Ten Tips for Delivering Bad News in the Doctor-Patient Relationship

Here are ten tips for doctors on how to deliver bad news, as outlined in the chapter “How to Deliver Bad News in the Doctor-Patient Relationship” from the latest edition of the “Manual of the Doctor-Patient Relationship” published by Spain’s General Medical Council (OMC).

1. Preparation and Planning:
   Before delivering bad news, it is crucial to understand the patient and their wishes.
   “Delivering bad news cannot be done unpredictably or unexpectedly without properly preparing the patient and even the family affected by it.”
   Plan how, when, and to whom you will communicate the information.
2. Patient’s Right to Information:
   Remember that the patient has the legal and ethical right to be informed about their health, even in cases of incurable diseases.
   “The patient has the right to know everything related to their health and to decide on the actions that will or will not be performed on them.”
   Do not give in to family pressure to withhold information from the patient (“silence pact”).
3. Clear and Personalized Communication:
   Use clear language and avoid technical jargon.
   “It is necessary to provide accurate and reliable information that also conveys confidence.”
   Adapt communication to the patient’s level of understanding and ensure they have understood the information.
4. Appropriate Setting:
   Choose a private and interruption-free location for the conversation.
   “It is essential in each case and situation of the patient and family to select the best space for privacy, which is often the patient’s home, an office or consultation room where no one disturbs or interrupts, or the hospital room at a time conducive to an unhurried and uninterrupted conversation alone.”
   Allow enough time: avoid rushing.
5. Gradual Information Sharing:
   Do not deliver all the information at once.
   “Use short sentences, support the facts, and provide information gradually without offering all the information suddenly.”
   Allow the patient time to process the information and ask questions.
6. Handling Reactions:
   Prepare for various emotional reactions from the patient, such as denial, anger, or confusion.
   “Special attention should be given to the patient’s psychological reaction after receiving bad news. It is normal for the patient to feel perplexed, hostile, or doubtful, or even to forget or deny the information received.”
   Stay calm, offer support and understanding, and avoid interrupting the patient.
7. Honesty and Hope:
   Do not lie to the patient, but do not eliminate hope either.
   “The doctor may not be able to communicate the whole truth at once or may do so over several conversations, but it is very important not to lie or deceive the patient.”
   “Always try to leave a door open to hope, even for patients with very limited prognoses.”
8. Family Support:
   Include the family in the process if the patient permits it.
   “When speaking to the family and primary caregiver, we must be just as delicate as when conveying information to the patient.”
   Offer support and information to the family and recognize their important role.
9. Continuous Communication:
   Remain available to answer questions from the patient and the family.
   “Always stay close to the patient with an easy way for them to reach you, as doubts will always arise, which are sometimes a way of seeking emotional support and comfort.”
   Adapt the information as the situation evolves.
10. Doctor’s Self-Care:
    Delivering bad news is emotionally challenging for doctors.
    “Delivering bad news to the patient or their family is a stressful situation for the professional.”
     Seek support among colleagues and care for your own emotional well-being.

By following these tips, doctors can provide more humane and compassionate care to their patients, even in the most challenging circumstances.

• FIAMC is signatory of the campaign Thankyoudoctor.

• Dr. José María Simón Castellví is ambassador to the campaign.