Forums > Social Chat > Breaking bad news
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HOP Mad Doctor
13,925 posts
Location: San Francisco, CA, USA
HOP Mad Doctor
13,925 posts
Location: San Francisco, CA, USA
Posted:
So today I had a "Standardized Patient Exercise" where I got to practice telling a patient that she has cancer and is going to need a colostomy if she is to survive.
Next week I get to tell her that the surgery failed and that she is going to die.
So...have any of you had to recieve really bad news from a doctor? What tips do you guys have for me? How would you like for a doctor to inform you that you or someone you care about very much is going to die? How can I help to defend against denial?
So today I had a "Standardized Patient Exercise" where I got to practice telling a patient that she has cancer and is going to need a colostomy if she is to survive.
Next week I get to tell her that the surgery failed and that she is going to die.
So...have any of you had to recieve really bad news from a doctor? What tips do you guys have for me? How would you like for a doctor to inform you that you or someone you care about very much is going to die? How can I help to defend against denial?
-Mike
Certified Mad Doctor and HoP High Priest of Nutella
A buckuht n a hooze! -Valura
BRONZE Member
member
42 posts
Location: Santa Barbara, USA
member
42 posts
Location: Santa Barbara, USA
Posted:
The truth is all you can give. Whatever happens after you tell her, is going to happen anyways, and honey coating the words will not do anyone
good.
Denial is part of human nature. With bad news like that, I do not see how you can keep it away. Only if the person has already come to terms with death will they accept such words.
The truth is all you can give. Whatever happens after you tell her, is going to happen anyways, and honey coating the words will not do anyone
good.
Denial is part of human nature. With bad news like that, I do not see how you can keep it away. Only if the person has already come to terms with death will they accept such words.
In this world of tears, you need a sense of humor.
Climbing up my leg
141 posts
Location: England
141 posts
Location: England
Posted:
I'd want a Doctor to be straight up with me. I'm probably unlike most people and i've never been told i'm going to die, but a bit of humour wouldn't go amiss either. You've either got to laugh or cry. When my Grandma was told she was dieing of bowel cancer she looked really upset for a while but all she said to me was that every one was walking around looking miserable and serious and it made it worse. She spent half her life laughing and I think she wanted to end it that way too.
I'd want a Doctor to look me in the eye, tell me the complete truth and then give me a hug. What else can you do??
I'd want a Doctor to be straight up with me. I'm probably unlike most people and i've never been told i'm going to die, but a bit of humour wouldn't go amiss either. You've either got to laugh or cry. When my Grandma was told she was dieing of bowel cancer she looked really upset for a while but all she said to me was that every one was walking around looking miserable and serious and it made it worse. She spent half her life laughing and I think she wanted to end it that way too.
I'd want a Doctor to look me in the eye, tell me the complete truth and then give me a hug. What else can you do??
BRONZE Member
the henna lady
6,193 posts
Location: WNY, USA
the henna lady
6,193 posts
Location: WNY, USA
Posted:
What I have disliked in the past about dr's breaking bad news....
The big medical words. We don't need them. They don't buffer the emotions any, and they sure as hell don't help understanding.
The detached "This is this, this is this, and this is the end." in a cold voice with the most insincere "I'm sorry." at the end of it followed by the *Now I am going to walk away because the situation is too damn uncomfortable for me to stick around* escape. This one burns my biscuits. I realize that doctors are very busy but sometimes the shock needs to hit before the questions can form. In a state of grief the last thing I want to do is track the dr. back down to have my questions answered. And really, don't say you are sorry unless you know you can sound like you mean it.
I know that Dr.'s are supposed to maintain a distance from their patient, and I understand fully. But in my experience, these Dr's have the worst bedside manner and approachability. It's like they are there to help save lives but in dealing with others they lost their humanity. The best ones I have dealt with have been residents, because they haven't gotten that far yet, and they are eager to understand what it feels like to be in the patient's position, not to just treat and move on, which is far more frustrating and unnerving than if the moment would be taken to explain.
(example: from my accident an MD comes in and says around me..not to me..that I needed another chest tube inserted into my other lung. I motioned that I had a question or two about that, and he said, "Just take it easy sweetheart". Like that helped! I freaked out and had a slight backslide because I was freaking out until a **nurse** told me what was going on. And most of the MD's were that way!!)
Anyway, my advice is to keep your humanity. Think about how you would want something like that broken to you, and adjust your game plan accordingly.
As to how to deal with denial...never been in that position so I don't know.
Good luck to you my friend. I do not at all envy your position.
P~
What I have disliked in the past about dr's breaking bad news....
The big medical words. We don't need them. They don't buffer the emotions any, and they sure as hell don't help understanding.
The detached "This is this, this is this, and this is the end." in a cold voice with the most insincere "I'm sorry." at the end of it followed by the *Now I am going to walk away because the situation is too damn uncomfortable for me to stick around* escape. This one burns my biscuits. I realize that doctors are very busy but sometimes the shock needs to hit before the questions can form. In a state of grief the last thing I want to do is track the dr. back down to have my questions answered. And really, don't say you are sorry unless you know you can sound like you mean it.
I know that Dr.'s are supposed to maintain a distance from their patient, and I understand fully. But in my experience, these Dr's have the worst bedside manner and approachability. It's like they are there to help save lives but in dealing with others they lost their humanity. The best ones I have dealt with have been residents, because they haven't gotten that far yet, and they are eager to understand what it feels like to be in the patient's position, not to just treat and move on, which is far more frustrating and unnerving than if the moment would be taken to explain.
(example: from my accident an MD comes in and says around me..not to me..that I needed another chest tube inserted into my other lung. I motioned that I had a question or two about that, and he said, "Just take it easy sweetheart". Like that helped! I freaked out and had a slight backslide because I was freaking out until a **nurse** told me what was going on. And most of the MD's were that way!!)
Anyway, my advice is to keep your humanity. Think about how you would want something like that broken to you, and adjust your game plan accordingly.
As to how to deal with denial...never been in that position so I don't know.
Good luck to you my friend. I do not at all envy your position.
P~
Pele
Higher, higher burning fire...making music like a choir
"Oooh look! A pub!" -exclaimed after recovering from a stupid fall
"And for the decadence of art, nothing beats a roaring fire." -TMK
SILVER Member
Mumma Hen
6,391 posts
Location: Brisbane, Australia
Mumma Hen
6,391 posts
Location: Brisbane, Australia
Posted:
When I was told that I needed to have brain surgery it was over the phone!!! I had a drs appt and I told the dr that I was sending my mum in my place because it was the first day of my new job and I DIDNT want to not turn up...as you can see I wasnt expecting really bad news.
Then outta the blue my new boss said that I had a phone call and I answered to my dr asking if I could talk...
From then on in he said that I had a very serious brain condition calld arnold chairi malformation ( which I had no idea what that was) and I would be having surgery on my head in one week...
Holey moley. He then asked my permission to tell my mum.. which I gave in a shell shocked manner.
I got in the car and drove the whole way home bawling my eyes out, becuase the whole thing seemed so clinical and unemotional.. The dr said it was "garden varity(sp) brain surgery"
I was all like YEAH as if ANY brain surgery is garden varity matey...
but alls well that ends well... Im one of the lucky ones that had support of a WONDERFUL surgeon who used humour and his personality to put me at ease unlike the nuerologist who had all the personality of peice of slightly over chewed meat.
When I was told that I needed to have brain surgery it was over the phone!!! I had a drs appt and I told the dr that I was sending my mum in my place because it was the first day of my new job and I DIDNT want to not turn up...as you can see I wasnt expecting really bad news.
Then outta the blue my new boss said that I had a phone call and I answered to my dr asking if I could talk...
From then on in he said that I had a very serious brain condition calld arnold chairi malformation ( which I had no idea what that was) and I would be having surgery on my head in one week...
Holey moley. He then asked my permission to tell my mum.. which I gave in a shell shocked manner.
I got in the car and drove the whole way home bawling my eyes out, becuase the whole thing seemed so clinical and unemotional.. The dr said it was "garden varity(sp) brain surgery"
I was all like YEAH as if ANY brain surgery is garden varity matey...
but alls well that ends well... Im one of the lucky ones that had support of a WONDERFUL surgeon who used humour and his personality to put me at ease unlike the nuerologist who had all the personality of peice of slightly over chewed meat.
TAJ "boat mummy." VALURA "yes sweetie you went on a boat, was daddy there with you?" TAJ "no, but monkey on boat" VALURA "well then sweetie, Daddy WAS there with you"
member
64 posts
Location: Cardiffy, Londony places
64 posts
Location: Cardiffy, Londony places
Posted:
Having never had to be subjected to or give this kind of information to anyone I'm not sure I'm hugely qualified to say anything, and you can pour scorn on me should you feel I'm too hopelessly wrong to bother a reply to, but:
Maybe try to sound up beat. I mean its always a bad thing if the doctor comes in the room looking at his feet, hiding behind his clipboard, starting the conversation with,"uh, the good news is..." and generally sounding uncomfortable. Maybe be confident, be friendly and understanding. I reckon the patients confidence will be directly proportionate to yours: if you sound edgy about brain surgery, then why the hell should your patient have any confidence in the procedure either! Maybe explain its not a bad thing, don't tell them its 'just run of the mill' or anything, but tell them everything will be fine... be positive and happy, smile, look them in the eye, take their hand if you think the needs be, sit beside them, don't make the situation any less confortable than it is already (bring them a cup of tea if they like it and you ave time... I dunno I'm thinking on my feet...)
I guess that could do... where I work I find I'm perpetually sarcastic, this helps me deal with the ignorance an lip I have to deal with on a regular basis, but then I'm just an artist, I just try to make people think, not fix them.
Having never had to be subjected to or give this kind of information to anyone I'm not sure I'm hugely qualified to say anything, and you can pour scorn on me should you feel I'm too hopelessly wrong to bother a reply to, but:
Maybe try to sound up beat. I mean its always a bad thing if the doctor comes in the room looking at his feet, hiding behind his clipboard, starting the conversation with,"uh, the good news is..." and generally sounding uncomfortable. Maybe be confident, be friendly and understanding. I reckon the patients confidence will be directly proportionate to yours: if you sound edgy about brain surgery, then why the hell should your patient have any confidence in the procedure either! Maybe explain its not a bad thing, don't tell them its 'just run of the mill' or anything, but tell them everything will be fine... be positive and happy, smile, look them in the eye, take their hand if you think the needs be, sit beside them, don't make the situation any less confortable than it is already (bring them a cup of tea if they like it and you ave time... I dunno I'm thinking on my feet...)
I guess that could do... where I work I find I'm perpetually sarcastic, this helps me deal with the ignorance an lip I have to deal with on a regular basis, but then I'm just an artist, I just try to make people think, not fix them.
BRONZE Member
old hand
1,107 posts
Location: In a test pit, Mackay, Australia
old hand
1,107 posts
Location: In a test pit, Mackay, Australia
Posted:
I hate it when doctors tell you stuff from behind their big desk; it's too remote. And don't apologise while you're doing it; it's not your fault.
I hate it when doctors tell you stuff from behind their big desk; it's too remote. And don't apologise while you're doing it; it's not your fault.
There is a slight possibility that I am not actually right all of the time.
Pooh-Bah
2,364 posts
Location: austin,tx
2,364 posts
Location: austin,tx
Posted:
for Pele and Valura
for Pele and Valura
-Such a price the gods exact for song: to become what we sing
-Seek freedom and become captive of your desires. Seek discipline and find your liberty.
-When the center of the storm does not move, you are in its path.
AnonymousPLATINUM Member
Posted:
I've never had this experience so I can't really talk from experience, but I would say that you can be too upbeat. You don't want to strut into the room with a big smile on your face and say "Hi there, are you doing ok?... well actually no you aren't..."
If your telling someone they are going to die, or at least have to under go a risky procedure you need to be honest, and wait for them to assymilate what you have just told them so they can ask the questions they'll have straight away. And you can't hide behind medical jargon (I'm not suggesting you do, but some do). You need to give laymans answers to the questions they raise. Anything else is just going to make the patient more confused...
Good luck m8,
Hope this helps a little.
I don't envy you for the world!
PsyB.
I've never had this experience so I can't really talk from experience, but I would say that you can be too upbeat. You don't want to strut into the room with a big smile on your face and say "Hi there, are you doing ok?... well actually no you aren't..."
If your telling someone they are going to die, or at least have to under go a risky procedure you need to be honest, and wait for them to assymilate what you have just told them so they can ask the questions they'll have straight away. And you can't hide behind medical jargon (I'm not suggesting you do, but some do). You need to give laymans answers to the questions they raise. Anything else is just going to make the patient more confused...
Good luck m8,
Hope this helps a little.
I don't envy you for the world!
PsyB.
SILVER Member
15,417 posts
Location: South Wales
15,417 posts
Location: South Wales
Posted:
you could try dropping hints..
you could try dropping hints..
GOLD Member
ZORT!
3,045 posts
Location: Brisbane, Australia
ZORT!
3,045 posts
Location: Brisbane, Australia
Posted:
it seems that your in a difficult place -
on one hand you cannot appear too personal - in part for your own sanity, but a general critisism is that doctors are not personal enough!!
some want a detailed explanation, some want a comforting positive statement.
humans are so unpredictable!
take care.
it seems that your in a difficult place -
on one hand you cannot appear too personal - in part for your own sanity, but a general critisism is that doctors are not personal enough!!
some want a detailed explanation, some want a comforting positive statement.
humans are so unpredictable!
take care.
"Here kitty kitty...." - Schroedinger.
Enter a "Title" here:
2,905 posts
Location: San Diego California
2,905 posts
Location: San Diego California
Posted:
Mike we dont agree on much, so our opinions will probably vary here as well
Given: You have to tell her the truth, she is gonna be upset, probably angry at you (or the doctor who did the surgery), lawsuits threatend yadda yadda yadda
Not Given: Personally I would hope to know something about the person. IE, religious, family oriented... and the list goes on.
Offer her couseling, suggest someone who can help her get her affairs in order, umm
Reasure her that you will do all you can to prevent there being pain.
Dont lie about her condition, but dont be afraid to do whatever you need to. We call it, "The price of doing business".
Another thing, that is really err kinda cheep, give her and her family all the discounts that you can.
Mike we dont agree on much, so our opinions will probably vary here as well
Given: You have to tell her the truth, she is gonna be upset, probably angry at you (or the doctor who did the surgery), lawsuits threatend yadda yadda yadda
Not Given: Personally I would hope to know something about the person. IE, religious, family oriented... and the list goes on.
Offer her couseling, suggest someone who can help her get her affairs in order, umm
Reasure her that you will do all you can to prevent there being pain.
Dont lie about her condition, but dont be afraid to do whatever you need to. We call it, "The price of doing business".
Another thing, that is really err kinda cheep, give her and her family all the discounts that you can.
Some Jarhead last night: "this dumb a$$ thinks hes fireproof"
I don't want a title.
940 posts
940 posts
Posted:
Look the patient in the eye. Eye contact reassures us that we're still people, alive, being taken seriously. If I have to receive bad news, I want to be sure that my doctor still sees me as a person and not as a statistic. That's the most important thing.
I also second Pele - don't rush out the door. Same rationale, really.
Look the patient in the eye. Eye contact reassures us that we're still people, alive, being taken seriously. If I have to receive bad news, I want to be sure that my doctor still sees me as a person and not as a statistic. That's the most important thing.
I also second Pele - don't rush out the door. Same rationale, really.
E pluribus unum, baby.
member
1,591 posts
Location: Nova Scotia, Canada.
1,591 posts
Location: Nova Scotia, Canada.
Posted:
I think it's a lot better for a doctor to be "machine like" then try to make the person feel like a person but come across of insincere.
I think it's a lot better for a doctor to be "machine like" then try to make the person feel like a person but come across of insincere.
GOLD Member
HOP Mad Doctor
13,925 posts
Location: San Francisco, CA, USA
HOP Mad Doctor
13,925 posts
Location: San Francisco, CA, USA
Posted:
Pretty much, our training is to do much as everyone here has said. Don't do it from behind a desk, tell it like it is, fire a "warning shot" first ("I'm afraid I have some very bad news for you"), be warm, give plenty of time for questions, don't sugar-coat it, etc.
I think you'll all be glad to know that this is an excerise so that we CAN break bad news without pissing patients off.
Pretty much, our training is to do much as everyone here has said. Don't do it from behind a desk, tell it like it is, fire a "warning shot" first ("I'm afraid I have some very bad news for you"), be warm, give plenty of time for questions, don't sugar-coat it, etc.
I think you'll all be glad to know that this is an excerise so that we CAN break bad news without pissing patients off.
-Mike
Certified Mad Doctor and HoP High Priest of Nutella
A buckuht n a hooze! -Valura
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