Consultation Skills

Breaking Bad News

Breaking bad news is a core microskill for any doctor

At some point or another, all doctors have to break bad news.   A lot of you might think of cancer diagnoses when breaking bad news but actually, as doctors, we break bad news more often than that.    Consider the case of telling a new patient that they have diabetes – and they have to now moderate what they eat and possibly take tablets for the rest of their lives because if they don’t, they’re at higher risk of heart disease, strokes, kidney disease and so on.   Having diabetes is not good news.  Having hypertension is not good news.   Having COPD is not good news.  

Can you see what I am getting at?   Breaking these sorts of diagnoses to patients is breaking bad news and therefore needs to be done sensitively and compassionately. 

They’re are several different models to aid your approach to Breaking Bad News.  The most popular are Kaye’s 10 step model (which was mainly developed for Palliative Care) and SPIKES.  

A simple approach that I particularly like is AKEFS

  • A for Anxiety – try and elicit all the patient’s prior concerns and worries.
  • K is for Knowledge – elicit what the patient already knows and is thinking.
  • E is for Explanation – explain the diagnosis, Rx, prognosis and FU in simple terms.   Don’t make it too lengthy.  Recheck understanding.
  • F is for Feelings – explore how the patient feels in response to what is said.  Encourage dialogue when explaining.
  • S is for Sympathy and Support – offer true genuine sympathy.  Show that you care.  And of course follow up and show them the support that is available from you and others working for the NHS.
BUT – before you do any of this – you must check your facts 
  1. that you have the right diagnosis
  2. you understand the diagnosis 
  3. have an idea of the next step in your own mind.  
  4. that you have the right patient in front of you!
  5. and whether the patient would like to bring someone along for support
Also remember, you need to give time to do all of this.  Don’t rush through it and accept the fact your surgery may run a little late.  Although many doctors don’t do this – it might be a good idea to offer a cup of tea afterwards and offer a private room to given them time and space to digest what you have said.   Also consider offering to see them again after their tea to provide that extra mile of support.

 

Please leave a comment if you have a tip, spot an error, spot something missing or have a suggestion for a web resource.
And of course, if you have developed a resource of your own, please email it to me to share with others.

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