DOCTORS ' LOUNGE
YOUR NEWS IS BAD , BUT YOUR METHOD IS GOOD Kathryn Vance
On Jan . 19 , the CATO Society of senior physicians met
via Zoom for another meeting , with Dr . Charles Oberst , Chair of the CATO Society , presenting Dr . Mary Helen Davis as the speaker . Dr . Davis is a psychiatrist and spoke on Communication , In Good Times and Bad Times . While the last year has not necessarily been the best of times , we must maintain good communication with our friends , family and patients .
She first shared the skills needed for anyone to communicate effectively . Listening capacity is a major factor in good communication and boils down to “ listening to hear versus listening to respond .” In order to have good communication , empathy and respect for the other person are paramount . In thinking about what it ’ s like to be in the other ’ s position , consider the level of respect you would want for yourself . This can give a better idea of how to convey information . She stressed that open mindedness is important not only for opening up to your own thoughts , but also in understanding what someone else is saying . If you are shut down in the beginning , the communication is destined to fail . Finally , clarity and conciseness are essential , especially in medical-related conversations so that nothing is misinterpreted . “ Don ’ t get lost in the jargon ,” she said .
The remainder of the session was spent discussing bad news and how to deliver it to a patient .
“ Bad news can be perpetuated at the speed of light ,” she said , noting that this has been especially true during the pandemic . Bad news conversations can present themselves in many ways in health care such as diagnosis of chronic illness , mental illness , necessary lifestyle changes , end of life discussions , cost and billing , and so much more .
Dr . Davis outlined a six-step process for how to break bad news .
1 . Setting : Make sure that when you are delivering bad news , you are in a private setting where you will have minimal noise and interruptions . Involve others , if the patient chooses , and make sure to sit down with them during the conversation .
2 . Perception : Pay attention to the patient ’ s body cues , language and vocabulary and try to mirror their words . It ’ s also important to ask before you tell , she said . For example , instead of diving straight into their diagnosis , ask the patient , “ What have you been told about your medical condition ?”
3 . Invitation : Find out how much information the patient wants to know about their condition and how and when they want to receive it .
4 . Knowledge : Dr . Davis suggests a “ warning shot .” If you ’ re breaking bad news to someone , give them a bit of an introduction to the news to help soften what ’ s to come . Start at the level of comprehension and vocabulary of the patient , avoiding medical jargon and instead opting for simpler , less technical wording . It ’ s also important to give information in smaller , bite-sized pieces and avoid excessive bluntness . Check for the patient ’ s understanding as you go along . “ We have to do a double back and check that what we said was what was heard ,” she said .
5 . Emotion : As you are delivering the news , check for the patient ’ s emotional response . Are they tearful , in silence , in shock ? Identify that emotion and use open ended questions to ask about what they are thinking and feeling in the moment . Utilize empathetic statements and validating responses . Make sure the patient understands ; underlying emotional impacts of this news may change how the rest of the information is heard .
6 . Strategic summary : “ Uncertainty breeds anxiety ,” Dr . Davis said . Ask the patient if they are ready to proceed with a discussion of their treatment options . Elicit specific patient goals and frame hope in terms of what they want to achieve and what is possible to accomplish .
Kathryn Vance is the Communication Specialist at the Greater Louisville Medical Society .
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