This presentation discusses breaking bad news to patients and their families by obstetricians and gynaecologists. It covers various situations that may require delivering bad news such as cancer diagnoses, infertility, stillbirths and deaths during or after procedures. The presenter emphasizes that breaking bad news is difficult but an important skill that requires preparation, empathy and communication. Strategies are provided for how to have difficult conversations, address emotional responses and support patients through crisis situations.

1. Breaking
BAD
News
Gynaecologists
Dr. Sharda Jain
Chairman
View Point

2. I Dedicate this PPT to my
Colleagues , Students & Patients
Review This Lecture at
slideshare.net
Presented an annual conference Ghazibad Obstetric society

3. PROFESSIONAL LIFE is
like See saw game.
Some time you up ;some time you down .
You have to take it in your stride …

4. CONSUMER
PROTECTION
ACT
1995
Cases have Sky Rocketed

5. Hippocratic
Oath

6. Bad News
Can not be eliminated all together !!
You have to take it
in your stride …

7. How a Person will Respond to a
BAD News
Difficult to Predict !!
Especially in a STRESSFUL Environment in
Hospitals & IVF Clinics

8. What do you Think
is BAD NEWS ?
• What went wrong?
• How it Could
be avoided.

9. How will you react –if you
were THE Patient or Relative ?
Place your self in Patient Position

10. What is Bad News?
It is ANY INFORMATION which is
Likely to
• ALTER PATIENT’S VIEW
OF THE FUTURE all together …
*
• ALTER PATIENT’S LIFE
ALL TOGETHER

11. VARIOUS IDEAS on BAD NEWS?
• Feeling of NO HOPE,
• A threat to MENTAL OR PHYSICAL
WELL BEING
• Left with FEWER CHOICES in her life
• News that drastically and negatively
alters her or his future”

12. Every Day’s
CONCERNS & REALITIES
in labour ward
People are
Critical with
Treatment
SB / NND
Mother’s Death

13. Concerns & Realities
CANCER WARD
Families & Patients are full of
Complains
• Doctors don’t offer much
advice
• Alternatives are not detailed
• How to manage the debilitating
pain associated with the
disease.

14. Trigger

15. “At times ,
causalities
happen & doctors
end up having
”RUDE & UNCARING“
Behavior of Public
Kerela Gynaecologist beaten – up
August 2014

16. Pro. PK Devi
MOST SUCCESSFUL DOCTORS
are Those Who Have
Good
Communication Skills.

17. Always Walk
Extra - Mile
To Make our
Patient / Family
Comfortable
Pro. PK Devi

18. We are not taught
“Soft skills” How to Handle
Emotional Outburst of patient & family
in four walls of medical college
YOU ARE LUCKY TO HAVE
GOOD BOSS / MENTOR !!

19. Breaking
Bad
News
it is mandatory to learn soft skills
how BBN to patients & family

20. Various Situations Faced by
We Gynaecologists
Bad
Diagnosis
CANCER
INFERTILITY
Azoospremia
Still
Birth
B/L Block Tubes
DOT NND IVF failure
Death
in O/G
Rec.
Endometriosis
Miscarriage Cerebral palsy
Thala. Major

21. DOT DEATH
STILL
BIRTH
Can’t Have
Baby

22. DEATH
on
Operation
Table
(DOT)
in O/G
is extreme rarity

23. DOT Seen occasionally
80/20

24. DEATH
Obstetrics /
Gynaecology
Is
no Joke !!!
A Gynaecologist is caught at least once in
lifetime in this tragedy !!

25. Still birth / NND
Within 24 hrs
O NE CRORE Compensation is minimum

26. Recurrent Miscarriage
Recurrent
IVF
Failures
HIV
CANCER
Young age Last stage Recurrence
REQUIRES CAREFUL HANDLING

27. Counseling for “Ending
Treatment” is “Big Dilemma”
When to advice patients that
“enough is enough”
Cancer Infertility Rec.
Miscarriage
Endometriosis

28. Few Facts
DOT / Still Birth
It is like death in police custody where
there is no help for patient & nobody knows
the facts except doctors & their team.
Litigation Arrest

29. Cause of Litigations
*Total Lack of Empathy
* Lack of Good
Communication skills

30. Doctor’s should leave
Silly Excuses
• Over work
• Over tired
• my junior explained you
before.

31. Breaking BAD NEWS for us!
Is the MOST DIFFICULT TASK !!

32. Why Difficult ??
• Both Party are UPSET
• NOT PLEASANT task by doctors
• TAXING for both (BBN / receiving BN )
• LOUSY JOB has long lasting impact &
repercussion.

33. What are we worried
ABOUT – Breaking Bad News
• Damage to reputation
• Facing questions of relatives
• Fear of mob violence
• Handling police enquiry
• Medico-legal issues – arrest,
courts, case, judgment…
• Compensation amount
• Loss of confidence
• Stress in future cases

34. Doctors - today are
realizing that they have to
deliver Bad News /
Diagnosis with care
Breaking Bad News
is an ART
This ART – We All Have to Learn it

35. Doctors Need to Polish Soft
Skills to Deliver
“Tough”
Bad News
Strategies
Challenges

36. ABCDE our 1st choice
A- ADVANCE PREPARATION
B- BUILD ENVIRONMENT / RELATIONSHIP
C- COMMUNICATION WELL
D- DEAL WITH REACTION
E- ENCOURAGE & VALIDATE EMOTIONS

37. BLAT
• BUILD TRUST
• LISTEN ,
• APOLOGIZE,
• THANKS
Is our 2nd choice
“in our practice it helps us in dealing with
difficult situations and breaking bad news

38. Other Practical Approaches to BBN
SPIKES
BREAKS
Setting and listening skill
B- BACGROUND
Patient perception
R- RAPPORT
Invitation to give
E- EXPLORE
Information
A- ANNOUNCE
Knowledge
K – KINDLING
Explore Emotion &
S- SUMMARIZE
Empathize
Strategy and summarize

39. Practical Tips
For
Great Interview
(Patient / Family)

40. Keep a Bold Face !!
Never worry, “Be concerned”

41. How to Handle The Situation…
Death / DOT / Still Birth
 Gather
 Ask for help.
 Relax
 Review sequence of events
 Do not adopt a “Blame Culture”
 Proper documentation
 No discrepancies in records
 No comments by junior staff
Never worry, “Be concerned”

42. RELATIVES WANT to know TRUTH
 Be honest
 Integrity pays
 Sympathetic approach

43. Anticipate Reaction of Patients /
Relatives & Handle it Well

44. LET US RECAP
Emotional Responses to a bad News
• Denial
• Despair
• Anger
• Bargaining
• Depression
• Acceptance
S upport Sys tems from doctor is must

45. Communication is two way Process
Let them air their emotions

46. Tips to Communication Skills
• Avoid AGGRESSION or putting BLAME
on relatives
• Staff SHOULD NOT CONTRADICT
statements made by consultants to
avoid misinterpretation by relatives.
• DO NOT REFUSE TO
GIVE RECORDS
or refuse postmortem,
rather suggest it from your side.

47. Being Sensitive to Verbal & Nonverbal
Language of the patients & Relatives
Give time & space:
EMOTIONAL DISCHARGE
Give opportunity to ask questions

48. Strategies for coping crisis in
Surgery / Obstetrics / IVF

49. INFORMED CONSENT
Is to be taken seriously
o Is vital for gynaecologists to fully understand the
importance of counseling & take
STD / High Risk Consents
Video Recording
(if smelling problems !!)

50. Meaningful 1ST COUNSELING of
couple biggest tip
Let them Be mentally prepared to
ACCEPT FAILURE
IVF / Cancer Cases

51. After crisis – problem
focused BBN
1. EMOTIONAL DISCHARGE
2. Encourage CALM ACCEPTANCE
3. Be a PROBLEM SOLVER
4. Explain ALTERNATIVES – to move
ahead

52. “Their first reaction is disbelief, then blame and
anger ..
as a doctor, don’t say
anything , just hold their
hand and let
them vent their anger .
They generally
come back and talk
to you after a while”
BBN in pregnancy / Infertility is
all together different game !!

53. BBN for “Ending Treatment”
is Another big task
* A patient – centered emotionally
focused approach is the key
* Help the patient set the agenda
•Help them to find MEANING IN LIFE ,
•Assist them in redefining goals
• To promote long term adjustment
in life by Real Life examples

54. Relaxation technique &
psycho therapeutic counseling
Helplessness
• Help her to speak - up
• Improve decision making skill
•Advice for treatment holidays
• Problem solving skill
• Benefits of physical well – being
• Nutrition.
• Spiritual counseling
Acceptance
doctor you are Great !! Now - I can handle the problems
related to my infertility / Pregnancy Loss

55. Arrange & Join
Soft Skill Workshops
• Leaders speak
• Experience Sharing
• Role Plays

56. CREATIVE WORKSHOP for
Doctors & Medical Students
to make them
• Expressive
• Empathetic
• Concerned
• But bold & self confident

57. Last, But Not The Least…..
Every new day brings CHALLENGES AND OBSTACLES
 Stop thinking about it constantly at HOME
 Keep your morale & self confidence intact
 Learn the lesson it teaches
 Take a small break

58. INSURANCE COVER

59. Cool..
Our Attitude
should become
like Hotel Industry

60. Left you with many Q unanswered

61. ADDRESS
11 Gagan Vihar , Near Karkari Morh
Flyover Delhi -51
CONTACT US
9650511339
011-22414049,
WEBSITE :
www.lifecarecentre.in
www.drshardajain.com
www.lifecareivf.com
E-MAIL ID
Sharda.lifecare@gmail.com
Lifecarecentre21@gmail.com
info@lifecareivf.com