Breaking bad news

Nothing tests our communication skills so much as breaking bad news. Such conversations can be extremely emotional for both doctor and patient. The right words said in the right way make a huge difference. Here are some tips:

• Always read the patient's clinical notes, the test results, in detail. Make a mental note of the patient's resuscitation status and past communications

• Speak to the nurse in charge of the patient and ask him or her to be present during the conversation

• Ensure privacy; try handing your bleep over to someone else

• Arranging the conversation in advance generally gives a better outcome. Ensure that appropriate family members or carers are present

• Introduce yourself. Asking questions—such as “What do you understand about your problems so far?”—will give you clues to the patient's ideas, concerns, and expectations

• Avoid jargon. Give information slowly and clearly, making sure that the patient has time to understand

• The crucial point in the conversation is the “bad news” itself. The way you phrase this depends on how the patient has responded so far in the conversation. Most will have an idea as to what's coming next. Explain the situation in a simple, unambiguous way and let the information sink in

• Discuss further options (therapeutic or palliative) and make a plan for the future. Remember to give hope. Information leaflets, Macmillan services, support groups, etc, play a vital role

• In concluding the conversation, ensure that everyone has understood the diagnosis, and the plan. Your job is not complete until you document everything in the patient's notes and fill out the necessary referrals

• Watching and learning from seniors handling these situations helps immensely. Ask for feedback from nurses.

University Hospital of North Tees, Stockton

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