Breaking Bad News

I have always thought that it would be too difficult for me to be an oncologist due to the emotional burden of sharing devastating news with a patient and their family. During this rotation, I spent the afternoon with an orthopedic oncologist. He had one of the best bedside manners that I have seen.  With every patient, he just seemed to build rapport effortlessly, and he seemed to have a deep connection with the patients he had treated that were now in remission. I not only saw him interact with the patients that were now doing well, but also patients who faced an undesired disease progression, specifically one patient with stage IV disease.

We walked into the room and he introduced me to the seventy-year-old patient and her daughter. He started off asking the daughter about a tattoo on her arm, and making friendly conversation. He then examined the mother’s shoulder where a tumor was growing underneath. He explained how the CT scan showed spots in her lungs in addition to the tumor on her shoulder, and what her options were for treatment. He explained this all in a calm and straightforward manner. He did not go into the medical specifics and what this meant for her prognosis, but instead discussed in simpler terms how he could help her.  I could tell the patient and her daughter were both shaken up by the results. The patient was trembling while tears formed in her daughter’s eyes. The physician allowed them to process this information with silence and again told her how he could help her in his role as the surgical oncologist.  He also provided a plan of action for them. He encouraged them to see the medical oncologist within the week, and he advised them to contact him with any questions or concerns they may have.

Cancer is horrible. There is no way to alleviate the shock, fear, and pain of that diagnosis. I have never been sure how I would break that news as a physician. Seeing this doctor tell his patient and her daughter about her cancer showed me a good way to do it. He was straightforward with his explanation, yet calm and empathetic in his delivery. He did not promise a cure, yet he did not take away all hope. Although I felt extremely sad for the patient and her daughter, I could appreciate the way the physician handled the situation.

This specific experience provided me with insight into a way to share difficult news with a patient. It is a balance between showing empathy and serving a source of strength and hope. It is explaining the diagnosis in clear and simple terms and taking the time to let the family process in the information. It is not leaving the patient feeling hopeless about their condition, but instead providing a plan of action and reassuring them that you are available to help them. Through this experience, I hope I am similarly able to discuss difficult diagnosis in a way that makes the experience as easy as possible for the patient.