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Doctors, Patients and Bad News: Why These Conversations Matter So Much (Part 1 of 2)

Want to end small talk at a cocktail party? When someone asks you what you do, say: “Um, I break bad news.”

Immediate downer, right? Maybe not.

As a clinician, I break bad news all the time; so does every medical provider in practice. Talking to our patients about illness or unforeseen negative events is one of the most difficult but also one of the most important parts of providing medical and emotional care.

Breaking bad news can strain doctor-patient relationships

It turns out that these breaking-bad-news encounters are more challenging than you might think. Research has shown that patients often don’t understand what we tell them in the immediate aftermath of a difficult event or result. Dealing with unexpected bad news raises well-understood cognitive roadblocks. The blow is emotional and intellectual. The mind freezes.

Because of this, patients might make decisions that they regret later, because they simply were not given the tools to process the information that was necessary at the time.

In addition, breaking-bad-news discussions are more important than most of us realize. Research shows that when patients feel dissatisfied with their care (and are therefore more likely to sue) it’s usually not because of what happened in the hospital, but rather because of how it was handled afterward. Feeling that they were lied to, that the truth was obscured, or that their provider abandoned them in the middle of a difficult experience are common reasons that patients leave the experience angry. Taken on a larger scale, this communication deficit has contributed to our current malpractice crisis, and in no small part to the increasing expense of medical care in general.

So, all of a sudden, “breaking bad news” becomes an issue with personal and public health ramifications. And because of the importance of this topic, I’ve spent the last few years trying to figure out how all clinicians can do it in a more effective, more compassionate, and less damaging way.

During my Montefiore Medical Center fellowship in maternal-fetal medicine (a subspecialty of obstetrics and gynecology, also known as “high-risk obstetrics”), I’ve been working hard on my research project, “Breaking Bad News in Obstetrics: A Trial of Simulation-Based Education.” The project focuses on the critical importance in medical-provider education of how we talk to patients whenever something bad happens; it explores whether we can teach the skills to make this encounter less painful and more effective, and if so, what is the best way to do that.

On Thursday, in part two of this post, I’ll take a look at research findings from this project and the important roles that simulation and feedback play in improving communications skills when conveying difficult and potentially life-changing news.

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Chavi Eve Karkowsky, M.D.

Chavi Eve Karkowsky, M.D.

Dr. Karkowsky is assistant professor of obstetrics & gynecology and women’s health at Albert Einstein College of Medicine and medical director, obstetrics & gynecology and women's health at Montefiore Medical Group-Comprehensive Family Care Center.

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