Communications
Beaking Bad News
When patients receive bad news, the staff must be prepared to provide support.
Laura Baldwin, RN, Scottsdale, Arizona
Delivering difficult news to patients can be a sensitive and uncomfortable challenge for health care professionals. In most instances, the physician is responsible for leading this dialogue. However, it is important all staff be adequately prepared to provide support and reassurance. Seasoned health care professionals may become desensitized to serious diagnoses, but for patients, learning they have a serious, life-altering disease or one that may rob them of their sight can be devastating. They need to be made to feel as though a compassionate and understanding team is surrounding them.
Defining Bad News
Before a practice can identify ways to help patients who have received bad news, it is important first to recognize that bad news may be defined differently for everyone. One patient may have an intense reaction to something that others perceive as minor and routine, while another patient may be relatively unaffected when given news that is seemingly dire. Members of the team should never assume their interpretation of the severity of the news is the same as the patient’s. It is easy to become desensitized to medical conditions when working day in and day out at a practice. Keep in mind, though, that even the smallest bit of unpleasant news can create stress and anxiety in patients.
Address Patient’s Emotions
When faced with bad news, patients will react in a variety of ways, from silence to anger to denial to crying. Staff members should attempt to address reactions so the appropriate response is provided. Verbal clues would be ideal, but it’s unlikely a patient will say, “I’m sad” or “I’m angry.” More often, staff need to look for nonverbal clues such as tears, a look of sadness, or clenched fists.
It may also be helpful for the staff to use openended questions to help identify the patient’s feelings. An example might be, “How are you feeling after your talk with Dr. Smith?” Simply asking if a patient is OK does not require an expression of feeling by the patient, only a yes or no response that may allow the patient to discuss his or her feelings.
A crying patient is one of the most challenging situations. A staff member faced with this response might ask, “Do I stay strong? Do I cry along with the patient?” The answer may depend on the staff member’s relationship with the patient. If a patient has been with the practice for a long time, there may be a more personal and close bond. In that case, it may be completely appropriate that the staff member sheds tears. That demonstrates to the patient there is genuine concern. At the very least, when faced with tearful patients, staff should provide supportive and comforting gestures. A gentle touch to the arm, offering a tissue, or asking if they can get anything for the patient are all qualify.
Be Available
Once a patient has received bad news, the ability to absorb and process any additional information is limited. However, the patient may feel inclined to stay and speak with someone immediately following the visit. If that’s the case, do not try and rush the patient out the door. Allow them to spend the time necessary expressing feelings or concerns.
Typically, there is an element of shock when less-than-favorable news is delivered, which may impact the patient’s ability to comprehend anything else that is discussed at that time. The best scenario may be to schedule a follow-up visit in the next day or two to give the patient time to let the news sink in. Suggesting someone accompany the patient can help him or her remember what is discussed. If there is a time lapse between the initial delivery of bad news until the next visit, have someone place a call to allow the patient to check in. The person making the call should let the patient know the practice is thinking of them and should make him/ herself available to talk or answer questions. Small gestures such as this can make a world of difference in the patient’s ability to move forward.
Allow for Hope
Most people continue to have hope, even in the difficult situations. It is important staff support that hope, no matter the odds. Hope is individual and personal. That being said, it is a fine line between supporting hope and instilling false hope. As a caregiver, it is important to continue to gently reinforce the appropriate message related to the condition so accurate expectations are set. If it is known, based on the diagnosis, that a patient is likely to completely lose vision, staff members should not make statements that will give false hope, such as, “Maybe you won’t lose your vision. You never know what can happen.” Instead, they should provide acknowledging and supportive comments such as, “I know you are hopeful, as we all are, that your vision will not diminish. We will be here to help you through this, regardless of the outcome.” OP
| Demonstrating Empathy |
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While many employees may never personally have received bad news, they must put themselves in the patient’s position and consider their own reactions. To better do this, staff should asking themselves these questions: ▪ How would I feel if I were told that my vision loss is irreparable? ▪ How would I react if someone told me that I will continue to have vision loss until I am blind? ▪ How might I feel if I were on the receiving end of news that will impact my quality of life and independence? A staff member’s own feelings are some of the most important tools that can be utilized when interacting with patients. While it may be impossible to fully understand how the patient feels, being empathetic may provide a gateway for providing appropriate support and comfort. However, it is important to avoid such phrases as, “I know how you feel” and “You must be very upset.” These types of phrases tend to come across as insincere and insensitive. Appropriate responses may include, “I wish the news had been better, but we will be here for you” or “You are very important to us, and we will support you through this.” |
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Laura Baldwin, RN, is a senior consultant for BSM Consulting based in Scottsdale, Arizona. She provides support to BSM and corporate clients in all aspects of physician and hospital practice management. Contact her at lbaldwin@bsmconsulting.com. |
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