{"id":4092,"date":"2018-11-13T16:47:06","date_gmt":"2018-11-13T21:47:06","guid":{"rendered":"https:\/\/health.uconn.edu\/connecticut-area-health-education-center-network\/?p=4092"},"modified":"2018-11-26T12:24:34","modified_gmt":"2018-11-26T17:24:34","slug":"on-delivering-bad-news","status":"publish","type":"post","link":"https:\/\/health.uconn.edu\/connecticut-area-health-education-center-network\/2018\/11\/13\/on-delivering-bad-news\/","title":{"rendered":"On Delivering Bad News"},"content":{"rendered":"

By Kate Schiff, MHS, PA-C<\/h3>\n

\"Kate

For guidance, I turned to Dr. Gerard Fumo, medical oncologist and hematolgist at Midstate Medical Center. \u201cSit down, sit close, don\u2019t rush, remove distractions and don\u2019t allow interruptions. Watch your patient closely as you talk. Make sure you are not losing them,\u201d Fumo advises. \u201cPause if necessary, let them absorb what you are saying. Frequently people stop processing when they get bad news\u2026don\u2019t be uncomfortable with a little silence. This is where you can \u2018read\u2019 the situation \u2013 is your patient coping well or decompensating? You will proceed differently based on how you read the situation.\u201d The ability to read the situation is critical, and patients will notice when their provider fails to do so even if the patient appears distracted by their diagnosis. When labor and delivery nurse Amy Murlowski received news that she had a progressive, degenerative spinal disorder, she explains she wished her spine specialist had \u201csimply acknowledge[d] the shock and discomfort\u201d Amy was in due to both the diagnosis and her level of pain at the time.<\/p>\n

Patients watch their medical providers closely, and read their demeanor for clues to the diagnosis. Breast cancer survivor Kimberly Jones* describes her first doctor's visit after a breast biopsy: \u201cWhen the initial biopsy came in, she checked [the biopsy site] and never looked at me. We have a history of friendly banter usually with each other\u2026I already knew it was bad.\u201d She recalls feeling alarmed and offended by the sudden loss of friendliness and withdrawal. Later, when pathology revealed her cancer to be worse than what she had initially understood it to be, Kimberly resisted returning to the office to discuss her treatment and prognosis. \u201cI said call me, I can read your body language so not looking at me doesn\u2019t work for me. She said \u2018well I don\u2019t like to give bad news\u2019\u2026in my heart I want to say I\u2019m glad she has not been desensitized, but in my head I\u2019m like my God it's your job to inform me of everything\u2026\u201d<\/p>\n

While tact and body language are extremely important, the greatest nuance lies in knowing the right amount of information to give the patient. To gauge the proper amount, Dr. Fumo suggests observing how comfortable the patient is with the conversation. \u201cYou don\u2019t always have to give all the bad news in one meeting. Some individuals just can\u2019t cope with it and others don\u2019t do well with bad news that just seems to be getting worse and worse. Many times bad news can be given in stages.\u201d He also cautions health care professionals to be aware of the influence of accompanying friends and family. \u201cIt\u2019s great to make sure that family and friends are getting what they need from the conversation, but your first obligation is to your patient. Even as you address family\u2019s questions, always keep an eye on your patient and make certain your patient is comfortable with how things are going. Stay at the pace of your patient, not the family or friends.\u201d<\/p>\n

My hope is that this essay will provide some useful tools, insight, and reassurance for a distressing medical moment. In conclusion, I offer one last pearl from Dr Fumo: \u201cBe sincere and empathetic. Patients sense whether you are just giving them standard recommendations\u2026or whether you\u2019re giving them individual care and guidance based on medical information. Earn their trust and guide them with your heart and instinct; you have the knowledge.\u201d<\/p>\n

*Name changed at patient's request.<\/p>\n

\n

To leave a response to this post, please email\u00a0Ellen Ravens-Seger<\/a>.<\/p>\n<\/div><\/div><\/div><\/div><\/div>","protected":false},"excerpt":{"rendered":"

Kate Schiff, MHS, PA-C, advises medical practitioners on how to deliver bad news, drawing on interviews with Medical Oncologist Gerard Fumo, as well as some former recipients of bad news.<\/p>\n","protected":false},"author":771,"featured_media":4222,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"wds_primary_category":0,"footnotes":""},"categories":[1],"tags":[],"acf":[],"publishpress_future_action":{"enabled":false,"date":"2026-05-02 04:39:54","action":"change-status","newStatus":"draft","terms":[],"taxonomy":"category"},"_links":{"self":[{"href":"https:\/\/health.uconn.edu\/connecticut-area-health-education-center-network\/wp-json\/wp\/v2\/posts\/4092"}],"collection":[{"href":"https:\/\/health.uconn.edu\/connecticut-area-health-education-center-network\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/health.uconn.edu\/connecticut-area-health-education-center-network\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/health.uconn.edu\/connecticut-area-health-education-center-network\/wp-json\/wp\/v2\/users\/771"}],"replies":[{"embeddable":true,"href":"https:\/\/health.uconn.edu\/connecticut-area-health-education-center-network\/wp-json\/wp\/v2\/comments?post=4092"}],"version-history":[{"count":14,"href":"https:\/\/health.uconn.edu\/connecticut-area-health-education-center-network\/wp-json\/wp\/v2\/posts\/4092\/revisions"}],"predecessor-version":[{"id":5520,"href":"https:\/\/health.uconn.edu\/connecticut-area-health-education-center-network\/wp-json\/wp\/v2\/posts\/4092\/revisions\/5520"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/health.uconn.edu\/connecticut-area-health-education-center-network\/wp-json\/wp\/v2\/media\/4222"}],"wp:attachment":[{"href":"https:\/\/health.uconn.edu\/connecticut-area-health-education-center-network\/wp-json\/wp\/v2\/media?parent=4092"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/health.uconn.edu\/connecticut-area-health-education-center-network\/wp-json\/wp\/v2\/categories?post=4092"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/health.uconn.edu\/connecticut-area-health-education-center-network\/wp-json\/wp\/v2\/tags?post=4092"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}