- 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
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 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?
- 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?
- 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 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?
8. THE INTERVIEW
- Patient should have someone with him / her
- The doctor explains his status and extent of his involvement
9. THE INTERVIEW
- 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.
- Provide some positive information and hope tempered with realism.
10. THE INTERVIEW
- Find out what the patient has understood so far
- Agree on the next appointment and for what purpose
- Provide written information
11. What not to do?
- Jargon and technical language
- Percentages and statistics
- Every thing is going to be fine