David Borenstein, MD, MACR, MACP, partner, Arthritis and Rheumatism Associates, and clinical professor, Medicine Division of Rheumatology, Department of Medicine, The George Washington University Medical Center, Washington, D.C., begins by saying that he has formed his opinion by reviewing the patient’s medical history, laboratory studies and radiographs, and by completing a physical examination. “Patients realize that I have spent the time to arrive at a conclusion that is based on what pertains to his or her situation at the present time,” he says. “I may agree with what may have been given as a diagnosis previously or tell the patient why I have formed a different conclusion. If this is a new diagnosis, I assure the patient that I will provide the reasons for my diagnosis.”
Nuts & Bolts
When relaying negative news, it’s helpful to share information in small quantities and to pause frequently. “This allows you to assess the patient’s understanding of what you said and gauge his or her emotional response to the information,” Dr. Kim says.
“Part of communicating bad news is also giving the patient the space and time to respond to it. Initially after hearing the bad news, the patient may be angry, confused or distressed. You should allow the patient to go through this phase by waiting quietly. When the patient is ready to talk, you can respond with empathetic statements, such as, ‘I can only imagine what you’re going through right now,’ or ‘this must be overwhelming for you.’”
Sometimes, visuals can be helpful. If you think drawing a diagram is the best way for the patient to understand what you are saying, say, “I think it would be helpful to explain it this way,” and then offer the diagram. “Looking at something, rather than just listening, is a different way to take in information, which some patients really welcome,” Dr. Minardo says. Handouts and pamphlets can be helpful as well.
When sharing information about the diagnosis, it can also be important to discuss the prognosis. Regarding RA, Dr. Kim might say, “I do have some good news. In the past couple of decades, many new medicines for RA have come onto the market. RA is actually a very treatable condition. I want you to feel hopeful about this disease, because we can control it with medications and prevent future damage and deformities in your hands.”
Likewise, Dr. Borenstein tries to reassure patients that the medical community’s abilities to care for individuals with osteoarthritis, RA and other rheumatic diseases have advanced significantly in recent years. “I tell patients that therapy will correspond to the intensity of disease and the patient’s response,” he says. “I will begin by prescribing therapies with fewer toxicities, and only advance to medications with more side effects if necessary. I also point out that non-drug therapies, such as physical therapy, certain forms of exercise and good nutritional choices, can have beneficial effects.”
