When Giving Bad News, Keep the Patient’s Feelings in Mind

By Hannah O. Brown
June 13, 2017

Crisis communication isn’t easy, but it is essential — and empathy goes a long way in helping. 

When patients are given bad news, it sometimes takes them a minute to process what they just heard.

Kathleen Bonvicini, MPH, Ed.D, chief executive officer of the Institute for Healthcare Communication, says many physicians do not consider what happens to a patient or family member physiologically when they hear information that shocks them or makes them feel uncomfortable.  

“There’s a lot of blood flow in the brain, and they can become really — well, it doesn’t sound very technical — frazzled,” she said. “It’s hard to make sense of anything, and once you hear that bad news, it’s like nothing else goes through your head.”

Before moving forward with the details, Bonvicini suggests health care providers start by acknowledging the patient’s or family member’s reaction. Offer the person a tissue or give them a moment to collect their thoughts.

“When that person thinks back on that time in their life when they got the bad news, they are going to remember how they were treated,” she says.

When that person thinks back on that time in their life when they got the bad news, they are going to remember how they were treated.


Kathleen Bonvicini, MPH, Ed.D, chief executive officer of the Institute for Healthcare Communication

According to a 2015 report from CRICO Strategies, a division of Harvard’s Risk Management Foundation, communication was a factor in 30 percent of 23,658 malpractice suits filed from 2009 to 2013. In high-severity injury cases, 37 percent involved some kind of communication failure. Of all the malpractice cases found to be linked to communication failure, 55 percent were because of poor communication between a health care provider and a patient.

“Bad communication is at the root of most malpractice suits,” Bonvicini says. “In the same vein, most medical errors happen because of a breakdown in communication between teams. Communication training becomes kind of a life-or-death issue versus what some people … might think, which is that communication is a soft skill.”

Bonvicini’s organization developed educational tools and strategies for professionals in the early 2000s at the behest of several health care organizations that were concerned about low scores on patient satisfaction surveys. A significant part of that dissatisfaction stemmed from interactions patients were having in emergency departments with health care providers.

Though participants sometimes enter the institute’s Strangers in Crisis communication workshop with the idea they already have all of the skills they need to communicate with patients, most everyone learns something essential. The workshop relies on both the intuitive skills from experience and evidence-based research, combined with interactive exercises so participants can practice their skills and try new communication approaches.

Fear, for example, is common for physicians who must share bad or uncertain news with patients. Their fear can be multidimensional: of how a patient might react, of not having an answer for every question, of failing the patient, of destroying a patient’s hopes or of their own lack of confidence to share the news. 

Time also is an issue, Bonvicini says. “You want to give that patient and that family the sense that you are giving them a lot of time and care and that you are concerned about them,” she says, “but the reality is that you have other patients waiting.”

So what can physicians do to combat those fears? Bonvinici says it might be as simple as just taking a few minutes to breathe before walking in the room.

“Can you take, like, a minute, take some deep breaths and really think about what your intention is?” she says. “Something as quick as that can really help you as well, in terms of centering yourself and getting yourself to a place where you can be as present as possible with this person.”

Hannah O. Brown is a freelance health care writer based in Florida.

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