5.

Always wear a neat apron; Only if you look like a Doctor, will they respect you as a Doctor is due.

Understand their Feelings.

Tell them that this is one of the complications that may happen at this age or with this disease or comorbidities.

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From IIM Ahmedabad,
BREAKING BAD NEWS - A Case Study with few doctors and attendants involved in mob attacks.