Use This Proven 6-Step Process to Deliver Bad News

Physician Leaders Need to Know and Teach This Skill

To make some extra money, I worked as an internal medicine intern for a short while after graduating early from medical school, while waiting to start my family medicine residency. While covering the medical floors and ICU, one of the duties that I felt very unsure about was to deliver bad news to patients and their families.

On several occasions, I recall feeling totally unprepared to inform an elderly woman that her spouse did not survive the cardiopulmonary arrest that occurred while I was on call. Or the fact that the chest X-ray demonstrated a likely lung cancer in a patient admitted with a cough and bloody  sputum.

Admittedly, I probably should not have been the one having those conversations, but it just worked out that way.

Over the years, I became more comfortable with delivering bad news. I watched others do it. I read about it. But I never did receive any formal training on how to do it.

Several decades later, I was asked by the Director of Graduate Medical Education at my hospital to present a series of lectures to the residents. This past month, I presented one of those lectures devoted to the topic of delivering bad news to patients. It gave me an opportunity to review the subject.

I developed my method of delivering bad news by observing my instructors as I completed medical school and family medicine residency training. I don’t recall being taught a consistent method or process to follow.

deliver bad news difficulty

As I reviewed the subject matter and integrated what I learned with the approach that I had come to follow, I was pleased to find out that there has been an effort to study the subject and several processes have been described and tested.