Last week I had to break bad news to a patient and tell her that her sad mood is not a result of her husband’s attitude but it is part of bipolar disorder.
A long period of silence followed that moment after I “dropped the bomb”, as we call it.
I gave her space to process her feelings. Understandably, she was shocked. She asked me for evidence. I explained that the deep depression that she experiences which she once described like “being lonely in a deep cave “which is then followed by a period of high energy and raised self-confidence are part of the symptoms. This was not because of her demanding husband or over protective parents, the long nights she spent writing her three-part fantasy novel were under the influence of the manic phase.
She went silent again trying to hide her anger “well, you could be right, but I need a second opinion”.
I told her that is her right.
Doctors share bad news with patients and their families on daily bases. This news varies from being told you have a particular illness to being told your condition is terminal and there is no cure, or that your loved one just died.
Sometimes non-doctors also share bad news like telling someone their son failed their exams or their parent died at home, or their visa to study abroad has been rejected.
People react to this bad news differently. Some accept it and try to move one while others experience prolonged denial, clinging to hope that their doctors is mistaken, or something is wrong with the way he or she arrived at that conclusion.
Regardless of the initial reaction people eventually accept the new situation and try to adjust their lives accordingly.
I personally have shared bad news with my patients and let me tell you it does not get easier; you know that the news you will be sharing will change someone’s life forever.
You try to distance yourself from feeling guilty, after all no one wants to upset others.
The key is to express empathy, use simple language and avoid misleading hope. Most people do not appreciate being lied to by their doctors, so be truthful and say it clearly and gently.
Be prepared for their reaction, which range from anger to denial could therefore do ask if they prefer a friend or a family member to be with them when you share the news.
Be mindful of their emotions, acknowledge them and try to mirror them.
Watch your tone of voice and speed of your talk, most people shut down when they hear the bad news so do pause and give them time to process it.
Tell them that you are available to answer any questions and do not bombard them with information. Remember people may forget what you said but they never forget how you made them feel.
Research suggests that delivering bad news appropriately has a significant impact on a person's well-being and their adherence to treatment plans.
As for the patient I described above, she did seek second opinion and agreed with my diagnosis and she agreed to start medication.
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