Delivering Bad News: Is There a Wrong Way to Do It?

Brandon Cohen

Disclosures

April 22, 2019

Source: Almay

How should the worst medical news be conveyed? A recent news story on Medscape described a case in which a specialist used a remote video to inform a patient that he likely had only a matter of days to live.

This led to dynamic and often outraged responses in the comments from medical professionals.

A strong majority objected to the way the bad news was given. A dentist kicked things off with a simple formulation:

[The doctor] could not treat the lung, but he could treat the dying patient appropriately. The bad lung was attached to a person who was still alive.

A registered nurse was livid:

Ethics is no longer of any importance to the medical profession. But physicians who are devoid of ethical principles today may find that what goes around comes around.

An emergency physician agreed:

Just because you have this capability [to communicate remotely] doesn't mean it's appropriate in all circumstances. The [doctor] should reconsider their approach to discussing emotional topics like this.

A physician assistant saw an ugly trend developing:

This is simply the next step in corporate medicine, where the dollar and bureaucrats call the shots, no matter how tacky it is.

A nurse practitioner agreed and gave a stern warning:

Something must be done to halt the progression of corporate medicine as well as insurance companies dictating what appropriate medical care consists of.

A registered nurse agreed and yearned for earlier forms of medicine:

I think I long for the old-time practitioner who made house calls, sat with the dying, knew the patient and the family, and actually cared about them as more than just another lung.

An allergist also wanted more old-fashioned medicine:

This is the best advertisement for having a trusted, long-term primary care physician. One who is well-known to the patient and family and more able to soften the blow and sit for a time with the patient and family when delivering grave news.

But a registered nurse wondered whether the trusted primary care provider was a thing of the past:

Trusted, long-term PCP? Who are they? I can't even see my own doctor when needed... If I do want to see my doctor, it's a 3-month wait and then I only get the designated 10 minutes of them staring into a laptop screen.

But there were some who saw little wrong with telecasting the worst news. One medical professional offered a verbal shrug:

I don't believe I would have been upset in the situation presented. The patient was in hospice care. He knew "soon" but perhaps not "how soon."... I'm not someone who would feel comfortable with my doc hugging me or something like that.

Another professional was also unappalled:

We are a technological society now, and telecommunication is the norm... I personally think the family was looking for publicity. The family was already well aware of his condition and prognosis (he was in hospice, for goodness sake!), so they were not being given any new information, and it was provided by a physician who was available to answer any questions (telecommunications systems are 2-way). I really don't see an issue here.

A physician also saw little wrong:

There is no doubt in my mind that both the patient and the family knew his condition was dire. As humans we know when the end is near. It is also human to externalize blame. Telemedicine was used for the convenience of the patient.

Many felt that the major problem was not with the remote communication itself, but with the support that was offered along with it. One registered nurse spoke for many:

If a specialist delivering news long distance is concerned about the ability of the primary care physician to deliver news and details accurately, then they should have arranged for the video conference to take place with the PCP at the bedside.

A primary care physician agreed:

A nurse in the room does not have the training to interpret the specialized information that only a doctor can relay, and does not hold the shroud of expertise we expect in these wrenching moments.

But a registered nurse was quick to respond:

Really? I cannot tell you how many times I have had to interpret the doctor's words to the patient after the doctor has dropped in for two minutes to spout information and then left. I also have spent much more time at the bedside of dying patients than any physician I've ever worked with.

The last word goes to a registered nurse, who offered a perspective from the patient's side:

I recently received a diagnosis of malignant melanoma over the phone from a nurse who said not to ask her any questions about the diagnosis because she didn't have any answers. "Just wait for a call from the dermatology clinic," [the nurse said]. It's not just technology. It is healthcare management that is virulently infected.

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