Bad News Delivery in the Medical Industry - Essay Example

Personal communication and effectively communicating the message or thought is not only a skill but it turns into an art in the medical industry. In this industry, the patients and their carers alike, need to be told some unpalatable facts and hence the doctors and counsellors, need to be trained specially in this art of communication. The EPEC1 participant’s handbook is highly relevant document that details the ways and means to communicate bad news to the patient and the carer in a manner that both informs about the news and at the same time, it is able to provide them with the inner strength to cope with it. The manual is able to envisage the various difficulties including the language barriers that one is sometimes, required to overcome, in order to effectively communicate the bad news. Language barrier notwithstanding, the basic criteria for communicating the bad news remains the same. The manual has outlined the main objectives into four sequential steps, each of which need to be followed with specific protocol and appropriate emotional response. The manual has effectively demolished the pre-existing notions that conveying bad news, especially in the life threatening cases, is not only distressing for the patients and the carers but it is also bad for their therapeutic relationship. It has, in fact, established that the conveying bad news to the people concerned is not only necessary but when delivered directly and compassionately, prepares them to face the challenges of the disease with much more confidence and optimism. The bad news gives them an opportunity to make realistic goals for the future and provide emotional support to the patient. The bad news delivery is complex by nature and must be delicate handled by experts and preferably delivered by the physician concerned only. When the patient is directly informed about his medical status by his physician, it sends a silent message of trust which is taken positively by the patient and his carers. Hence the six step protocols as recommended by Robert Buckman in his book ‘How to Break Bad News: A Guide for Health Care Professionals’, are very pertinent and probably form the backbone of patient-physician relationship and which are; getting started, what does the patient know, how much does the patient wants to know, sharing the information, responding to patient and family’s feeling and planning and follow-up. The first three protocols basically try to find the patient and his family’s understanding of the disease and to gauge their apprehensions, hopes and expectations. At the same time, the physician is able to inform them about the various aspects of the disease or the illness. It is important that the meeting between the physician and the patient and his family, is carried out in privacy and in an environment that encourages informal and frank discussion. The physician must be fully prepared with all the hard facts and must answer any awkward and sometimes silly questions of the family with the same patience and seriousness. This phase gently prepares the family for any bad news that might be in offing. The fourth protocol of sharing the information or the bad news is the toughest part and is best delivered directly but slowly, in plain words that are easy to understand. This gives the patient enough time to absorb the gravity of the situation. The rightly chosen words have more impact and help develop mutual trust that may be more effective than anything else. Sometimes the patient may not like to hear the bad news directly from his physician or the family may not want the seriousness to be disclosed to the patient. In such cases, it is advised that matter be resolved by effective communication with the parties concerned. The last two protocols can be defined as the emotional response to the bad news and here again the onus to act appropriately and sensitively falls on the physician who must be prepared with tissue papers, water and tea or coffee so that the patient and his family can recover from the shock with relative ease. The emotional outbursts are natural and must be allowed to express them. Once they are overcome, they pave way for future course of actions that they have to take. ‘A shared understanding of the news and its meaning will enhance the physician-patient relationship and facilitate future decision making and planning’(handbook). Bad news at any time is distressing but bad news to a patient is more emotional because they go to the physician to get well. That is the reason that the bearer of bad news must be fully equipped and trained to alleviate the emotional distress of not only the patient but also that of his family. He must also reassure them time and again, of his support and advise them appropriately for their future course of action that would be required. When the bad news is to be given to a person who does not understand the language of the physician, interpreters must be used by the physician. During the course of disclosing the bad news, the physician must continue to make eye contact with the patient and his family and make sure that they understand the full meaning. Robert Buckman’s 6-step protocols are universal in nature, therefore, language is just a barrier that can be overcome by the use of interpreter and the rest of the procedure is same as before. The affect of bad news is often mitigated by the correct prognosis. The patients have often different motives to know the progress status of their illnesses. Where some may like to plan their future according the prognosis, the others may be terrified and may need reassurance. It is, therefore, advisable that in the course of the treatment itself, the patient and his family is informed about the prognosis. This way, they are prepared for any adverse situation, so far as the patient is concerned and may be able to take any bad news with relative calm and equanimity. The physician must prepare them for any eventuality or unexpected surprises so that they are not so vulnerable when they finally receive the bad news. Sharing information with caregivers is critical because it facilitates ‘continuous plan of care, avoid constant repetition of questions, and avoid unwanted activities’ (manual). The bedside log book of patient’s prognosis is a ready reckoner that must be accurately maintained and must be accessible to all the persons concerned. Bad news delivery in the medical industry is indeed a highly skilled job that is carried out by the physician himself. The Buckman’s guide has succinctly provided the six gems in the form of protocols that promote the creation of appropriate environment and the easiest way to deliver the bad news. The patient-physician relationship is highly personal that is backed by the full trust of patient on his physician. Hence the way physician delivers the bad news to his patient and his family is crucial for the patient as well as for his family or caregiver. A good physician would always strive to give the bad news in a manner that would help him to retain the trust of his patient. Reference Buckman R. How to Break Bad News: A Guide for Health Care Professionals. Baltimore, MD: The Johns Hopkins University Press; 1992:65-97. . Communicating Bad News. EPEC Participants’s Handbook. © EPEC Project, The Robert Wood Johnson Foundation, 1999 Read More