Sharing bad news with a patient

How to Share Bad News with a Patient

Advising your patients that you need to refer them to a specialist because you detected a suspicious mass on the X-ray or telling a patient they may eventually need surgery are examples of clinical information that may be perceived as bad news. While conveying bad news to a patient may conjure up fear and anxiety in the patient's mind, many doctors dread performing the task as much as the patient fears receiving the news.

Doctors must be willing to have honest conversations with their patients—no matter how difficult. This in turn reflects on the high levels of caring within the profession, a key reason why many Doctors of Chiropractic chose this career in the first place.

Here are some tips to convey the bad news with as much professionalism as possible.

Give the Patient Advance Warning

Bad news usually comes on the heels of an X-ray or other test. When ordering the study, explain what problem you’re trying to rule out, including any serious conditions. Convey possibilities such as, “It could be serious or it may be easily treatable. That is why it’s important to have a consultation/evaluation immediately.”

Although giving a patient an advance warning can produce some anxiety, this is far outweighed by the risk of delay in treatment or a future allegation of failure to refer in a timely fashion.

How and Where to Break the News

Always choose a private setting when talking to patients about their health issues. Arrange to be close enough to extend a comforting touch, should the need arise.

Request the most appropriate family member to accompany the patient. However, keep in mind family members may not want to hear the news or may disagree with treatment options, which can complicate the decision-making process. Document the process and specifics in the patient’s record.

You should also convey hope to help diminish fear. For example, “While a herniated disc is serious, we’ve found many patients do very well with a course of conservative chiropractic care and are able to avoid surgery. We will monitor your case carefully and if surgery is needed we will make the appropriate referral.”

After you share the information, stop speaking and let it sink in. Be ready to respond to questions from both the patient and his or her family. It is often helpful to obtain the patient’s consent to speak with other family members who may call your office for information.

Manage the Tense Moments

When faced with bad news, patients and their families react in different ways. Taking a “we’re in this together” approach may minimize some of the feelings of isolation and being overwhelmed that many patients experience. In addition:

  • If there’s denial, which can lead to non-compliance, repeat the basic information and schedule a follow-up appointment within two days. Be certain there is a process to monitor the scheduled appointment.
  • If you’re challenged about the accuracy of the findings or criticized about your treatment plan, be even more emphatic about the need for a consultation to confirm or refute your findings.

All in all, Doctors of Chiropractic can take solace in the fact that it’s harder for patients to deal with uncertainty than it is to deal with bad news. And by helping your patients deal with their underlying health issues, you’re providing them with an essential and valuable service.

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