Learning to Break Bad News

Kendra L. Campbell, MD


September 26, 2012

In This Article

Training for Bad News

According to British-Canadian physician and author Robert Buckman, "bad news" is defined as any information that "drastically and negatively alters the patient's view of her or his future."[1] Buckman developed a well-known 6-step protocol for breaking bad news. The American Academy of Family Physicians has also published recommendations.

Most medical students receive at least some training during their preclinical or clinical years on how to compassionately deliver sad news. I know that this topic was covered during my medical school experience, but I can honestly say that I remember little about what was taught to me.

In fact, thinking back to medical school, I recall how much I enjoyed the protection from having to break bad news to a patient. The attending physicians and residents I worked with unanimously told me that I was never to tell a person that she was HIV-positive or had metastatic colon cancer, for instance. That "privilege" was reserved for my seniors and was not to be attempted by a lowly medical student, such as myself.

This fact highlights the significance we place on breaking bad news to patients. As a medical student, I was allowed to stick needles in people, numerous times unsuccessfully in order to become more skilled at it. I placed my hands in every orifice of patients while I learned to perform a proper examination. For some of those patients, it was my first time. However, when it came to having a conversation with a patient about a bleak diagnosis or prognosis, my rights were limited.