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Writer's pictureWanjiku Ngigi

Tips for Delivering "Bad News"

Updated: Mar 1

Someone close to me shared a poignant account of how her husband received the news of his cancer diagnosis.


"The doctor had been making rounds for about a week, and Dan* was growing increasingly anxious from the prolonged wait. He just wanted to know what was happening," she began.


According to her, the doctor, after reviewing numerous documents, muttered a few words under his breath while standing at Dan's bedside. He then abruptly turned towards the exit. Dan, in a desperate attempt to grasp the situation, called out loudly. When asked about his diagnosis, the doctor, with an emotionless expression, uttered, "Oh, it's cancer," and left.


I refrained from probing into the depth of trauma Dan might have experienced during that encounter; it most probably was marked as a distressing moment that still haunts him years later.


Fortunately, Dan underwent successful surgical and medical treatments, entering remission and living a cancer-free life thereafter.


A Double-Edged Sword


As someone in the medical field, I can assert that no doctor desires to deliver negative news to their patients. I vividly recall confirming metastatic liver malignancy in one of my favourite patients, whose cheerful visits to the clinic with his loving wife starkly contrasted with the grim reality of his life-changing diagnosis. Witnessing the pain my medical advice inflicted on his family left me with a lingering sense of guilt.


Seeing posters of his family's fundraising efforts for his treatment added to my remorse, almost as if I had played a role in the illness that besieged him.

Sad doctor

Being the bearer of bad news is a daunting responsibility, and my heart goes out to clinicians who routinely face this challenging task.


Death and pain have a profound impact on the mind and heart. Never forget this as you practice.


Handle with Care


Acknowledging this reality, there comes a weighty responsibility to manage one's emotions and approach.


As a clinician, you must deliver health-related news with the utmost empathy, an integral aspect of the Hippocratic oath you took. May you never forget.


Here are some tips to ensure professionalism and effectiveness in delivering difficult news:


1. Verify the diagnosis with relevant practitioners, ensuring confirmation through necessary tests like a biopsy for malignancies rather than solely relying on imaging reports.

2. Consider the atmosphere; the delivery of "bad news" is unforgettable. Control the setting to the best extent possible, opting for a well-aerated, quiet, and private room.


3. Have support on standby; involve a counsellor or therapist and keep them nearby for emotional support, but not in the room during the initial revelation as this may create panic which may make the process more difficult than it already is.


4. Maintain composure and dissociate from emotional outbursts; as a healthcare worker, remember that this moment carries with it implicit structures that state that you hold a position of authority at this point, and patients and their loved ones look to you for strength and guidance.


5. Speak slowly, avoid jargon, and use clear language, especially when conveying news of death, to prevent misunderstandings and foster clarity. I am guilty of this as many times patients' loved ones would ask me "So when can we see them?" after I broke the news of their loved one's death. This was because I would use colloquial statements such as, "He/she has rested now" which is misleading and unclear, leaving room for denial to fester. Try your best to be kind but direct as you express a factual statement.


Doctors wheeling patient out of surgery room


6. Allow time for questions; don't rush away after delivering devastating news. Offer to address any inquiries and provide additional support, especially after a significant event like the death of a loved one.


Opportunities for Growth


In the ever-evolving field of healthcare, there's always room for improvement. Reflect on past experiences, seek feedback from colleagues, and embrace opportunities to shadow more experienced professionals. Learn from their approaches to this crucial aspect of clinical practice to enhance your skills in breaking difficult news compassionately.


*: Not his real name.


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