3 best practices for giving patients bad news

There is no one right or wrong way to tell a patient troubling news, but there are some best practices and common mistakes to avoid, according to an article from Medscape. Before the next serious conversation you have with a patient or family members, consider the following doctor-to-doctor advice:

Replace the term "bad news" with "serious news." The first letter of the widely used "SPIKES" mnemonic stands for "setup." This means not just ensuring you have the time and physical space for a private conversation with the patient but also helping the person prepare emotionally to hear what you have to say.

But the common "I'm afraid I have some bad news" preface isn't as constructive as it could be, according to Anthony L. Back, M.D., a professor at the University of Washington and the Fred Hutchinson Cancer Research Center in Seattle. "I think of this as serious news because, as a doctor, I talk to people about serious things," Back explained. "The frame of seriousness opens up what my role should be: I should help people figure out what's really worth doing."

Use definitive language. While the conversation doesn't have to be all negative, it's important to not use euphemisms that may give patients an overly optimistic outlook on the circumstances, noted Kevin Campbell, M.D., a cardiologist and assistant professor of medicine at the University of North Carolina in Chapel Hill. For example, don't use the phrase "moved on" or "passed away" to say that a person has died, according to the article.

Take time. It can be tempting for doctors to rush through the news of an unfavorable lab result, for example, because their own anxiety makes them want to get it over with, Back said. Or they may backtrack too far into explaining how a person's illness was diagnosed, making it difficult for the patient to follow along or anticipate where the story is going.

To avoid these pitfalls, Back recommends "giving patients the headline" first, pausing to let it register, and then filling in details and answering questions. Most physicians who spoke with Medscape agreed that these conversations take longer than a typical office visit, but that telemedicine may be an option if done with great care.

To learn more:
- read the article