Letters

Delivering bad news

BMJ 2001; 322 doi: http://dx.doi.org/10.1136/bmj.322.7290.864/a (Published 07 April 2001) Cite this as: BMJ 2001;322:864

Receiving bad news will always be unpleasant

  1. Charles Essex ([email protected]), consultant neurodevelopmental paediatrician
  1. Child Development Unit, Gulson Hospital, Coventry CV1 2HR
  2. Belfast BT9 6LP
  3. Alison Lea Medical Centre, East Kilbride G74 3BE

    EDITOR—Bad news is called bad news because it is … bad news. Most doctors are excellent communicators, but they have to give complicated, difficult, or unpleasant news to people who are anxious or frightened, or guilty or upset. The experience for patients or parents should be awful.

    The anonymous Personal View by a patient diagnosed as having a sarcoma of the hand shows several of the tensions inherent in the doctor-patient relationship, which are exacerbated under the circumstances described.1

    Firstly, there is the arousal gap. Every phrase, silence, and gesture is given a meaning by the patient far beyond its intention. The author complains about being ushered in first. Had that not happened, presumably the complaint would have been about being kept waiting. The patient found the direct eye contact and silences unnerving. The alternative might also have been criticised (”he avoided eye contact” or “he talked so I couldn't think or get a word in”).

    Secondly, the author thinks that he or she is a mind reader and the doctor should be one too. The author complains about the …

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