Breaking Bad News

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I admit that when I started to write my previous blog entry, "A Year of Helping Medical Students," my intention had been to focus on the topic of breaking bad news. But I balked and ran off in a different direction, basically extending last week’s opening paragraph and turning it into an entire entry. The truth: I’m not sure how to write about this topic. But I’m going to try. So join me as I fumble about…

You see, at each Family Centered Experience (FCE) meeting with Andrew and Megan, they would come prepared to speak about a predetermined topic. At our first meeting, we talked about my diagnosis story; then we spoke about our experiences communicating with doctors, both the good examples and the not-so-good. For our third and final meeting a few weeks ago, the topic on the table: breaking bad news. Megan and Andrew wanted to know more about how the doctor presented the news to me that I had Type 1 diabetes. Although we had previously discussed how the doctor chose to deliver my diagnosis—as well as how we’ve received other bad news in the past—the extent to which we covered it at this final meeting was much more comprehensive.

Our conversation piqued my curiosity. Other than programs like the FCE, how do doctors learn the skills it takes to deliver what could be devastating news to a patient? For the first time, I put myself on the other side of the diagnosis. How difficult must it be for the doctor? Most patients are no doubt counting on this medical professional to have the answers, to know exactly what to say. Many people assume their doctor—an M.D.! a doctor!—knows all when it comes to matters of a patient’s health. I’ve been guilty of this assumption many times in the past, often incorrectly assuming (or wishing, hoping, wanting) that the doctor would be able to fix me, that I’d only need to sit back and let the healing begin.

Is it the doctor’s responsibility to handle the situation appropriately, with as much skill, empathy, and professionalism as he or she possesses? Sure. But can a doctor be expected to handle diagnosis and care perfectly? Of course not. We’re as much involved in our own treatment and disease management as the doctors. No, we can’t prescribe our own medications and perform surgeries, and we’re not trained to diagnose ourselves. But the truth is, day-in and day-out, we have to be more involved in our condition than the doctor.

Several articles, including this one I read by Walter Baile et al., roughly defined bad news as “any news that drastically and negatively alters the patient’s view of her or his future.” Breaking bad news is an often-discussed area in the medical field. Deservedly so. Browsing a medical-journal database, I found quite a bit of literature on protocols and models for presenting patients with bad news. One example is the SPIKES protocol; another is the mnemonic ABCDE. I’ll spare you the dozens of articles I’ve printed out and looked through over the past few days.

For those of us with diabetes, that initial diabetes diagnosis may well be the tip of the having-bad-news-broken-to-us iceberg over our lifetime. The complications of diabetes, each one with potential to sneak up on us insidiously, will no doubt come as bad news.

So I’m wondering, as patients, how we can prepare ourselves to better receive that bad news when it’s broken to us. Maybe looking at it from the perspective of the doctor can help. I know our reactions in those moments will be emotional, and all preparation has the potential to fall by the wayside, but shouldn’t we be somewhat responsible for being present at that bad-news delivery, to help the doctor help us?

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