There are some responsibilities of health care professionals that just, well, suck. One of our most difficult jobs is telling our patients that they are very ill or going to die. The doctor needs to be clear and unambiguous about the patient’s prognosis, yet also must be sensitive to the patient’s emotions. We are taught that how you give bad news can be just as important as the news itself.
I am thankful that my med school provides us with opportunities to practice having difficult conversations with fake patients before we have to do the real thing. This week, my classmates and I met in small groups and were provided with an actress who pretended to be a patient with breast cancer. We took turns interviewing her, and then we would pause for class discussion. The first student had to tell the “patient” she had a suspicious lump in her breast. The second student told the patient it could be cancer. The third student – this is the role I volunteered for – had to discuss the patient’s prognosis and treatment with her.
We had a truly fantastic actress to work with, and when I was talking with her I completely felt like she was a real patient. When I sat down next to her, she immediately started hysterically sobbing about how she didn’t want to leave her children motherless. I tried saying things like “I’m so sorry, I understand this must be so difficult for you.” But she started yelling back, “You have NO idea how this feels for me!”. At that point, being brutally honest, I said, “I don’t know what to say,” and just left her alone with her tears for a few moments. This seemed to calm her down. I told her exactly what her treatment options were, breaking down the medical jargon as best I could.
I feel more confident about breaking bad news to a patient than I did before the exercise, but I think knowing that this was not a real patient made things much easier. I still have a lot more to learn before I’m skillful at giving bad news. Readers – I want to hear your stories about being told bad news, either about your health or that of a family member. How did the doctor do it? What should doctors avoid saying? What can doctors say or do that makes the load easier to bear?