The Art of Telling Patients Bad News: One Physician's Story

Melissa Mills, BSN

Difficult conversations are part of healthcare. However, when the news is that a patient is terminal, it might be a bit harder of a conversation than others. One physician found himself on the receiving end of a difficult chat that spurred him to start mentoring other physicians about how to approach telling patients they're dying.

Dr. Ron Naito's Story

Dr. Naito is an internist with over 40 years of experience. When he saw the abnormal results of his blood test, he understood the prognosis. However, when he attended an appointment with his doctor, instead of learning of his formal diagnosis in a compassionate, dignified manner, he was met with attempts to dodge the results. "He simply didn't want to tell me,” Natio said

He told Indian Country Today that at one point, he overheard a specialist discussing the tumor biopsy results with a medical student outside of his exam room door. "They walk by one time, and I can hear [the doctor] say '5 centimeters,’” said Natio. "Then they walk the other way, and I can hear him say, 'Very bad.’” Dr. Naito noted that the shock of this encounter still bothers him. He knew the diagnosis and prognosis because of his years as a physician. However, the lack of compassion, professionalism, and empathy in the way he found out is palpable.

Dr. Naito has been using his time since his diagnosis to help educate medical students at Oregon Health & Science University how to speak to patients when the news isn't good, which isn't a skill many medical or nursing skills teach.

How to Give Bad News

Nurses aren't often the ones who are providing dire test results and terminal diagnoses. However, once the severity of the news wears off and the patient and family has questions, it's often a nurse who sits at the bedside providing answers, education, and support. If you find yourself in the midst of these conversations, here are a few strategies you can use to navigate through:

Show Empathy

Empathy, not sympathy, is one of the most powerful emotions you can offer. Being able to understand and share the feelings of the patient and their loved ones can put you in an excellent position to teach and support them through a difficult time.

Be Honest

These conversations are tough, but glossing over the details doesn't help anyone. Patients deserve the full truth about their diagnosis, expected symptoms, and what the dying process might be like. One study found that only about five percent of cancer patients fully understand their prognosis. Without a thorough understanding of the disease process and what to expect, patients lack the ability to make informed decisions about their care. As a hospice nurse, I quickly learned how to navigate these difficult conversations with truth and compassion. It wasn't always easy, but most patients appreciated the honesty.

Be Open to their Questions

You might not know the answer to some of the questions patients have. Sometimes, you may not even be the best person to give the answer. However, letting them ask the hard questions, and providing support is paramount to your relationship with them. If you don't know the answer, tell them honestly that you'll need to get back to them. Always follow through and get them the information they need.

Don't Use Cliches

It can be very tempting to use phrases like, "just stay strong,” or "it will be okay.” When you are the one receiving devastating news, those words are worthless and even insensitive. Instead, use phrases like, "it's okay to feel this way,” which supports the patient in their feelings.

Show Support

Patients want to know that they have a team of healthcare professionals around them who are there to help. Your job isn't to tell them what to do or what treatment decisions to make, but rather to support them in the decisions that are best for them. Easy ways to show your support can come through your words, but often all you need to do is be present and use active listening skills so that they know you hear them.

After the Bad News

Dr. Naito is sharing his story in hopes of preventing other patients from having the same experience he had. He shared that difficult conversations can be a "heartfelt, deep experience.” We must always remember that our patients are human and have emotions and feelings about their life that we don't understand, so being their support after the bad news is one of the most important places you can be for them.

Have you ever found out a poor prognosis in a less than professional way? If so, tell us about it. Or, have you witnessed one of these conversations and had to navigate through it with the patient and their family? Let us know your thoughts about challenging conversations and how you get through them.