Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Doctors need to be better trained to deliver bad news

John Salter, MD
Physician
March 15, 2012
Share
Tweet
Share

Last week was tough.  I had to refer several patients to hospice, and a few more received bad news regarding their disease.  This has always been the toughest part of my job, but it’s also the part patients need me to handle best.  I have to remind myself that no matter how hard it is for me to give bad news, the patient and their families are the ones receiving it.  That fact has never made it any easier for me, it just helps to ground my perspective.

Oncologists have always recognized this aspect of their jobs.  We all acknowledge that this is the “hard part” of our specialty.  It’s what we do.  Most of us received very little, if any, formal instruction on how to properly deliver bad news. In fact, surveys conducted of oncology fellowship directors have clearly demonstrated that most oncologists are never formally “trained” to give bad news.  So how can young cancer doctors acquire this vital skill ?

Speaking for myself, this is something I had to learn “on the job.”  As a fellow, I would occasionally shadow my faculty in real patient encounters where bad news was delivered.  This was not something I got to do often.  When bad news was anticipated, often I was excluded from the encounter for the patient’s sake.  Who wants another person in the room, a complete stranger for that matter, when you find out something tragic ?  So, I would wait for my professor to return from the exam room and to summarize what he/she had said to the patient.  Learning this way is like me telling you how to drive a car by describing it for you – clearly not the most effective way to teach anything.  When the patient was actually mine, I personally gave the bad news myself in an unsupervised encounter.  No feedback from faculty, no opportunity to ask how I performed.  If I had done a lousy job, it remained between me and the patient.  I suspect this is how most practicing oncologists were trained to give bad news as well.  This also why, I suspect, many patients express such dissatisfaction with their doctor over this very matter.  If their physician has never learned how to give bad news properly, he/she will likely continue to make the same mistakes time and again with the next patients.

Maybe we need to take a closer look at how young doctors are trained to perform this task.  Many fellowship programs have adopted formal curricula for teaching their trainees how to communicate bad news.  This is very encouraging, and certainly suggests that the message has made its way back to program directors.  For those of us who have already left training, we can not be complacent with just being “okay” at this part of the job.  Delivering bad news is never easy, but if done well it can make a lasting impact on patient perception and satisfaction (in spite of the bad news).

Since leaving my fellowship, I have really strived to get better at giving bad news.  I have read On Death and Dying (again) and tried to glean some more insight on how to interact with dying patients.  I have adopted the so-called “SPIKES” technique, and now unconsciously apply this protocol to my patient encounters.  I talk with my colleagues, I de-brief with my nursing staff, and most of all, I try to learn from my mistakes.  I don’t always get it right, and recognizing that fact has helped tremendously to make me more effective in how I communicate with patients.

John Salter is a hematologist-oncologist who blogs at SalterMD.com. 

Submit a guest post and be heard on social media’s leading physician voice.

Prev

Why one-third of hospitals will close by 2020

March 14, 2012 Kevin 334
…
Next

Will Peyton Manning ever fully recover from his spinal nerve injury?

March 15, 2012 Kevin 5
…

Tagged as: Oncology/Hematology, Palliative Care

Post navigation

< Previous Post
Why one-third of hospitals will close by 2020
Next Post >
Will Peyton Manning ever fully recover from his spinal nerve injury?

ADVERTISEMENT

More by John Salter, MD

  • a desk with keyboard and ipad with the kevinmd logo

    Chuck Pagano has leukemia: An oncologist discusses his prognosis

    John Salter, MD

More in Physician

  • How New Mexico became a malpractice lawsuit hotspot

    Patrick Hudson, MD
  • Why compassion—not credentials—defines great doctors

    Dr. Saad S. Alshohaib
  • Why Canada is losing its skilled immigrant doctors

    Olumuyiwa Bamgbade, MD
  • Why doctors are reclaiming control from burnout culture

    Maureen Gibbons, MD
  • Why screening for diseases you might have can backfire

    Andy Lazris, MD and Alan Roth, DO
  • Why “do no harm” might be harming modern medicine

    Sabooh S. Mubbashar, MD
  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • A physician’s reflection on love, loss, and finding meaning in grief [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • A physician’s reflection on love, loss, and finding meaning in grief [PODCAST]

      The Podcast by KevinMD | Podcast
    • How fragmented records and poor tracking degrade patient outcomes

      Michael R. McGuire | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • How I learned to stop worrying and love AI

      Rajeev Dutta | Education
    • Understanding depression beyond biology: the power of therapy and meaning

      Maire Daugharty, MD | Conditions
    • Why compassion—not credentials—defines great doctors

      Dr. Saad S. Alshohaib | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 5 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • A physician’s reflection on love, loss, and finding meaning in grief [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • A physician’s reflection on love, loss, and finding meaning in grief [PODCAST]

      The Podcast by KevinMD | Podcast
    • How fragmented records and poor tracking degrade patient outcomes

      Michael R. McGuire | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • How I learned to stop worrying and love AI

      Rajeev Dutta | Education
    • Understanding depression beyond biology: the power of therapy and meaning

      Maire Daugharty, MD | Conditions
    • Why compassion—not credentials—defines great doctors

      Dr. Saad S. Alshohaib | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Doctors need to be better trained to deliver bad news
5 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...