Breaking bad news can be a daunting and stressful situation for young GPs. You have read all the theory but this may be your first time having to break bad news to a patient. It is important that you are clear in your mind how to approach this as this will be a traumatic event for your patient. Let’s split this into two sections: Pre-meeting and Meeting.
Pre-meeting
- Make sure you have the correct patient details with the correct results for that patient.
- Know as much as you can about the diagnosis, treatments, follow up schedule and prognosis of the condition. Consider speaking to the patient’s hospital consultant to assist with this as it pertains to this individual patient.
- Ask your secretary to contact your patient to make an appointment with you to discuss their test results. Make it clear that you are happy for them to bring a family member with them for the meeting if they wish.
- Avoid making this initial contact yourself as your patient may ask you questions at this stage and you do not wish to break bad news over the phone, when your patient may become upset or distracted, for example when driving.
- Don’t contact your patient and leave the appointment hanging over the weekend or for later in the week. It preferably should occur on the day of contact as your patient will be anxious following the practice contact.
- Organise the meeting for a time that you are not going to be interrupted and when you can allow a lengthier consultation. This may be at the end of the morning session or the end of the evening session.
- It may be necessary to inform other partners in the practice of the meeting so that they can take on any extras or calls coming in for you.
- Organise your room appropriately in a welcoming fashion with no desk barrier between you and an extra chair if needed.
Meeting
- Make sure that your patient is sitting comfortably. If your patient has a relative with them, explain that you are going to be discussing the test results and ascertain if your patient is still happy for the relative to be present or would like to proceed alone.
- Explain that the test results had not turned out as you had hoped. In a small number of cases your patient may indicate at this stage that they don’t want to know the full extent of the diagnosis but would rather leave the followup to you and your hospital colleagues. The vast majority of patients however will want to know the treatments available, who will be carrying out the treatments, at what facility and what the prognosis is for the condition.
- Speak in plain language and if asked about the prognosis be honest. This is your patient’s diagnosis and they will have to make decisions about work, family and their financial affairs based on the prognosis.
- Avoid providing false hope, but it is okay to say that diagnoses affect everybody differently. A prognosis is not an exact figure but rather an average of how the disease progresses and each individual progresses differently.
- Avoid giving precise timeframes for progression of the disease as the patient may take this as being an exact prognosis and we have all heard of the patient given six months to live and who is still alive five years later.
- Allow for patients displaying various emotions on hearing the diagnosis. These can range from shock, denial, anger or tears. All are possible and always be supportive.
- Allow silences during the consultation as the patient needs time to assimilate what you are saying.
- Explain to your patient the next steps involved after the diagnosis. What other specialist tests are necessary, the teams involved and any potential procedures or treatments such as chemotherapy, radiotherapy or immunotherapy.
- Allow that your patient may not have assimilated all the information that you have discussed, so leave the door open for a followup consultation where your patient may have more questions or where they may wish to bring a relative in to you to discuss further.
Closing remarks
I hope that this article will be of help to you going forward and help to provide you with a strategy in these instances.
Next week we will look at the topic of the Angry Patient which we all find difficult especially if that anger is directed at us.
About the author
Dr Brendan Woods is a qualified GP and a member of the RCGP. He ran a successful General Practice for many years and was a GP Trainer for 15 years. He is the Managing Partner of a global medical recruitment company Woodston Personnel Ltd and Woodston Personnel UK. The company’s experienced Medical Partners, team of Recruitment Consultants and Personal Relationship Managers provide daily advice and direction to all their GP candidates and assist them in their career objectives.
