Communicating Bad News to Patients Best Done In Person

In a busy medical practice, we have all been faced with the task of how to handle effective patient communication. Whether relaying test information such as laboratory results, radiology tests, or biopsy results, there is really no substitute for face-to-face communication with our patients.

The best way to handle patient communication is with a face-to-face encounter. This is very useful because not only does it allow the physician to deliver potentially bad news to the patient in a relaxed office setting, it also allows the patient and their family to ask the physician any questions that might be pertinent to the situation.

I was faced with a similar task just last week. A longtime friend of mine came to the office with complaints of a productive cough and wheezing. What makes this patient unique is that he had not had a medical evaluation in over 25 years. He called the office to request service for the cough and after the encounter was completed, he went to radiology for a chest X-ray. Unfortunately, the X-ray showed not only a new left lobar infiltrate, but it also showed the presence of a 7 cm mass. The patient and his wife were called back to the office the next day to discuss the result and to plan for follow up testing. To make a long story short, a CT scan of the chest did in fact demonstrate a mass in the lung that was very worrisome for lung carcinoma.

The patient was then sent to the pulmonologist for bronchoscopy and biopsy. The result of the biopsy was a poorly differentiated non-small cell lung carcinoma. The patient was then sent for a CT scan of the head which unfortunately showed the presence of an enhancing mass in the brain. I was then faced with the task of explaining the test result and the need for follow up oncology care. The patient and his wife were called back to the office to discuss the test result. While the patient and his wife were understandably very upset regarding the result of the scan, they did very much appreciate the time that we had taken to properly explain the test result and also to explain the need for follow up care.

Situations such as this are very sad. Physicians must remember that our patients place a very high level of trust in us, and as a result, even though the news to be conveyed is ultimately very bad for the patient, it does allow for additional time to spend with the patient for effective communication. In situations such as the above example there is not much else we can do other than to be a careful listener to the patient. It allows us to demonstrate to our patients that we are genuinely concerned regarding their well-being. And, more importantly, such news was not conveyed by a phone call or a letter.

When I am faced with situations such as the above, I ask myself what I would be comfortable with if the patient were a family member. When you treat your patients as if they are either family members or close friends, you can be assured that proper care will be delivered. Even if the news to be delivered is ultimately bad for the patient, I have always found that patients are very pleased with honesty and straightforward explanations.

We are all going to be placed in similar situations as the above example. Even though your schedule may be busy, even though you might be pressed for time and find yourself constantly running behind, please take time to spend the needed amount of time with your patients to explain the results of important testing to them and they will ultimately be very grateful for your efforts. We never know when we ourselves or members of our family might be in a similar situation one day. Taking the necessary time to spend with your patients to listen to them, pray with them, or just quietly sit with them and share a tear shows that you are deeply concerned for their well-being.

While I never enjoy the process of conveying bad news to patients, I want to make sure that the communication of such bad news is completed in an office setting and the proper face-to-face encounter is always completed properly.