How do you approach giving bad news to patients?
“One thing I’ve learned over the years is that sometimes things aren’t as bad as you think. So although you like to prepare patients, moderate what you say. I prepare the patient for a difficult situation, but say we always hope for the best. I’m a glass half-full kind of person—that really helps. Don’t ever lie. Never conceal anything. You have to be honest because patients have to deal with it.
Patients will guide you as well. Your job is to educate them, but they will help you make the decision. Similarly, when you’re giving bad news, if you look at their body language and listen, you can tell how they are taking it. Sometimes it’s better to give them bad news in little increments.
When you’re involved in a team it’s important that everybody be on the same page. The team needs to communicate.
In a recent tumor board conference on a young man, we had 12 people: residents, attending, specialists. I asked why nobody had talked with the patient and family. It turned out nobody realized this guy was as sick as he was. They were so focused on his immediate problems—primarily pain and cosmetic issues—that nobody realized he was going to die, really soon. What seemed simple to me was not at all obvious to them. That’s why making sure everybody is on the same page is so important.
I don’t like telling people they’re going to die in a certain amount of time because that’s ridiculous. Everybody’s different. A patient with bladder cancer asked how much time he had if he didn’t do anything. I told him the literature said about 2 years. So he went about his business and ultimately died of his disease. He made sure, however, that his daughter told me that he had lived 4 more months past the 2 years I told him he had.”
Nina Davis, MD