Dr. Anthony J. Orsini

Making bad medical news better

December 27, 2013
By Dr. Anthony J. Orsini

Everyone remembers the moment. The moment they heard a devastating diagnosis about themselves or a loved one, and their whole world changed.

Almost everyone is faced with bad medical news eventually, but the way a physician delivers this news can help determine how people face the challenge in front of them. However, less than 10 percent of physicians receive any formal training in how to effectively and sensitively communicate bad news. Often, when faced with a frightened patient and their loved ones, clinicians hide behind confusing medical jargon or shy away from discussing the gravity of the situation, leaving everyone unprepared for the eventual outcome. Even worse, many physicians deliver the news abruptly, leaving pain and shock in their wake.

These experiences stay with people forever. That’s why it’s so important to keep the gravity of the situation in mind. Regardless of how many times a physician has delivered bad news, they need to remember it’s going to be the first time the patient has heard it. Physicians delivering difficult diagnoses are meeting people at the worst moments of their lives. What we say and how we say it can make the experience even more devastating. But if it’s done well, that is the moment when healing can begin.

I have personally seen physicians help families and patients by communicating in the most sensitive and caring manner. I have also seen it done badly time and time again, devastating so many people. Beyond the personal element, there’s also a potential financial impact — poor communication is cited as a cause in 40% of lawsuits.

Positive physician communication has physical, as well as emotional benefits for patients. Studies published in medical journals including Lancet and the Journal of the American Medical Association, have demonstrated when patients feel that their doctor has communicated with them compassionately, they are more likely to follow their treatment plan.

The following are 10 rules for Breaking Bad News that I’ve picked up over the years:
1. Choose a private setting. Sit down and show appropriate (serious and sympathetic) body language.

2. Give the patient and/or loved ones your undivided attention. Shut off all pagers and phones.

3. Get on the same page by reviewing the situation first. Ask them what they know about what is going on.

4. Break the news gradually. Do not “blindside” the patient by being too abrupt.

5. Do not hide behind medical jargon. Speak in terms the patient and loved ones can understand.

6. Give the patient and family time to absorb what you just said. Show them you are not in a rush. Sit and be comfortable with silence.

7. It’s OK to show emotion.

8. Build a relationship. Use words or phrases such as “I will help you get through this” or “I am sorry”. Let them know they are not alone.

9. Be patient and answer all of their questions.

10. Make a plan for the future. Encourage them to call you with any questions. Make clear what the next step should be.

Dr. Karen Knops, Chief of Palliative Care at Morristown Medical Center and BBN instructor, says, “It seems almost cruel to give medical residents training in almost everything else in medicine and when this very important thing comes up, there is no experience and no guidance. I think it’s not a luxury to do something like this. It’s a necessity.”

For more information on the BBN Foundation or the BBN Model, visit www.bbnfoundation.org, or email info@bbnfoundation.org.

About the author: Dr. Orsini is the president of BBN Foundation. He is a graduate of Rutgers University and the Philadelphia College of Osteopathic Medicine. He is board certified in both Pediatrics and Neonatal-Perinatal Medicine. Upon completion of his fellowship training he spent five years as a neonatologist and assistant Professor of Pediatrics at NYU Langone Medical Center in New York City. He then moved to New Jersey in 2001 and has been working as a neonatologist at Goryeb Children’s Hospital in Morristown, N.J. ever since.