Breaking bad news ----

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    27-May-2015

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  • 1. -----BREAKING BAD NEWS----- Dr. Shaharyar Ahmad Bhatti MBBS, MCPS, DPP, MRCGP (INTL)

2. I would rather feel compassion than know the meaning of it Thomas Aquinas 3. WHAT IS A BAD NEWS?

  • It is any information which is likely to alter drastically a patients view of the future

4. Emotional responses to a bad news

  • Denial
  • Despair
  • Anger
  • Bargaining
  • Depression
  • Acceptance

5. WHY IS IT DIFFICULT?

  • It usually means that biomedical measures cannot help, and thus it undermines the clinicians familiar role of the healer
  • The clinician is upset
  • The patient will be upset too, and can respond unexpectedly
  • The patient may require emotional support which may be beyond what the clinician can give
  • The patient may blame the clinician, and indeed there may be an element of medical mishap to complicate matters

6. TELL THE PATIENT?

  • No way?????
  • The patients:-
  • Usually know more than anyone has guessed
  • May imagine things to be worse than they are
  • Welcome clear information even about the worse news
  • Welcome liberty to speak as they wish about their illness and their future rather than join in a charade of deception decided be others
  • Differ in how much they can take at a time

7. HOW DO WE KNOW HOW MUCH A PATIENT WANTS TO KNOW?

  • Two ways:
  • BUCKMAN (Canada)
  • If this condition turns out to be something serious are you the type of person who likes to know exactly what is going on.
  • SANSON-FISHER (Australia)
  • Explicit catagorisation by direct questions in succession
  • If you would like to know, I will tell you..
  • What the diagnosis is?
  • What the treatment will be?
  • What sort of symptoms you will have?
  • What examination and test will be necessary?
  • What can be done for any physical discomfort or pain you may have?
  • What the outcome may be?

8. THE INTERVIEW

  • OPENING
  • Sooner then later
  • Patient should have someone with him / her
  • Everyone introduced
  • The doctor explains his status and extent of his involvement

9. THE INTERVIEW

  • EXPLORING
  • Find out if anything new has happened since last meeting
  • What does the patient know and how does he react to it?
  • WARNING SHOT_______ very important
  • Allow time / pause to let the warning sink in
  • Discover how much the patients want to know
  • Then place the facts ________ better in small chunks with pauses
  • Be prepared to stop at any point & resume later.
  • Plan and support
  • Provide some positive information and hope tempered with realism.

10. THE INTERVIEW

  • CLOSING
  • Recap / Summarize
  • Find out what the patient has understood so far
  • Safety net
  • Agree on the next appointment and for what purpose
  • Provide written information
  • Goodbye

11. What not to do?

  • Jargon and technical language
  • Euphemisms
  • Evasion
  • Conflicting information
  • Percentages and statistics
  • Obfuscation
  • Every thing is going to be fine