You answer your pager– it’s the nurse on your unit’s ward.
“You paged me?”
“Yes. Mr Finlay wants
to know the results of his CT. Are you able to come and speak to him?”
“Um, okay. I’ll be there in a minute.”
As an intern or a junior resident in a public hospital, you are usually the first port of call when patients or their relatives have questions – even when covering other units and unfamiliar patients after hours. And even as a junior doctor in the Emergency Department, you may need to tell a patient that they have had a ‘heart attack’, or a ‘broken hip’ requiring surgery.
As a doctor, delivering some degree of bad news will be part of your everyday job. This is particularly challenging when you have only just started life as a doctor. All that medicine you’ve learnt suddenly becomes real and a diagnosis is no longer an answer to an exam question but concerns a real patient, with real emotions.
In an ideal world, sensitive conversations should be handled by senior doctors, however this is often not possible in a busy public hospital. Ultimately, it’s preferable to keep a patient informed, provided you are clear on the limits of your knowledge and understanding. This guidance will help you manage these discussions with confidence.
Planning the discussion
- Remember that if there is anything you are not comfortable doing as an intern, speak to a senior doctor.
- If you need to speak to a patient, ensure you know and understand the facts – and if you are unsure, say so. Don’t guess! There is nothing wrong with admitting something is outside your experience and that you need assistance.
- Always consider whether you need an interpreter, and preferably use someone onsite. If an interpreter is unavailable, it’s best to defer the conversation. Asking friends or family members to act as an interpreter is not advisable.
Breaking the news
- Find a comfortable and private meeting place to have the discussion – often this will mean the patient’s bedside, so ensure they are comfortable with this. Allow ample time so you do not appear rushed, impatient, or distracted, and avoid answering phone calls or pages (unless a code is called).
- If you feel you do not know enough to speak with the patient and all efforts to contact a senior doctor have failed, explain that while you are not in a position to inform them fully, you will continue to seek the advice of a senior doctor.
- In any event, confirm you are speaking with the correct patient and establish what they already know. This allows you to reinforce correct information and understand what they are expecting to hear. In any event, confirm you are speaking with the correct patient and establish what they already know. This allows you to reinforce correct information and understand what they are expecting to hear.
- Show empathy and sensitivity. Speak clearly and avoid medical jargon or acronyms, repeating information if necessary.
- Gauge how much information the patient wants to know as everyone is different. Give them an opportunity to digest the information and ask questions. If you don’t know the answer, be honest and admit any uncertainties, but don’t offer false hope.
- Offer to speak with the patient’s family or others, if the patient gives their consent.
- Give the patient an opportunity to express their emotions. Ask how they are feeling and whether they have any thoughts they wish to share.
- Sometimes a patient enters a state of shock immediately upon hearing unexpected bad news. In this case, don’t rush through details; if possible, offer to come back at a later time when they are better able to process the information.
- Explain that treatment options will be discussed with the senior doctors.
Ending the discussion
- Summarise what has been discussed and encourage the patient to contact you or another member of the treating team with any further questions.
- Always acknowledge the patient’s fears, and follow their cues for information. Seek to reassure the patient, for example, “We will make sure you are as comfortable as possible”, however do not be patronising or casual.
- Patients often misremember or mishear information they are given, especially under stressful and unfamiliar circumstances. Therefore, thoroughly documenting the discussion is very important. This includes the names of anyone else present, whether an interpreter was used, the matters discussed and information provided (or not provided).
- Breaking bad news can be a difficult experience, especially for junior doctors; so remember to take a short break afterwards and settle yourself before moving onto your next task.
Find out more
For more information, download our factsheet What to do when the news is bad or view our short video.
For more advice, call Avant’s Medico-legal Advisory Service on 1800 128 268.
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