Breaking Bad News To A Patient- Medical Ethics

Breaking bad news to a patient is one of the most difficult duties for a physician. Without proper training and formal preparation the discomfort and the uncertainty associated with breaking a bad news can lead to emotional misunderstandings between the physician and the patient.

What Is Bad News?
Information that can drastically alter the life and the world of the patient is termed as a bad news.

Reasons Why It is a Difficult Task To Break Bad News?
Conveying a bad news to the patient is a skilled communication and not at all easy. There are many reasons why it is a challenging task for the physicians and doctors.

1. The amount of truth to be disclosed is subjective.
2. There is a feeling of incompetence on the part of the physician and a fear of a negative reaction from the patient and the relatives.
3. The physician is reminded of his/her own vulnerability to a terminal illness and many times they find themselves helpless over the emotional distress.
4. Lack of sufficient training in breaking bad news is a major drawback to most physicians and health care workers.

A Few Protocols To Learn For breaking Bad News:
In order to deliver a bad news to the patient in a diciplined and a structured manner different protocols have been adviced and few of them are discussed below:

Getting An Occupational and Environmental History During Clinical Skills Exam

The occupational and environmental history concerns exposure to potential disease producing substances or environments.The following are some sort of questions that can be asked regarding the exposure:

• What type of work do you do
• How long have you been doing this work
• Describe your work
• Are you exposed to hazardous material. Do you ever use protective eqipment
• What kind of work did you do before you had your present job
• Have you lived near any factories, shipyards, or other potential hazardous facilities
• Has anyone in your household ever worked with hazardous materials that could have been brought home
• What type of hobbies do you have. What type of exposures are involved
• Do you now or have you previously had enviornmental or occupational exposure to asbestos, lead, fumes, chemical, dusts, louid noises, radiation or toxic factors

Question Types to Avoid During History Taking

While taking a history during the exam on standardized patients there are many question types to be avoided and taken care of. These are explained here briefly:

1. Suggestive Question:
One is the suggestive question, which provides the answer to the question. For example,
  ' Do you feel the pain in your left arm when you get it in your chest? '
A better way to ask the same question would be,
   ' when you get the pain in your chest, do you notice it anywhere else?'

2. Why Question:
The Why question carries tones of accusation. This type of question almost always ask a patient to account for his or her behavior and tends to put the person on the defensive. For example,
   "Why did you stop taking medication? "
The answers, however to the Why question are important, Try rephrasing the 'why' question to ' What is the reason...' so the above question can be asked like
     " What is the reason you haven't seen a doctor for three years?"

3. Multiple or Rapid fire Questions:
The multiple or rapid fire questions should also be avoided . in this question , there is more than one point of inquiry. Don't confuse the patient with a list of questions and mostly the patient will answer only the last inquiry in this way you will feel you have asked a question but will not get an answer. For example avoid asking,
    " Have you had night sweats, fever, or chills? "

4. Questions with Medical jargon:
The questions should be concise and easily understood. The context should be free of medical jargon. for example,
 "You seem to have homonymous hemianopsia."
   "Have you ever had a myocardial infarction?"
Using medical terminology as in above examples should be avoided.