1. Delivering Bad News
Tom Poulton MD

2. What exactly is “Bad News”

3. What we’re gonna do here
Why is this so hard?
Can we make this fun?
Can we make this doable?
OMG. Will I survive this?

4. “Never break bad news---it will only get you in trouble.”
Bonus Points: What famous personality made this statement?

5. Just how is this going to go?
For me?
For the family?

6. The difficulty We want to ease suffering, not trigger it
Little or no training
Facing our own mortality
Facing our children’s vulnerability
Violates “the natural order” of things
Universal fear of failing

7. What else? Fear of lawsuits Fear of someone shooting the messenger
Fear of misdirected anger
Fear of properly directed anger
Fear of failing my duties

8. Who should do this job?

9. Who should do this job?
The Doctor
Why??

10. How about delegating this one?
Who should not do this job?
Everyone else.

11. What’s the research on this?
Not born knowing how to do it.
It’s a learned behavior
Certain things are considered forbidden
Families value certain things
The impact lasts a long time

12. What do families value? Apparent Medical Competence Honesty
Taking time
Crystal clear language
Effective communication Good listening No jargon

13. Preparing
Read
Think
Roll play
Team planning and feedback

14. The best prep? Happened before today Role playing?
Honesty Self Others
Being at peace with the big picture

15. Immediate Preparation
“This is a part of my job”
“I am calm”
“I can do this”
“Doesn’t have to be world class”
Shift gears
Know pt’s name and DOB
Know events
Accept your limitations

16. Immediate Preparation
If you are lucky enough, you can build a relationship with the family right now.

17. The setting Location, location, location! Seats for all Private
Telephone if no cell service
Amenities

18. Who will be there?
Your team?
Family “team”?

19. Details, details Make sure all team members on same page
Clean clothes---check each other
Sit down
Focus on parents---not the pushiest person
“Warning shot”---use surrogates

20. An “Approach” A Plan: setting, people, do it. Get it done
Family Info---what do they know?
Explain clearly what they do not know
Then say it. “I am terribly sorry to have to tell you that Heather just died.”
Pause. Pause some more.
Make certain they got it.
Let them express whatever they must
Answer questions honestly, simply, completely
Be willing to sit in that moment. Accept, validate.
Reassure---explain the death was painless if you can honestly do so
Develop plan for next ten minutes
How to reach me

21. Then shut up
Do not say stupid stuff
Monitor what you say

22. What constitutes “stupid stuff”?
He’s gone to a better place.
God needed another little angel.
At least you still have two healthy kids.
Your other kids need you to be strong for them
You’re young. You can have another child.
He’s with God
It will get better
I feel your pain
God doesn’t give us more than we can handle
Pray more and you will be at peace
I know exactly how you feel
I understand completely; when my ______ fell off the ____ and broke her ____, I nearly ______!

23. I dunno---what if I cry?!

24. What can I say?
We are all very sorry that you are having to experience this terrible loss.
Then be quiet.
For a very long time.

25. Coping and moving on My, that sucked. I still feel sad later
I am having anxiety attacks
We are all grouchy and irritable