Doctors are healers. We want to deliver good news.
“That worrisome PSA test was a false positive.”
“Your breast biopsy was negative.”
“You are responding to the treatment.”
You get to share high-fives with your patient. That’s one of the reasons you went into medicine.
But biology doesn’t always cooperate. You may have given it your all, and all that’s left is bad news.
Still, there’s more “doctoring to be done.”
Maya Angelou once said: “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”
Sometimes it’s not what you say. It’s how you say it.
Your tone. Body language. How much time you give the patient—and their family—to process bad news. Can you still offer hope in the face of bad news? Even if the 5-year survival rate is 3%, not everyone perishes within that window. There are outliers.
What do you do if the patient cries? Is it OK for you to express emotion? Even share a tear? Hug your patient?
I don’t remember learning any of this in medical school. Or residency. But I have observed some are better at these discussions than others. I also believe these skills can be taught and learned.
A shout out to Dr. Tony Orsini, whose organization, The Orsini Way, teaches doctors how to deliver bad news. We did a two-part podcast series with him in the not-too-distant past.
If you get better at delivering bad news, it will still be painful to utter the words. But you would have discharged your duty with grace. And the patient and their family will remember your compassion during the worst moments of their life.
Delivering bad news in the proper way will minimize a lot of lawsuits.
We do teach the art of communicating with patients in med school or residency or even in all of the hundreds of academic conferences I have been to over the years.
It should be taught in medical school, just the way that business communication is taught as a course in business school.
Bad news over the phone, NO.
Bad news over email or text, NO.
Bad news in person always.
Sit with the patient and family.
If they have not seen a horrendous xray, pull up the film and show them.
A picture is worth 1000 words.
Like a whited out lung from tumor in a 5 pack a day smoker.
Or a back pain patient that has metastatic bone disease.
Show the family the picture.
Reassure them!
And never ever tell family that the patient has two weeks or 6 months to live.
I’ve seem patients have miraculous recoveries, so that the patient outlived the doctor.
Never tell the patient or family bad news and just walk out.
Sit down. This is the time to slow down the clock and act like a human being with compassion, and feelings and spend time with them.
Tell them you will help refer them or come up with a plan of how to battle this.
Most patients don’t want to just give up.
They want to live, they will get prepared to fight.
Thank you, Jeff, for discussing this critically important topic in your newsletter.
Breaking bad news is a skill that can—and should—be learned. Studies show that when these conversations are handled poorly, the emotional impact on patients and families can last for decades. Research also demonstrates that physicians who deliver bad news with compassion are less likely to face malpractice litigation.
Using our unique Breaking Bad News PROGRAM – The Orsini Way has trained thousands of clinicians to navigate difficult conversations and deliver life-altering news in the most effective, compassionate, and human way possible.
Many medical schools say they teach this skill, but it is often limited to a brief simulation or short lecture—simply not enough preparation for conversations that can permanently change a person’s life.
Communication is not a soft skill in healthcare. It is a clinical skill.