How Do Doctors Tell Patients the Terrible News?

Many of us have experienced that moment, that terrible moment, when we get the worst news in our lives.  We have an illlness, and it may well be incurable, or terminal.  What’s it like to be a oncology doctor and have to fill in your patients and their families about bad diagnoses every day?   There are new ways of breaking bad news, said a story in the WSJ, and it begins with SPIKES.  Below are the tenets taught to doctors about how to say the unsayable to family and patients.

* Setting.  Always deliver the bad news in a private, quiet room. No cellphones beeping, no distracting open laptops, and ask if there is anyone else the patient would like to be present when the news is delivered.

* Patient Perspective:  The doctor inquires about how much the patient knows about the illness, and to talk about who they were before it happened, and how it has affected them.

*Knowledge  One tip is to prepare the patient with a ‘warning shot,’ such as “I”m afraid I have some bad news,” and then continue. And don’t walk too much, use as few words and as little jargon as possible to explain the situation.

Empathy  Docs are encouraged to ask how the patient feels , and even to shed tears for the shared emotion of that terrible moment. Be human.

Strategize.  Tell the patient about the next steps, and ask them how they will communicate what is going on with their family and friends.