EBM and Clinical Support Librarians@UCHC

A blog for medical students, faculty and librarians about their use of evidence based medicine, clinical literature, Web 2.0, sources and search strategies

Patient Counseling, End of Life Care, Medical Communications: When Delivering Bad News, Speak Carefully

The life of a sick person can be shortened not only by the acts, but
also by the words or the manner, of a physician.  It is therefore a
sacred duty to guard himself carefully in this respect.

—American Medical Association, Code of Medical Ethics, 1847

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Physicians are trained to seek a cure for their patients, to deliver treatments, to act promptly yet with deliberation; much less time is spent during graduate medical education on how to deliver bad news to a patient or their family.

Unfortunately, communications about treatment failure, impending death or options for end-of-life care – including emotional or psychosocial issues – can be delivered by the physician in an incomplete, ambiguous or unintentionally insensitive manner.

Poorly chosen words complicate an already emotional and anxiety-charged scenario for the patient or their loved ones. Counseling family members after an unexpected or traumatic death is even more difficult for the care provider.

UCSF physician Stephen Z. Pantilat wrote a practical, thoughtful essay about doctor-patient communications at end of life, entitled “Communicating with Seriously Ill Patients: Better Words to Say“.  It was published in JAMA on Mar 25 2009 (Vol. 301, Issue 12, page 1279-1281).  (Note: Subscription necessary to view the text.)

Following is an excerpt from Dr. Pantilat’s article:

Words matter. What clinicians say and how they say it hugely affects patients.  Communicating about emotionally and medically complex topics such as advance care planning, preferences for care, prognosis or death and dying is challenging.  Doing so requires clinicians to attend to their own and the patient’s cognitive reactions, tone, affect and nonverbal cues… Although poor communication may harm patients by leading to unwanted invasive procedures, generating unnecessary anxiety, or creating feelings of abandonment, good communication can improve outcomes for patients and their families by promoting shared decision making and addressing patient concerns”.

Excerpt from: “Communicating with Seriously Ill Patients: Better Words to Say” – JAMA, Vol. 301, Issue 12 (Mar 25 2009) – All rights reserved – Copyright 2009

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This 3-page article should be required reading for every third-year medical student before the beginning of their clinical clerkship year.

Over the next few weeks, I will post a brief series on learning to care for dying patients’ physical and emotional needs.

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2 responses to “Patient Counseling, End of Life Care, Medical Communications: When Delivering Bad News, Speak Carefully

  1. Alisha Miles May 25, 2009 at 8:44 PM

    Thank you for pointing out this article. It should be required of all doctors, nurses, and other in the medical field.

    I heard a recent account where the doctor should have been required to read this article and many other items. A patient fell and hit his head. He was sent for scans and eventually sent to the cancer center to go over the scans with a doctor.
    Physician: “Have you ever fallen before.”
    Patient: “No this was the first time.”
    Physician: “Have you ever had headaches or any problems concentrating.”
    Patient: “Nothing abnormal. Just mild headaches.”
    Physician: “Have you ever had cancer?”
    Patient: “No.”
    Physician: “Well you do now.”

    When I heard this, I couldn’t believe it. Kind of blunt and it came completely out of left field. The patient, although sent to the cancer area, was never informed he might have cancer or that something was wrong with his scan. He was just told to go there so a doctor could review the scans with him. After hearing this news his wife, very agitated, just walked off. I’m not sure what I would have done, but I wish the physician would have read this article.

    Thank you again for pointing it out!
    Alisha Miles

    http://alisha764.wordpress.com
    Twitter: Alisha764

  2. creaky15 May 27, 2009 at 7:06 AM

    Yes, indeed, what a horrible way for this man to learn that he is seriously ill, and one which could have been handled very differently by the physician. Giving bad news is an area which needs to be addressed within the medical school curriculum. Thanks for your reply,
    Creaky

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