Learning on the Job
Since that first experience as an intern, I've had to break bad news to many patients and their families.
Sometimes I have to tell patients (and their relatives) that they have a chronic mental illness, which is the most daunting of all. Explaining to a mother that her 19-year-old son has schizophrenia, a chronic disease with a usually deteriorating course -- and which some patients are in denial that they even have -- is one of the most challenging and distressing experiences. What's more, I've found that it is harder to tell patients that they have chronic and incurable diseases than it is to tell them they are dying.
Another experience that will forever remain ingrained in my mind is that of a 22-year-old woman who presented with rapidly developing paralysis from her neck down. After a million-dollar workup, we determined that she had neuromyelitis optica, a rare and serious condition affecting the central nervous system that carries a poor prognosis and limited treatment options.
My patient asked that I discuss her diagnosis with her mother present in the room. After breaking the news, my patient's mother began sobbing uncontrollably. "But will she ever walk again? Will she be able to have her wedding? Can she have children?" she asked. Answering these questions honestly took enormous effort on my part and very careful selection of words. At one point, tears welled up in my eyes, and it took a huge amount of force to hold them back.
As a third-year resident, I now have a fair amount of experience breaking bad news to patients. At this point in my training, I can say that when I am about to break bad news to a patient, I definitely feel more confident and less terrified than I did during my first experience as an intern. Having practice and knowing what to expect from patients makes the process somewhat less scary. However, it still remains a daunting task, one that I never look forward to, and one that I expect will always inspire growth as I continue my journey as a physician.
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Cite this: Learning to Break Bad News - Medscape - Sep 26, 2012.