Healthcare often involves having life-changing discussions. You may need to recommend an unwanted procedure. It could be advising there’s been permanent loss of function. Sometimes you may need to inform that an error has occurred. And, potentially the most challenging, there are conversations about death and dying.
These can be traumatic experiences for all concerned. Traumatic for the patient. Traumatic for the family members or carers . And, of course, traumatic for the doctors themselves. So, it’s little surprise that delegates on our Advanced Patient Communication Skills Courses want to improve their ability to manage these situations and to manage them well. A significant percentage of them are looking for an effective process that they can use. And we do conclude our course by exploring a structured framework which has been proven to help. However, before we think about how to do this, there is a fundamental question to consider.
What do we mean by “breaking bad news well?”
When we delve into this question, there are always a number of doctors with a clear aim. Deep down, what they really want, is to communicate their message in a way that avoids any uncomfortable openly-emotional upset. Desire to prevent unnecessary distress is admirable. But can a lack of emotional disturbance really be considered as a useful indicator of success here?
At Oxford Medical, our definition of good communication is: To ensure that all concerned hear what needs to be heard.
So, an essential element of communicating any type of news is that your message is received and understood. If that message is truly life changing then an emotional reaction should not be surprising. But neither should it be considered inevitable. The initial reaction may well be one of silent shock or questioning denial. Alternatively, it may be calm factual discussion when the message has been heard but the unimaginable full consequences have not yet registered.
And good communication cannot purely be about transmission of a message. You need to be sure that the message has been received and understood. “Hearing what needs to be heard” goes well beyond simple sharing of words. Expressions of emotion are a very powerful form of human communication. They can help you know what message has been heard and understood, what the impact may be and how you should adapt.
It’s likely that you have experienced numerous instances of hearing bad news yourself at various points in your personal life. You may have experienced health issues of your own. You may have lost colleagues, friends and/or family members. Take a moment to think about the reactions you felt in some of these instances.
Process versus comprehension
Chances are, as each set of circumstances was in some way unique, that you experienced a unique range of feelings in response to each event. Patients and their families are no different. They all have unique personalities, unique circumstances and unique relationships with the people around them. So, their reactions are often difficult to predict, sometimes surprising. In fact, approaching the task of breaking bad news with fixed expectations will limit your ability to react to the events as they unfold. The problem with frameworks and processes is that, on their own, they lead to cold, unresponsive communication.
If your role includes regularly delivering life-changing messages then it is likely that these acts of communication will typically be remembered in far greater detail and for much longer by the receiver than by yourself. And they will remember you as a person every bit as much as the message itself. Their memories and emotions are forever interconnected with the way the message was delivered and your reactions to their situation.
Our approach on our courses is to begin by thoroughly exploring the human condition and principles of good communication. What drives our feelings, thoughts and actions. What we need and want. The nuts and bolts of communication. How we react to different circumstances. And we consider this from the aspect of patients, family members and doctors. We then take this deeper understanding and relate it to the various communication models that can be helpful in healthcare.
Comprehension enables intelligent application of frame works or processes. This in turn leads to caring, effective communication with benefits of all concerned.
What steps are you taking to improve you abilities with break bad news?
Stephen McGuire – Managing Director