Delivering Bad News

1. Delivering Bad News Tom Poulton MD

2. What exactly is “Bad News”

3. What we’re gonna do here • Why is this so hard? • Can we make this fun? • Can we make this doable? • OMG. Will I survive this?

4. “Never break bad news---it will only get you in trouble.” • Bonus Points: What famous personality made this statement?

5. Just how is this going to go? • For me? • For the family?

6. The difficulty • We want to ease suffering, not trigger it • Little or no training • Facing our own mortality • Facing our children’s vulnerability • Violates “the natural order” of things • Universal fear of failing

7. What else? • Fear of lawsuits • Fear of someone shooting the messenger • Fear of misdirected anger • Fear of properly directed anger • Fear of failing my duties

8. Who should do this job?

9. Who should do this job? • The Doctor • Why??

10. How about delegating this one? • Who should not do this job? • Everyone else.

11. What’s the research on this? • Not born knowing how to do it. • It’s a learned behavior • Certain things are considered forbidden • Families value certain things • The impact lasts a long time

12. What do families value? • Apparent Medical Competence • Honesty • Taking time • Crystal clear language • Effective communication Good listening No jargon

13. Preparing • Read • Think • Roll play • Team planning and feedback

14. The best prep? • Happened before today • Role playing? • Honesty --Self --Others • Being at peace with the big picture

15. Immediate Preparation • “This is a part of my job” • “I am calm” • “I can do this” • “Doesn’t have to be world class” • Shift gears • Know pt’s name and DOB • Know events • Accept your limitations

16. Immediate Preparation • If you are lucky enough, you can build a relationship with the family right now.

17. The setting • Location, location, location! • Seats for all • Private • Telephone if no cell service • Amenities

18. Who will be there? • Your team? • Family “team”?

19. Details, details • Make sure all team members on same page • Clean clothes---check each other • Sit down • Focus on parents---not the pushiest person • “Warning shot”---use surrogates

20. An “Approach” • A Plan: setting, people, do it. Get it done • Family Info---what do they know? • Explain clearly what they do not know • Then say it. “I am terribly sorry to have to tell you that Heather just died.” • Pause. Pause some more. • Make certain they got it. • Let them express whatever they must • Answer questions honestly, simply, completely • Be willing to sit in that moment. Accept, validate. • Reassure---explain the death was painless if you can honestly do so • Develop plan for next ten minutes • How to reach me

21. Then shut up • Do not say stupid stuff • Monitor what you say

22. What constitutes “stupid stuff”? • He’s gone to a better place. • God needed another little angel. • At least you still have two healthy kids. • Your other kids need you to be strong for them • You’re young. You can have another child. • He’s with God • It will get better • I feel your pain • God doesn’t give us more than we can handle • Pray more and you will be at peace • I know exactly how you feel • I understand completely; when my ______ fell off the ____ and broke her ____, I nearly ______!

23. I dunno---what if I cry?!

24. What can I say? • We are all very sorry that you are having to experience this terrible loss. • Then be quiet. • For a very long time.

25. Coping and moving on • My, that sucked. • I still feel sad later • I am having anxiety attacks • We are all grouchy and irritable