How to Deliver Difficult News about Patients’ Diagnoses

Telling a patient that he or she has been diagnosed with rheumatoid arthritis (RA), ankylosing spondylitis, fibromyalgia or another debilitating, painful and/or chronic condition can be upsetting for a patient to hear and difficult for a rheumatologist to convey. Given this, it’s important to prepare for the appointment.

“Take a few minutes beforehand to contemplate how you want the meeting to go,” advises Daniel Kim, MD, rheumatologist, The Ohio State University Wexner Medical Center, Columbus, Ohio. “Review the patient’s medical history, and be ready to address any obvious potential questions.” Minimize the possibility of interruption by silencing your phone and pager, if possible. Ask not to be interrupted.

If time allows before the meeting, offer the patient the opportunity to bring along a family member or friend for support as “another set of ears. This will assist the patient in processing the information emotionally while knowing that someone else is there to take in the other details that might not fully register with the patient after he or she hears the initial bad news,” says Josephine S. Minardo, PsyD, clinical psychologist, White Plains, N.Y.

In addition, make sure you have allotted adequate time for the conversation and that it can occur in a private, quiet place. “The meeting should be conducted in an unhurried manner so the patient can absorb the information and ask questions,” Dr. Kim says. Taking these simple steps to reduce stress will benefit everyone.

Starting the Conversation

Dr. Kim

At the onset of the meeting, the physician should sit and speak at eye level with the patient, making eye contact. Remove any barriers, such as a desk or computer, between the physician and patient. Set the emotional atmosphere by conveying a caring attitude with your posture and tone of voice. “Introduce yourself, and greet everyone in the room, asking about their relationship to the patient,” Dr. Kim says.

An empathic and honest approach is always best. “Telling patients, ‘I know this may be difficult to hear, but it is important for you to know exactly what is going on so we can make good decisions together,’ is a good way to start the dialogue,” Dr. Minardo says.

“Touching a patient’s arm can be reassuring, but only if you are comfortable doing so,” says Anne A. McVey, PhD, clinical psychologist and assistant clinical professor, The Ohio State University Wexner Medical Center, Columbus, Ohio. “Do not rush the conversation, and do not look at your watch or the clock. Be sure to use direct, straightforward language. Match the language you use to the patient’s education level; do not use medical jargon. Choose your words carefully, avoiding doom-and-gloom messages.”