THE OPEN LETTER
On breaking bad news…
Dr. Ekansh Debuka,
We all enjoy fortune telling, don’t we! It conjures up the image of an old lady with a magic shining bowl, which can show us our future and tell us of all the good things to come. As healthcare professionals, we often indulge in our own bit of fortune telling. What we decipher by our tests and examinations determine the fortune and the future of the patient. Unfortunately, this is not always of the happy kind and thus comes one of the hardest parts of the profession – breaking the bad news to the patient or his family and friends. It is the most definite form of unwanted fortune telling that we indulge in and we usually have enough science and experience backing us to not be wrong.
Most have all seen or maybe even experienced the consequences of bad news being delivered to them. It’s devastating no matter how much you prepare for it and it rarely gets any easier. I can vouch for my fraternity that every doctor or healthcare professional tries their level best and more to ensure a favorable outcome for the concerned individual but the outcome is not entirely in our hands. Consequently, there are times we must be the bearer of bad news to people who have pinned all their dearest hopes on us. Their grief is palpable and obvious and the impact is often devastating, to say the least but the task is not optional and cannot be subordinated.
The situation must be handled delicately and deftly and with lots of compassion, empathy and patience for it’s both an art and a science. Good communication skills become paramount and ensure the doctor-patient relationship doesn’t abruptly break off at the point. It is a very sensitive and crucial interaction that if not handled with utmost can turn extremely ugly and distasteful for both parties concerned and often the messenger gets blamed for the misfortune and suffers the ire and wrath of those present.
It is imperative to ensure a comfortable and dignified atmosphere, the patient is seated comfortably, only relevant information be communicated concisely in the mildest of words. Spacing out the content helps in better reception and affords the patient some time to process it. As far as possible it should be done in person and be avoided over text or telephone, as it is rude and impersonal. All options and possible outcomes should be discussed patiently while maintaining composure and neutrality but sensitively. The gravity of the situation should never be undermined with lose and impractical advice and a comforting hand must always be offered.
I have been at the receiving end and I do understand the impact of such news and therefore try and put myself in the position of the receiver and behave accordingly. We would all be well reminded that we aren’t just doctors, we are healers and must tend to these mental wounds with a gentle hand and even gentler words. Love never killed anyone; it’s always the lack of it if any.