Responding to ‘bad news’

In this blog I want to add just a word or two to my last posting. This is because there really is need to spare a moment in consideration of the consultant involved, who so often has the unenviable task of breaking bad news to his/her patients. In the first place he/she is, like every one of us, human and the possessor of multifarious ongoing individual concerns and issues of his/her own, about which – as it should be – we know nothing. Almost daily, those bearing such responsibilities are being faced with the thankless and unenviable task of breaking bad news to tense and not infrequently terrified patients. Bear in mind also that all of this is taking place in a highly-charged and ‘pressured’ environment, more often than not, further hampered and complicated by time restrictions, unscheduled and unforeseen interruptions and delays; all in addition, perhaps, to the need to repeat the entire ‘exercise’ more than once during the course of that single clinic session.

Having made that important caveat, it remains true that over the years, countless numbers of patients and carers have described similar irregular and alarming experiences as that recounted in the previous blog in response to the receipt of bad news. One does need, therefore, to be aware of the truth; namely, that such news and all that it entails, can – and not infrequently does – produce the most devastating and, at such moments in time, surprising and unexpected outcomes.

Now let me pursue what I have written in the preceding sentence, in search for the answer as to why this should be so. In the first place there is the complexity of effect caused by what is commonly referred to as “individual differences”. If one were to place a fragment of a known metal into a vat of a prescribed acid, the outcome (in terms of the effects of the one upon the other) can safely and confidently be predicted on the basis of the results achieved in and the knowledge obtained from all such previous experiments. In other words, all relevant variables entailed and involved in such an exercise can be strictly controlled: this provides an important advantage when working with “things” (or at any rate, most “things”).

However, when it comes to people, matters differ vastly. One might pursue the hunch or (if you prefer the fancy term) hypothesis, that in the young, a history of, let us say, inadequate domestic and social background, combining with unsatisfactory educational achievement will result in an outcome of juvenile delinquency. However, in the light of the host of potentially confounding variables present but uncontrolled, any such prediction would be as likely to fail as it would succeed. Moreover, this would be quite apart from the fact that neither of the two combining variables stated above, possess the necessary or sufficient predictive power to confirm it.

Now all of this doesn’t, of course, mean that nothing of worth can be achieved. Just two major variables of common usage and everyday simplicity, which can at any rate influence the outcome profoundly, are to do with “seeing” and “hearing”, i.e. what we see and what we hear. By way of example of the above point, body language – especially that of the person who is conducting the clinical interview – can leave a lasting impression. “He talked to me from behind the clinic room desk” or “He held the door slightly ajar as he enquired “Was there anything else you wanted to raise?”.

So far as what one hears, both in the sense of what one is told and how one responds, is likely to be more accurately retained where the patient is accompanied by a reasonably aware and articulate relative/friend/ companion. Also, an old-fashioned portable tape recorder can prove to be an invaluable aid at such times. Indeed, I have known and worked with several consultants who have welcomed such an initiative taken by the patient or by a close relative/friend, on the patient’s behalf. The key issue here is to hear what is actually said and then, hopefully in a more congenial and relaxing environment and with the imput of a trusted “other” (preferably including the one who also was present at the clinical interview) to address those issues and concerns that arise from it and readily spring to mind.

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