Imagine that you’ve just been told, “You have cancer.”
While you imagine the feeling of devastation, numbness or overwhelming fear those three words hold, you’ve likely never pictured the emotional impact the delivery of diagnosis has on the person saying them.
For the medical professional, there is a lot of preparation that goes into the way you deliver a life-changing diagnosis.
First, the medical team discusses how to break the news. Then, the lead physician sets aside enough time to meet with you and your loved one in a quiet area. He asks what you both understand about the situation and if you would prefer more or fewer details. He says the words with empathetic context and leaves long pauses, waiting for you to break the silence. And he takes ample time to explain and confirms that you understand.
He says, “I know this is a lot of information. I want you to know that we have staff available to help you through this, and they are ready to meet with you afterward. Is there anything I can do for you right now?”
Why delivery methods matter
When bad news is conveyed, it should be done intentionally and not hurriedly.
While this methodology of delivering bad news should be the standard, it’s not necessarily so in hospitals around the country. Some people don’t naturally have the skills or the appropriate words to deliver bad news, and they may jump in blindly. When bad news is conveyed, it should be done intentionally and not hurriedly.
After receiving difficult news, patients may not hear anything else. When patients go silent, they’re trying to process the information. Often, though, people try to fill that silence to ease their own anxiety. As physicians, we’re discovering that it’s important to learn to be comfortable with such silence, and give people time to truly process the information.
This topic isn’t new — in 2013 The Atlantic shed light on the same issue — but we’re finding that it needs more research to chisel out solutions.
Clinical empathy was once dismissively known as “good bedside manner” and regarded as far less important than technical acumen.
Via The Atlantic
Recently, we surveyed a group of surgery residents and faculty at Baylor University Medical Center at Dallas about this. While 93 percent of surgeons said that “delivering bad news” is an important skill, only 43 percent said they had received the training to learn it. To us, this means an opportunity to improve the way bad news is given — both at Baylor Scott & White Health and beyond.
So we developed a improvisation program to train doctors on delivering bad news with patience, empathy and understanding. We created fictional scenarios, gave actors background about their medical histories, recorded the interactions and then replayed them to the residents with feedback. We then went through the exercise again for improvement and practice.
The future of “bad news training”
For now, the program is still being piloted within Baylor University Medical Center’s department of surgery, but the hope is to expand the program across the hospital, pending grant funding. And while we intend for our future research to improve the way physicians deliver bad news, the missing puzzle piece is within medical school, before residency. A more formalized curriculum — something more experiential and interactive — could impact the way future physicians are taught to break bad news with grace, patience and understanding.
Baylor Scott & White Medical Center – Round Rock has implemented similar professional training that teaches physicians how to express empathy. The class, called Communicating for Outcomes, dedicates an entire section to the topic.
“As technicians and scientists, we often get caught up in our head in trying to ‘fix’ the medical problem in front of us and assume the patient knows that we really do care — that we really are sad they’re hurting and we really do want to partner with them to improve their health,” said Tiffany Berry, MD, Baylor Scott & White chief patient experience officer in the Central Texas region. “The reality is that if we don’t say those things, they don’t know it.”
Of course, bad news is hard to give and hard to hear. But with empathy and better training, we can help patients navigate the tough times—and tough words—together.
I was recently interviewed by the Orlando Sentinel about this topic. Read more here.