The art and science of communicating bad news

• Whew – week 1 of being back in the classroom is done. It’s actually been really fun to be back with my classmates again, reunited after a year apart. To hear about their experiences and learn “what they wanna be when they grow up” (aka to which residency programs they applied).
• The lectures have been topical and succinct and we ended the week on a high note. This afternoon we were put into small groups in which to practice breaking bad news. I volunteered to do one of the 2 interviews because the preceptor we had is a family friend who’s also a palliative care doctor and someone for whom I have great admiration – so I really wanted his feedback. Having said that, exactly because of who he is (local palliative care doc & head of the department) he may well play a role in my future career and so I was QUITE nervous about the interview before it started. This is how this interview worked (and how these types of interviews work in general):
• We’re given the scenario with background info on a little sheet of paper telling us about the patient, their diagnosis, the treatment required and what our understanding is of the reason why we brought them in today. In this situation I was a GP filling in on a 2 month locum (aka the equivalent to a substitute teacher but in the doctor world), and had to tell a patient about the treatment plan required for their Hodgkin’s Lymphoma (a type of blood cancer). In the room are a group of 5 other classmates, my preceptor, and then me and the patient pretending it’s just us. These “simulated patients” as they’re called, are played by highly skilled actors who’ve studied their script and taken on the role of that patient, with all of the knowledge and emotion that patient would have. So even though the setting is fabricated, the experience of the patient encounter feels VERY real. As it turns out, as my interview unfolded, I came to understand that my patient had a completely different purpose for the interview than what I had and to my surprise, was MAD with all the medical doctors he’d encountered to date that had been pooooor communicators. Anyway, it was a very intense experience – for me and for my classmates that were watching. It generally went well but I learned from their feedback afterwards that I could have been even more mindful of using any jargon in my language – specifically I used the terms “prognosis” and “processing” (as in needing time to process this information) which could both be potentially too “lingo”-ish depending on my patient. It was valuable feedback. It’s amazing that even when you think you’re not using any jargon, you might be because by now it’s so ingrained in you that it’s sometimes hard to notice those borderline words that your friends might understand but joe public might not. Especially if you’re breaking news of a diagnosis of cancer in which case often the information that follows sounds like many speech bubbles in a Snoopy cartoon that say “Blah blah blah”. That is, nothing is heard but the word “cancer”.
• One of my classmates told the story about how a patient’s wife was called by a surgeon just before surgery to say “So you know how your husband just ………(had this injury with this machine)”. Well, in fact NO, she DID NOT know. Moreover, she had taken his call on her cellphone and as she was driving down the road. He hadn’t given her any kind of warning shot or “is this a good time?” or anything to let her steel herself for what he was about to say. Later she told him that she almost drove off the road when he called her and told her that. His response to her was “Well, I had to tell you.” Horrible, eh? At least these stories are told as horror stories in medical school so we can equally learn what NOT to do vs what TO do. And I must say, that I see strong skills and even more potential in my class on the whole. And that goes for me too. Because I love communicating (can you tell?), I plan to make the sensitive delivery of terrible news one of my specialities. Having said that, I hope I’m never in the situation to be the one to deliver such news to you.
• Now to get on with a weekend of fun & frivolity with my girlfriends visiting from Vancouver. Have a wonderful weekend.