How to Deliver Bad News
Written by Sara Kurtevski
Giving bad news, even in a non-medical setting, is a hard. However, it is a reality of our career and it probably occurs more often than we speak about. Delivering bad news is unfortunately inevitable regardless of the specialty you choose, and these interactions can easily be one of the most challenging moments. The way that bad news is communicated can impact the interaction, and in some instances, it can bring closure and healing to the patient or family. I am not sure if one ever feels ready for the task when it presents itself and I have yet to meet someone who enjoys doing this. Delivering bad news is all about communication, and I believe that communication is a skill we can all work on to improve.
Start with SPIKES:
You may have been introduced to SPIKES (Setting, Perception, Information, Knowledge, Empathy, and Summarize) in medical school or this may be the first time you are ever hearing of the term. Whenever I practiced giving bad news, using this protocol never seemed natural. But when the moment came and practice suddenly became real life, this approach helped navigate the situation. Before even beginning, try to limit any interruptions and ensure privacy. Remember that the news should be given under the receiver’s time, not yours. Before giving any further information, it is a good idea to first ask about what information has been shared so far and what their understanding of the situation is. This can be especially helpful if you are in a setting with frequent handoff, and it assists with assessing any misunderstanding or missed information. When the person is ready to receive the news, begin by sharing the news in small increments and avoid using any complex medical terminology. You should not be telling the person the entire medical event log as you might do on your morning rounds. In addition, using clear and direct language is crucial as people tend to easily misunderstand things. After the information has been shared allow time for a reaction. There is no right or wrong way to react to bad news and this can vary greatly from one person to the next. At the end of the conversation, always ensure everything was understood and all questions were answered.
Do not take things personally, give yourself a moment to feel, and debrief
As mentioned earlier, each person may react differently, and sometimes those reactions can be unpredictable and directed at you. Although you can feel attacked by this reaction, it's rarely actually meant to be directed at you. Try to remind yourself what the big picture is and that this is about the patient, not you. After the event has passed, allow yourself a moment to process the conversation and emotions. In my opinion, as physicians, we learn how to repress our emotions almost too well. After having a difficult conversation, taking a moment to acknowledge our own emotions allows us to stay human and avoids desensitization. This permits space for compassion and empathy, which connects us and builds trust and a good patient-physician relationship. It is when we allow for this to happen that delivering bad news will go much more smoothly. And finally, after all, is done take a moment to reflect and debrief. In retrospect, it is usually much easier to begin pointing at things that went wrong. The point of debriefing is by no means to be hard on yourself as there will be no instance where one interaction will resemble another. Instead, it will help you learn from each conversation so that you can continue to improve. Since there is no bulletproof recipe and each situation will be unique, taking a moment to debrief will help you take away a lesson so that you can better apply it next time.
