While medical students may go into the profession dwelling on the lives they can save, the inevitable fact of the profession is that there will be times when they have to deliver very bad news.
Steven Pantilat, MD, a professor of Medicine at the University of California knows all too well about delivering bad news to patients. He is the inaugural chief at the University’s palliative medicine division and an innovator in the field and says that he has probably given “really bad news” to thousands of patients over the years.
How a physician communicates to a patient a life-altering prognosis or diagnosis can have a serious effect on how the patient views their situation. There is an art form to delivering bad news and Dr. Pantilat gave a presentation at TEDMED 2018 about it. TEDMED is a health and medical version of the famous TED Talks that takes place once a year.
Dr. Pantilat compares a patient receiving bad news to a passenger being in a plane that suddenly takes a nose dive.
The physician has a lot of power however; to inform the “passenger” that even though it seems like they are going to die, there are a lot of steps and things they can do to get the plane leveled out and flying again.
In his recent talk, Dr. Pantilat gave four specific tips to help medical students and residents be able to deliver bad news in the best possible way.
Tip #1: First, a physician has to understand the seriousness of the news they are delivering.
Especially recognizing what a patient may perceive as bad news, like being asked to retake a test. An an example, a woman being asked to do another mammogram may be bad news to her. Sometimes physicians may not realize how worrying this request might be and are not prepared for the patient’s response.
Tip #2: Prepare the patient for the news that you are about to deliver.
A good tip for delivering bad news is to start with a sympathetic line or phrase. Dr. Pantilat recommends starting a delivery of bad news with, “I’m sorry to have to tell you this but [You have cancer],” for example. And Pause. Many times, physicians want to rush into what can be done or to fill the uncomfortable silence after presenting bad news, but many times after a patient has received devastating news they are too shocked to even hear what is being said next.
Even telling a patient what you are looking for when ordering a test and what it could mean if it comes back positive beforehand can prepare the patient way in advance for potential bad news.
Tip #3: Have a plan
When Dr. Pantilat used to work in primary care, he first started seriously reflecting on how to deliver bad news to patients during the AIDS crisis when he would often do HIV tests.
A physician should be able to support patients facing a scary diagnosis and help them understand what their next steps are. They have to provide the plan of action after a diagnosis.
Tip #4: Be honest
After receiving bad news, one of the main questions patients often ask is, “Am I going to die?”
Dr. Pantilat stresses the importance of not lying to patients. After some diagnosis, physicians may not know if the condition is terminal or not; on the other hand, with other terminal illnesses, like with ALS for example, the eventual outcome is known.
Dr. Pantilat says he keeps it honest with his patients but even if they are going to die, he tries to keep the focus on what can be done now. He may offer realistic support by saying something like, “We’re going to do everything we can to help treat this illness and see how it goes.” A physician never wants to give false reassurance.
Read the original article here.
