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Views And Reviews

Breaking good news: an essential skill for avoiding too much medicine?

BMJ 2018; 362 doi: (Published 11 September 2018) Cite this as: BMJ 2018;362:k3843
  1. Avril Danczak, GP
  1. Manchester, UK
  1. avril.danczak{at}

Breaking good news might be even more difficult than breaking bad news, but there is far less attention paid to learning this important skill

“Unfortunately, your ultrasound scan is normal.”

Watching a trainee’s video consultation, I speculated about his next steps—my fears were realised.

“So, we still don’t know what’s wrong with you. This means I need to refer you to a specialist and get some more tests done in the meantime.”

This negative view, of a result that is actually good news, was confusing and frustrating for both doctor and patient. The patient had mild, colicky abdominal pains, which had reduced in intensity, without other symptoms. Physical examination was normal. The purpose of the scan was unclear and the result, although predictable, did not help the situation. Yet, the referral and investigations came up with no answers either. A diagnosis of irritable bowel syndrome was given, which worried the patient, although her symptoms had resolved before she went to the clinic. Excessive investigation and referral drives a lot …

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