How to Deliver Difficult News about Patients’ Diagnoses

Dr. Borenstein emphasizes his years of experience in caring for people who have rheumatic conditions—many of whom have been able to live full and happy lives. “Many young women are concerned about becoming pregnant while having RA,” he says. “I tell them that I’ve had many young women go through pregnancy with healthy babies. They figure out ways to take care of their children even when they have pain in their hands or wrists.”

Dr. Elyse Rubenstein, rheumatologist, Providence Saint John’s Health Center in Santa Monica, Calif., also sheds positive light on all news. “Although I will mention higher risks of cancer, such as in the case of dermatomyositis, I let the patient know that we will watch for it appropriately. When a patient is stuck on being ill, I will make him or her realize that this is not cancer and that they can get better with treatment,” she says.

Calming an Emotional Patient

If the patient becomes emotional and begins to cry, take a break and offer an empathic remark such as, “I know this must be difficult to hear” or “It must be overwhelming,” and just pause for him or her to have a natural reaction. Often, what is best, and what a patient needs, is for someone who cares to bear witness to his or her pain and to not feel alone. After a little while, or when the patient appears to be reconstituting, say, “There is more we need to talk about, but I want to make sure you’re OK first,” Dr. Minardo says.

“Try to understand what the patient is most concerned about,” Dr. Minardo continues. “Again, making empathic statements, such as, ‘You seem very upset. Tell me what you are most concerned about,’ will help you to gauge which direction to go. Saying, ‘Let’s talk about treatment options so you understand your choices’ and offering comforting remarks along with explaining that there are medications that can ease pain or providing some statistics (if they are compelling) will also reassure patients.”

Dr. Borenstein

Dr. Borenstein always has tissues in exam rooms for patients who are upset. “I offer them to the patient and say that he or she is having a natural response and we will work together to fight their illness,” he says. “Many times I refer to ‘we,’ in terms of taking on the challenge of the patient’s illness. Most patients respond to that pronoun in a positive way.”