Some patients get angry. “In rare instances, they may even blame me for the bad news,” Dr. Borenstein says. “I tell them I wish they did not have the diagnosis, but I deal with realities.”
Dr. Kim has also found that silence can be more therapeutic than anything eloquent that could be said. “Sitting there in silence with him or her while being there for the patient emotionally can be very healing,” he says.
Dr. Minardo
In cases in which patients clearly have a poor prognosis and there is not much more to offer in terms of therapeutic treatments, reassure the patient that he or she will not be abandoned. Involving a palliative care consultant can be extremely helpful in these situations.
“If the patient is in denial, I always state that I am ready to start treatment when he or she is ready,” Dr. Rubenstein says. “I say that he is welcome to call after the appointment if new questions arise.”
Closing Remarks
Dr. McVey
At the end of the appointment, summarize the information you presented and collaborate with the patient to make a plan for the next step, which includes any treatment plan or follow-up appointment. Also make sure the patient has understood the information and does not have any more questions or concerns, Dr. McVey says.
Say, “Tell me in your own words what you understood from our conversation today” so you can clarify any misunderstanding or confusion, Dr. Minardo adds.
“Gently let them know that they may continue to have some negative reactions over the next few days or weeks,” Dr. Minardo continues. Depending on your policies, offer the patient your contact information and state that it’s OK to contact you before meeting again. Suggest that he or she write down any additional questions before the meeting to make sure he or she gets all of the answers at your next meeting.
Dr. Rubenstein tries to end on a positive note. “I give realistic expectations of time lines [because] some medications can take weeks to months to make people feel better,” she says. “I let patients know that the goal is to make him or her feel better and that we will continue to work hard together to reduce their symptoms.”
Support Mechanisms
Patients can have many different responses to bad news. For some, the initial reaction is most intense, but then they are able to cope sufficiently thereafter. Other patients may be vulnerable to depression or anxiety, and it is important for doctors to be aware of this and to normalize it. “Making appropriate referrals to mental health professionals is often a good idea. Whether the patient is depressed or just having some difficulty coping or sticking to a treatment plan, psychologists have a wide range of expertise in behavioral medicine and can serve as invaluable resources,” Dr. Minardo says.
