A feeling of deep sympathy and sorrow for another who is stricken by misfortune, accompanied by a strong desire to alleviate the suffering.
Compassion Corner is a series from Patient Worthy that will focus on the subject of compassion in the healthcare and rare disease space. In this series, we explore the role of compassion in this field and what it means for caregivers, patients, and others.
One of the most difficult aspects of a doctor’s practice is delivering a poor prognosis. A 2018 study conducted in Poland sought to understand the perspectives of patients after receiving bad news from their healthcare professionals.
The patients were asked about the way in which the news was delivered. The interviewers also inquired about the attitude of the clinician who diagnosed the illness. The challenge to the physician is to deliver the bad news in an appropriate manner.
The doctor’s method of communication can have a significant impact on the way patients perceive their illness and even if they wish to continue medical treatment.
According to previous studies, a direct correlation exists between a doctor’s skill in communication and therapeutic results.
Basic rules to build a doctor/patient relationship and establish trust in their doctor may include:
- Addressing the patient with empathy
- Being clear in the use of medical terms.
- From the doctor’s perspective, it prevents work burnout
The researchers found a distinct correlation between the attitude of the physicians and the number of patients who left their doctors.
A Reciprocal Approach
Recently we have seen a gradual increase in conflicts (lawsuits) among patients and doctors. We have also seen an increase in agitation on the part of doctors. Evidence points to poor communication and work overload as the cause of these conflicts.
About the Study
The study was conducted in Poland where its Medical Ethics Code (article 17) cautions doctors to issue a poor prognosis with “care and tact.”
The study took place between February and October 2017 using a web interview technique and a customized questionnaire. Most of the 314 participants received their negative prognosis in hospitals. The patients, who remain anonymous, were randomly chosen. Their involvement in the study was voluntary.
Seventy-nine percent of the group were women with fifty-nine percent listed as highly educated. Patients with a variety of diseases were included in the questionnaire.
Forty-nine percent of patients remained with their doctors after receiving a poor prognosis while forty-five percent changed doctors after receiving the bad news.
Further, forty-seven percent of patients surveyed agreed that the doctors conducted themselves in a proper manner. On the other hand, thirty-three percent of patients declared that the doctors violated their ethical obligation and acted without proper care when delivering bad news.
The Time Element
It is critical that patients feel they are being given adequate time for such an important visit by their doctor. Forty-two percent of patients felt the doctor did not spend sufficient time discussing their poor prognosis. The opposite was noted by thirty-seven percent of other respondents.
The researchers’ earlier studies indicate that there are two critical factors that increase a doctor’s stress when delivering bad news to patients. The first is an education gap regarding soft skills.
The second factor can be termed as paternalistic, such as showing concern but not involving the patient directly.
Many respondents said that information about future diagnostic tests and prognosis were subjects covered most often by doctors. A lesser number of patients felt they were not given sufficient information about treatment options.
The researchers intend to use the results of their study as a way to identify the training needs of current and future physicians. They hope to use the information provided to them by the questionnaires in educational material for the benefit of patients and physicians.