COMMENTARY

Learning to Break Bad News

Kendra L. Campbell, MD

Disclosures

September 26, 2012

In This Article

The memory of the first time I had to break bad news to a patient will forever be imprinted in my brain. I was an intern rotating in internal medicine. I had admitted a patient for severe abdominal pain with a recent large amount of weight loss. He was about 40 years old and had no prior medical problems. We performed a CT scan of his abdomen, which showed undeniable evidence of advanced pancreatic cancer -- a disease with an incredibly poor prognosis and survival rate.

My first thought was, "Someone is going to have to tell the patient that he has pancreatic cancer." That thought was immediately followed by, "[Expletive], that person is me!" I was actually the patient's doctor. Yes, my resident and attending were there to back me up, but I was the one responsible for his basic care, and it was my job to provide him with information about his diagnosis.

It occurred to me that before entering my patient's room, I needed to brush up on my knowledge of pancreatic cancer. Yes, I knew quite a bit from medical school, but I was terrified that he would ask me a question that I didn't know the answer to, so I went online and refreshed my knowledge base.

As I entered his room, some of the guidelines I had learned in medical school floated around in my cranium. However, most of that information flew out of my mind and was replaced with apprehension regarding what I was about to do. I ultimately did follow many of the strategies that I had learned: I made sure that the curtain was drawn for privacy, for example, and I asked the patient what he understood so far about his condition.

And then, I stated it in plain words: "You have pancreatic cancer." He took the news better than I had imagined. We discussed the prognosis and various treatment options. At one point, tears welled up in his eyes, and I reflexively gave him a tissue. He asked that I also share the news with his family, so I ended up also having a conversation with them on the phone. The experience was not as horrific as I had imagined, but it was definitely not an easy or pleasant task.

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