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Delivering Bad News to a Patient: 5 Best Practices

By Melissa Wirkus Hagstrom, contributor 

The truth can hurt, especially when delivering bad news to someone in a vulnerable state. In fact, physicians and other clinicians are responsible for one of the most inherently complex and uncomfortable tasks—delivering a terminal diagnosis or other difficult news to their patients. 

Breaking bad news and difficult diagnoses is never be easy, but physicians can do their best at this type of doctor–patient communication by implementing certain protocols and best practices. 

Linda Girgis, MD, a family practice physician who also pens the successful “Dr. Linda” blog and contributes to a variety of healthcare publications and sites, recently tackled this tough topic. 

She provides the following insights and tips that healthcare professionals can implement when delivering bad news to their patients, while offering the best support and care.

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5 Tips for Sharing Bad News with Patients

1. Be straightforward

“Be completely honest,” Dr. Girgis explained. “Don't sugar-coat the truth. Patients need to know the most accurate information in order to make the best choices for their medical care.”

Honesty is always the best policy in this type of scenario. A straightforward approach is best, and clinicians should be prepared to lay out the facts and then address any questions that the patients and their families may have about the information delivered. Allowing time for patients to ask questions will help ease their fears and apprehension. 

2. Don’t delay

Timeliness in this kind of physician–patient communication is extremely important, so don’t put it off. There is not benefit to be gained from hesitating to deliver a difficult diagnosis. Waiting out the inevitable will only make the process more onerous for all parties involved. 

“As soon as you know the results, no matter how bad, set up an appointment to tell the patient. Patients are sitting worrying over the results,” Girgis said. “The sooner they know the better.”

3. Provide information and resources for next steps

Dr. Girgis explained that it is critical to give patients as much information about their diagnosis as possible. Connect them to resources that they may need, whether it be hospice care, counseling, home health or another medical specialist.

Many hospitals and medical centers have special liaisons and counselors available for end-of-life care and other difficult types of diagnoses. Physicians should ensure that each patient has the resources and information they need to navigate a difficult diagnosis. 

4. Keep it personal 

Bad news should always be shared with patients face to face, Girgis emphasized. While some types of doctor-patient communication can be done via phone calls, emails or patient portals, the personal touch is important in these interactions. 

“[Bad news] should never be given in a phone call. Patients will have many questions, even some they may not realize at the time,” she said. “Allow the patients time to ask questions, at the appointment and after they leave the office. Many patients feel they are pushed out of the office.”

“Sit down with the patient and ask open-ended questions. Let them talk without cutting them off with more questions.”

5. Take advantage of patient-centered training 

Although physicians cannot control a patient’s reaction to a difficult diagnosis, they can control the way that they communicate bad news. Comprehensive and structured training can improve doctor–patient communication and may even lead to increased patient satisfaction. 

A study published by the National Library of Medicine, led by Kimberley R. Monden, PhD, found that the best training will embrace a patient-centered approach that includes the patient's family. “A patient- and family-centered approach not only keeps the patient at the center, but has also been shown to yield the highest patient satisfaction and results in the physician being perceived as emotional, available, expressive of hope, and not dominant.”

Girgis agrees that the more training, the better. “Giving bad news is never easy but it should be given in a well-informed manner. Small training sessions can be conducted at the end of rounds and department meetings, and hospitals can conduct CME events around this training.” [Qualify for free CME courses when you work with Locum Leaders.]

“It is OK to feel bad, we are human,” she concluded. “When we try to make ourselves immune to these feelings, we burn ourselves out. As doctors, we see many bad things in our careers. We need to allow ourselves to have human emotions around them.”

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