-----BREAKING BAD NEWS----- Dr. Shaharyar Ahmad Bhatti MBBS, MCPS, DPP, MRCGP (INT’L)
“ I would rather feel compassion than know the meaning of it” Thomas Aquinas
WHAT IS A BAD NEWS? <ul><li>It is any information which is likely to alter drastically a patients’ view of the future </li...
Emotional responses to a bad news <ul><li>         Denial </li></ul><ul><li>         Despair </li></ul><ul><li>        ...
WHY IS IT DIFFICULT? <ul><li>    It usually means that biomedical measures cannot help, and thus it undermines the clinic...
TELL THE PATIENT? <ul><li>No way????? </li></ul><ul><li>  </li></ul><ul><li>The patients:- </li></ul><ul><li>      Usuall...
HOW DO WE KNOW HOW MUCH A PATIENT WANTS TO KNOW? <ul><li>  Two ways: </li></ul><ul><li>BUCKMAN (Canada) </li></ul><ul><li>...
THE INTERVIEW <ul><li>OPENING </li></ul><ul><li>     Sooner then later </li></ul><ul><li>     Patient should have someon...
THE INTERVIEW <ul><li>EXPLORING </li></ul><ul><li>      Find out if anything new has happened since last meeting </li></u...
THE INTERVIEW <ul><li>CLOSING   </li></ul><ul><li>      Recap / Summarize </li></ul><ul><li>      Find out what the pati...
What not to do? <ul><li>Jargon and technical language </li></ul><ul><li>Euphemisms </li></ul><ul><li>Evasion </li></ul><ul...
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Breaking bad news ----

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Breaking bad news ----

  1. 1. -----BREAKING BAD NEWS----- Dr. Shaharyar Ahmad Bhatti MBBS, MCPS, DPP, MRCGP (INT’L)
  2. 2. “ I would rather feel compassion than know the meaning of it” Thomas Aquinas
  3. 3. WHAT IS A BAD NEWS? <ul><li>It is any information which is likely to alter drastically a patients’ view of the future </li></ul>
  4. 4. Emotional responses to a bad news <ul><li>        Denial </li></ul><ul><li>        Despair </li></ul><ul><li>        Anger </li></ul><ul><li>        Bargaining </li></ul><ul><li>        Depression </li></ul><ul><li> Acceptance </li></ul>
  5. 5. WHY IS IT DIFFICULT? <ul><li>    It usually means that biomedical measures cannot help, and thus it undermines the clinicians familiar role of the healer </li></ul><ul><li>    The clinician is upset </li></ul><ul><li>    The patient will be upset too, and can respond unexpectedly </li></ul><ul><li>    The patient may require emotional support which may be beyond what the clinician can give </li></ul><ul><li>    The patient may blame the clinician, and indeed there may be an element of medical mishap to complicate matters </li></ul>
  6. 6. TELL THE PATIENT? <ul><li>No way????? </li></ul><ul><li>  </li></ul><ul><li>The patients:- </li></ul><ul><li>      Usually know more than anyone has guessed </li></ul><ul><li>      May imagine things to be worse than they are </li></ul><ul><li>      Welcome clear information even about the worse news </li></ul><ul><li>     Welcome liberty to speak as they wish about their illness and their future rather than join in a charade of deception decided be others </li></ul><ul><li>     Differ in how much they can take at a time </li></ul>
  7. 7. HOW DO WE KNOW HOW MUCH A PATIENT WANTS TO KNOW? <ul><li>  Two ways: </li></ul><ul><li>BUCKMAN (Canada) </li></ul><ul><li>“ If this condition turns out to be something serious are you the type of person who likes to know exactly what is going on.” </li></ul><ul><li>  </li></ul><ul><li>SANSON-FISHER (Australia) </li></ul><ul><li>Explicit catagorisation by direct questions in succession </li></ul><ul><li>“ If you would like to know, I will tell you…..” </li></ul><ul><li>What the diagnosis is? </li></ul><ul><li>What the treatment will be? </li></ul><ul><li>What sort of symptoms you will have? </li></ul><ul><li>What examination and test will be necessary? </li></ul><ul><li>What can be done for any physical discomfort or pain you may have? </li></ul><ul><li>What the outcome may be? </li></ul>
  8. 8. THE INTERVIEW <ul><li>OPENING </li></ul><ul><li>     Sooner then later </li></ul><ul><li>     Patient should have someone with him / her </li></ul><ul><li>    Everyone introduced </li></ul><ul><li>    The doctor explains his status and extent of his involvement </li></ul>
  9. 9. THE INTERVIEW <ul><li>EXPLORING </li></ul><ul><li>      Find out if anything new has happened since last meeting </li></ul><ul><li>      What does the patient know and how does he react to it? </li></ul><ul><li>      WARNING SHOT_______ very important </li></ul><ul><li>      Allow time / pause to let the warning sink in </li></ul><ul><li>      Discover how much the patients want to know </li></ul><ul><li>      Then place the facts ________ better in small chunks with pauses </li></ul><ul><li>      Be prepared to stop at any point & resume later. </li></ul><ul><li>      Plan and support </li></ul><ul><li>      Provide some positive information and hope tempered with realism. </li></ul>
  10. 10. THE INTERVIEW <ul><li>CLOSING </li></ul><ul><li>      Recap / Summarize </li></ul><ul><li>      Find out what the patient has understood so far </li></ul><ul><li>      Safety net </li></ul><ul><li>      Agree on the next appointment and for what purpose </li></ul><ul><li>      Provide written information </li></ul><ul><li>      Goodbye </li></ul>
  11. 11. What not to do? <ul><li>Jargon and technical language </li></ul><ul><li>Euphemisms </li></ul><ul><li>Evasion </li></ul><ul><li>Conflicting information </li></ul><ul><li>Percentages and statistics </li></ul><ul><li>Obfuscation </li></ul><ul><li>“Every thing is going to be fine” </li></ul>

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