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

I broke my own rule when giving bad news

James C. Salwitz, MD
Physician
March 11, 2015
Share
Tweet
Share

For 25 years, I have taught medical students how to give bad news.  Step one: Be prepared.  Step two: Find a safe, personal, quiet environment.  Step three, and this is most important: Before you speak, ask.  What do the patient and family understand? Fail to follow this vital rule and reap the whirlwind.   So, therefore, you might ask, if I have such wisdom and experience in this critical area of communication, how did I screw up so badly?

It seemed simple.  I was making hospital rounds, seeing my own patients and covering for my partners’.  My sign-out instructions said the husband of a patient who had been in the hospital for two weeks, wished to be called with the results of his wife’s biopsy.  Clear enough.  Therefore, when I saw the report, I picked up the phone.

Unfortunately, before I could consider my action further, he answered.  It would have saved a lot of angst, had he been in the shower.  Instead, after briefly introducing myself, I simply said, without a pause, without further reflection, “I am sorry, the news is not good. The biopsy came back, and it shows lung cancer which has spread to the liver.”

Now, of course, I expected him to be upset. It was terrible news.  What I did not plan for, nor expect, was that he would become completely hysterical, losing the ability to speak in a rational manner, sobbing, screaming and eventually slamming down the phone.

I was shocked.  What had I done wrong?  Why was he unhinged?

Perplexed, I took a deep breath and started to do my job the proper way.

I carefully reviewed the chart and spoke to the patient’s nurse. I learned that while the disease was advanced, the biopsy was, in fact, the first time that the cancer diagnosis had been proven.  In other words, for the husband my call was the first and final confirmation of his worst fears.

The second thing I learned, to my astonishment, was that while the patient had been in the hospital for a long time, no one had actually told the patient or the husband that she probably had cancer or that if she did it would likely be fatal. Rather the admission had focused on pneumonia, and they believed the biopsy was to investigate a “small spot” in the liver.

Thus, I had violated all of my rules.  I was not fully prepared.  I had told awful life changing news over the phone.  Moreover, I did not start with the simple question, “what have they told you?”  I really screwed up and made a very hard moment much harder.

Now, I can argue, that after all those days in the hospital, all those treatments, preparing for and performing a biopsy, and finally waiting for the result, that the husband and patient should have been better prepared by the medical staff.  Alternatively, I can justify my stupidity by noting I was just following sign-out instructions.  Nevertheless, it is my responsibility, therefore, my error.

I met with the husband, and then the two of them, later in the day.  We started from the beginning. I explained, piece by piece, everything that was happening. This time we sat quietly together in her room, and I first listened to their understanding of what was happening.  Step-by-step with time for thought, tears and silence.

Of course, I apologized.  It helped, some, but I feel guilty and sad I put him through such a horrid and unprepared shock.  Not fair.  Not compassionate.

I will start again.  I will have similar conversations. I will teach students and add this story to my list of important experiences.  Just maybe, I will get the practice of medicine closer to right.

ADVERTISEMENT

James C. Salwitz is an oncologist who blogs at Sunrise Rounds.

Prev

Ease the transition to hospital medicine

March 11, 2015 Kevin 5
…
Next

What does it take to collaborate in health care? Here are 3 ideas.

March 11, 2015 Kevin 4
…

Tagged as: Oncology/Hematology

Post navigation

< Previous Post
Ease the transition to hospital medicine
Next Post >
What does it take to collaborate in health care? Here are 3 ideas.

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by James C. Salwitz, MD

  • Each line on the radiology list is a patient’s line in the sand

    James C. Salwitz, MD
  • The broader mission for hospice care

    James C. Salwitz, MD
  • Is the medical profession at its end?

    James C. Salwitz, MD

More in Physician

  • How doctors took back control from hospital executives

    Gene Uzawa Dorio, MD
  • How art and science fueled one woman’s path to medicine

    Amy Avakian, MD
  • In a fractured world, Brian Wilson’s message still heals

    Arthur Lazarus, MD, MBA
  • Why being a physician mom is harder than anyone admits

    Cynthia Chen-Joea, DO, MPH
  • Removing vaccine advisers could jeopardize lives

    J. Leonard Lichtenfeld, MD
  • Why would any physician believe that the practice of medicine will become less abusive for them in the future?

    Curtis G. Graham, MD
  • Most Popular

  • Past Week

    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • Key strategies for smooth EHR transitions in health care

      Sandra Johnson | Tech
    • Reassessing the impact of CDC’s opioid guidelines on chronic pain care [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
  • Recent Posts

    • Inside human trafficking: a guide to recognizing and preventing it [PODCAST]

      The Podcast by KevinMD | Podcast
    • Earwax could hold secrets to cancer, Alzheimer’s, and heart disease

      Sandra Vamos, EdD and Domenic Alaim | Conditions
    • Why male fertility needs to be part of every health conversation

      Hoag Memorial Hospital Presbyterian | Conditions
    • Why health care must adapt to meet the needs of older adults with disabilities

      Lynn A. Schaefer, PhD | Conditions
    • How doctors took back control from hospital executives

      Gene Uzawa Dorio, MD | Physician
    • Improving patient encounters: time-saving strategies for physicians [PODCAST]

      The Podcast by KevinMD | Podcast

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 14 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

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • Key strategies for smooth EHR transitions in health care

      Sandra Johnson | Tech
    • Reassessing the impact of CDC’s opioid guidelines on chronic pain care [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
  • Recent Posts

    • Inside human trafficking: a guide to recognizing and preventing it [PODCAST]

      The Podcast by KevinMD | Podcast
    • Earwax could hold secrets to cancer, Alzheimer’s, and heart disease

      Sandra Vamos, EdD and Domenic Alaim | Conditions
    • Why male fertility needs to be part of every health conversation

      Hoag Memorial Hospital Presbyterian | Conditions
    • Why health care must adapt to meet the needs of older adults with disabilities

      Lynn A. Schaefer, PhD | Conditions
    • How doctors took back control from hospital executives

      Gene Uzawa Dorio, MD | Physician
    • Improving patient encounters: time-saving strategies for physicians [PODCAST]

      The Podcast by KevinMD | Podcast

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

I broke my own rule when giving bad news
14 comments

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

Loading Comments...