How to break bad news: talking to patients and family members

There is no perfect way to tell someone bad news. That they are about to die. That their child is dead. That they may never walk again.

I have heard many pieces of advice on this. Here is a collection of the best I have found.

  1. First up, prepare yourself, prepare the person, and prepare a space as best as you can.
    This means pausing a moment to collect your thoughts and emotions, work out what you’re going to say. It means when you can, finding a private quiet space. You never do this on the front door step. You never do it standing. Sit down, sit them down.
  2. Be honest, be gentle, be clear. Tell them facts only, and don’t give them false hope. Don’t leave them hanging: mention in your first one or two sentences that they are dead, dying whatever. Because as soon as you say that the person will start reacting, which means you can start helping.  Half of what you say will go in one ear and out the other. Potentially, the rest will stay with them and their families for life. Use language they understand.
  3. Let them ask questions, and if needed sit with them in silence for a few minutes. Before you leave offer them a phone to make phone calls, a number to call if they have further questions. Give them permission to grieve, and definitely give them permission to seek help.
  4. If the circumstance is there, let them say goodbye to one another. Tell them that the person will die soon, even if it’s 24 hours away. It doesn’t matter that the person is in a coma. Sometimes it doesn’t even matter if they’re dead. Cover up all the injuries and cords you can with a blanket, and let the person sit with the family member. Let them cry.
  5. Look after yourself. Once this is done, you have to go back to work. But that doesn’t mean seeing a woman nurse her dead baby isn’t going to hit you hard. Each patient you treat will take a little bit of you with them, never let them take all of you. Get counselling. Take time off. Cry. Tell family and friends your struggling. High five a colleague for all the lives you have saved, get better and keep going.

Sometimes this job sucks. Sometimes a person will walk up to you that you don’t even recognise and tell you that the way you helped their relative, broke the news, whatever, made a big difference. That makes it suck a bit less.

 

What’s your advice?

 

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