Here is how one physician handles breaking bad news.
CASE
Dr. Bob, we’ll call him, typifies the overworked primary care physician. Yet, when a lab or imaging report that reveals an abnormal result lands on his desk, he, not a nurse, calls the patient. He waits a few days if the test or study was ordered by another physician; in that situation, he often reaches a frightened, confused person who had already been called by the specialist’s nurse.
When that happens, Dr. Bob invites the patient, and a close relative, to schedule an office visit with him. In the interim, he forms a liaison with the specialist so that they can function as a team.
At the office visit, Dr. Bob refuses to prognosticate. Instead, he recommends that they take matters “one step at a time.” His approach is positive and reassuring but not overly optimistic. His message is clear: “You are not alone. I will be a supportive presence throughout your journey.”
Two notable things about Dr. Bob: First, he does not suffer burnout or what some have called “compassion fatigue”; to the contrary, the relationship he forges with his patients and their loved ones, and the gratitude and loyalty he receives from them, sustain and reward him.
Second, Dr. Bob has never been sued.
The key to Dr. Bob’s success is that he does not shy from breaking bad news. Instead, he views the occasion as an opportunity for healing. His approach is to detach from the outcome but not from the patient. He relieves fear and isolation, and offers, as one patient said it, “candor with hope.”
Summon your personal strengths to succeed
But taking this approach requires a shift from the standard biomedical philosophy—a three-pronged cultivation of personal resources. Here is how you can make that shift.
First, cultivate equanimity—that evenness of mind
Consider that destruction is an inherent component of creation. There can’t be light without darkness, birth without death, joy without suffering, perfection without imperfection. The Sufi mystic, Rumi, said it succinctly: “A butterfly needs two wings to fly.”
Recognize that not all news is equally bad. The spectrum runs from merely inconvenient to utterly devastating; how the news is perceived and received is highly subjective. Avoid projecting your personal perspective onto the recipient:
- I was totally perplexed. I had just broken the news that Mrs. Smith had an incurable colon cancer, and they responded by nodding, then asking me whether I preferred a chocolate cake or an apple pie for their next visit because it was their custom to bring home-baked goodies for the staff.
- After her death, Mr. Smith faithfully continued this tradition. Then one day he arrived for his regular appointment unshaven, distressed and sans cake. He had lost weight and looked every bit of his 78 years. Something was very wrong.
- “She’s gone, she’s gone,” he lamented.
- At last he’s grieving flashed through my mind, so I responded: “Yes, it’s been about 9 months now, hasn’t it?”
- “No, just two weeks…she said she was my girlfriend…just 29 years old…moved in last month then left taking my money,” he cried.
- She assumed the mantle of a grieving widow. Only years later did she write that she had been secretly relieved that her husband was killed in an automobile accident. He had been abusive and she was planning to leave him anyway.
- It was my birthday, and we were about to celebrate with a dinner of leg of lamb and roast potatoes. My cell phone rang. It was my internist calling; my LDL cholesterol was mildly elevated and my dexa scan demonstrated slight osteopenia. The tone of his voice was matter-of-fact but I felt awful: I am getting old.
Realize that long-term well-being doesn’t depend on good vs. bad news: