March/April - West Virginia State Medical Association

| Scientific Articleis delivered in a hospital room, thedoor to the room should be closedas should the curtain toward theother side of the room if the meetingoccurs in a shared hospital room.Bad news is difficult enough withoutan unintended audience or otherdistractions. Advance preparation canassure that patients and doctors haveample preparation, time, and spaceto deal with the taxing task at hand.Building a TherapeuticEnvironmentBuilding a therapeuticenvironment is more difficult than thephrase might imply. Chief among thegoals of a therapeutic environment issupport. The patient will likely havefamily members or friends whomthey wish to participate for moral andemotional support. In addition, thephysician may opt to have clergy ora counselor available depending onthe severity of the bad news beingdelivered. However, not all patientswant to have others present. Thebest approach is to ask about thepatient’s wishes. A good exchangecould include the following:“I have some news that I wish toshare with you. Whom would you liketo be with you when we talk about it?”While we might assume that thepatient needs the family, we need torespect his or her wishes to include,or exclude whomsoever he or shedesires. The patient needs to be ourguide. At times a patient may notwish to know the bad news. If apatient refuses a meeting, one canwait until later in the day or the nextday, depending on the urgency.The final step is to start the sessionwith an introduction and a “warningshot.” The introduction lets the familymembers know who the physicianis. An example of this might be:“Hello, I am Dr. Wilson, Mrs.Johnson’s family doctor.”A warning shot after theintroduction will help prepare thefamily and the patient for the newsthat is about to come. While it islikely that they know that a meetingis rarely for good news, it still ishelpful to soften the blow withsome well chosen words, such as:“I have gathered you all becauseI have some difficult news.”“I regret to say that I havesome tough news for you all.”“I am sorry to say I havesome bad news to share.”Communicating WellThe next task in breaking badnews is communicating well withthe patient (and family). Even inthe present era of high technologyBeckley ARHAdolescent Behavioral Science CenterTeenagers face numerous challengestoday that can sometimes cause them tohave serious issues.Beckley ARH’s Behavioral Science Center can intervene to help themcope and prevent a problem from becoming worse as they enteradulthood.The Unit allows for an excellent opportunity to identify,diagnose and treat problems at an early stage so they can get back toschool and what should be some of the happiest times of their lives.Beckley306 Stanaford Rd | Beckley,WV 25801304-255-3000 | www.arh.orgMarch/April 2012 | Vol. 108 33