I'm a facilitator for a small group of medical students in the first-year principles of clinical medicine course. Yesterday's session was on some practical pointers on what to do when you have to deliver bad news to a patient. The presentation was much like others that I have been through where the lecturer discussed what we as providers need to do to make this difficult process as easy as possible for both us and the patient. There was emphasis on making sure the setting is appropriate (ie finding a quiet space where you can sit with no distractions), and delivering the news with appropriate empathy. He covered the importance of clear communication free of medicalese with frequent checks to see how well the patient and family members are receiving the news. He also talked about how some times what we view as a pretty routine discussion like admitting a small child for dehydration secondary to diarrhea, may be very scary, and the family may view this as very bad news. He talked about bringing closure to the discussion, and trying to instill some hope even in very dire circumstances. I left thinking it was a very solid presentation.
Then, when we got to our small groups, our discussion of the large group began with a comment from one of the medical students that I thought was very insightful. His point was that the lecturer spent a lot of time talking about us as the healthcare provider, and how it is uncomfortable for us to deliver the news, and ways to make this easier for us. The student then went on to say that the patient was really only referred to in how our behavior will need to change in reaction to the patient. He felt like the presentation appeased our need to feel better, and although making us feel better about the encounter will often also allow the patient and family to have a better experience, they are not always the same thing. As I reflected on this viewpoint, I think it is true. Every lecture I've been to on 'breaking bad news' couches the discussion based on the premise that this is uncomfortable to me. I'm not saying there is no mention of how the patient is involved in the process, but it's just always presented with the provider in the center of the news, and the patient being peripheral and receiving the news. Our student stated that it's not really our news, and we should not be central as the news truly belongs to the patient. Another student responded that this approach would help engender a team approach where the provider and patient are working together to navigate the illness with which they all must deal, and thus, makes it less of an 'us versus them' interaction between provider and patient.
I liked this discussion. I'm not sure it's going to change what I do when I talk to patients myself, but it may change how I'd give a lecture about this topic in the future. What do you all think?