Friday, December 11, 2009

How Not To Do It

The mother of a friend of mine has been diagnosed with cancer.

Now, that's bad enough: but the way in which she was told made it even worse.

The consultant sat at the opposite side of a big desk from the lady and her family, staring at his computer.

His explanation consisted almost entirely of "The test results are positive and it's cancer. I think we've got a leaflet that will tell you more about it."

He turned away from the family and spent a while rummaging on the shelves behind him, finally thrusting a leaflet at my friend's mother.

Meanwhile, a nurse who'd been sitting at the same side of the desk as the family was rustling through a pile of papers looking for information about a different patient. Not finding it, she finally got up and left the room in the middle of the consulation.

My friend and his mother weren't given any opportunity to ask questions: he said he barely spoke. Then they were all ushered out.

There's no excuse for this kind of thing. I've been working in the area of Communication Skills for nearly twenty-five years and this is the sort of consultation that was routine twenty-five years ago. But now all doctors receive Communication Skills training and as part of that there is Breaking Bad News training.

Probably some old-school consultants have missed out on it. "It's just common sense" they say dismissively. I've found that people who say that are always the ones who are incredibly bad at it, because they don't think it's important.

The room should be quiet and private and whoever's breaking the bad news shouldn't be staring at a computer - he or she should be focused on the patient. There shouldn't be a desk in between. It sounds like a trivial thing - it's not. The desk creates a barrier between doctor and patient and also suggests that the doctor has status and the patient doesn't. Trust me on this, because I know, and it's important.

If there's anyone else in the room - such as the nurse in this case - they should be concentrating entirely on the matter in hand and not on some other patient. That's just deplorable, and there is no excuse that is good enough for that to have happened.

The bad news should be introduced via a "warning shot" - - something like "I'm afraid it's bad news" - to give the patient a moment to adjust to it.

And then there should be a clear explanation, as jargon-free as possible and tailored to the patient's level of understanding as far as possible. Any leaflets should be given purely as back-up, and not instead of an explanation. And if leaflets are to be used, then they should be prepared before the whole thing begins, not tucked away in a file somewhere.

Even so, anyone who hears a diagnosis "cancer" will take in hardly anything after that, so the patient should be given an opportunity to ask any questions at the time, and then to come back as soon as they like to ask any further questions and, if necessary, to hear the whole explanation over again.

Any hospital department involved in breaking bad news should be prepared for all of this, and should have proper systems in place to do it.

It's not incredibly complicated: it requires no special equipment: it just requires healthcare professionals with the ability to understand how important it is to do it right.

If you've ever been given bad news in a hospital, do you remember the occasion? Of course you do. The hospital may break bad news every day, but for any particular patient it will - hopefully - be just a few times in a lifetime.

So it's important to get it right. And, with all the knowledge about how to do it that the medical profession has gained in recent years, it's unforgiveable - yes, totally unforgiveable, no excuses, no sorry-we-were-busy-that-day - - - because if they're often busy, then they ought to be prepared, and if they're never busy, then they ought to do it right.

My friend didn't mention it - it wasn't the time or the place - but actually, he works in Communication Skills teaching.

So he made a mental note of everything that happened. And he'll be writing to complain.

If such a thing ever happens to you, or to your loved ones - and I so hope it won't - please, please, write to complain, naming names, in the strongest possible terms, explaining what was wrong and how you felt, and for changes to be made. Perhaps, eventually, this cack-handed, careless and thoughtless form of consultation will be ended.


Anonymous Anonymous said...

Here's another way:

We were in receipt of medical bad news from an NHS consultant... and, because the diagnosis was not in his area of expertise, he ended up googling the condition, while we sat there.

It wasn't all bad: he was going to refer us to physician but, because of what he read online, he ended up refering us to a surgeon. A good call as it turned out.

And you'll be pleased to know, there wasn't a desk involved.

8:23 pm  
Blogger Yorkshire Pudding said...

I think that some doctors - especially "experts" in hospitals - still see conditions, problems, challenges instead of the human beings who are presenting these issues to them. I speak from personal experience. It is good to know that there are people like you and the far-sighted health mangaers who sponsor your work addressing the matter of communication. Years ago the medical profession would have sneered at such initiatives. Having said this of course most people working in health are brilliant, professional and genuinely caring - doing their best to provide a superb service in which understanding is a watchword.

10:15 pm  
Blogger Jennyta said...

All the billions of pounds spent on the NHS and especially on cancer and they still have medics who can't treat their patients as human beings. It beggars belief.

1:32 pm  

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