Doctor-Patient Communication: Communicating "Bad" News
Steve Adubato, Ph.D.

For physicians, one of the most difficult aspects of dealing with patients involves communicating news that is less than positive. Simply put, how does one communicate "bad news" to a patient who is anxious, nervous and downright afraid?

Doctor / patient communication is in many ways the most important aspect of delivering superior healthcare. Sure, the best medical technology and research has its place, but healthcare is largely about human interaction between patients who are sick and physicians who are expected to have all the answers but clearly don't. This column is intended not only for physicians who want to communicate more effectively, but also for the rest of us who are healthcare consumers who must interact with physicians and other medical professionals. It doesn't necessarily have to be the way that it is. Doctor patient communication can be a lot healthier, even in an age of managed care. With that in mind consider the following communication tips, particularly for physicians who have to deliver "bad" news to their patients:

Find a comfortable and appropriate environment to give the test results. Too often, medical information is communicated on the fly or in the hallway of a hospital or doctor's office. Medical professionals should do everything possible to avoid this. Hearing bad news is hard enough, much less having to hear it in front of an audience.

Make yourself available to the patient, understanding that they will be extremely anxious until you speak with them. The key here is to build in enough time to allow for an honest and thorough discussion with the patient. In the world of managed care this is easier said than done, but it is an absolute must in building rapport with patients and gaining their confidence.

Present your information clearly, with the least amount of medical jargon. Simply put; speak in everyday conversational English that people can understand. Use analogies and examples that patients will relate to. Remember, your patient wasn't sitting next to you in medical school and there is no reason to think they understand medical vernacular.

Empathy is king. One of the best ways to communicate to a patient is to imagine what it might be like to be a patient (and everything that entails) and communicate accordingly. This isn't just true for physicians but for anyone in the service or helping professions.

Offer the patient other resources to obtain information about their medical situation. A physician can help a patient become his or her own best advocate. However, that can only be done by obtaining accurate and relevant information concerning the illness, diagnosis or procedure in question.

Be aware of your body language and what it communicates to the patient. Sit at the patient's level and try to avoid looking down on them. Make steady, focused but relaxed eye contact. This does not mean staring and making your patient even more uncomfortable.

Take the opportunity to touch your patient's hand, arm or shoulder if you sense that it is needed, wanted and/or appropriate. You would be amazed at how many patients comment on the "warmth" of a physician, largely because of this personal, soothing, very human contact.

When dealing with certain patients who are often ignored or discounted (for example children and the elderly), make sure you talk directly to them and not exclusively to the family member or significant other who is accompanying them. All patients want and need to be acknowledged. They also need to participate directly in their own care.

Bottom line? Physicians have an incredibly difficult job these days. Then again, so do patients. It is easy to point a finger and blame the medical community for being insensitive and uncaring, but that won't get the job done. Like all professionals, physicians need help improving their communication skills. By being more aware and informed as to what good doctor-patient communication looks like, we can be part of the solution instead of contributing to the problem.

Dr. Steve Adubato coaches and speaks on the subjects of communication and leadership and is the author of the book "Speak from the Heart." Write to him at The Star-Ledger, 1 Star-Ledger Plaza, Newark, NJ 07102, visit his Web site at www.stand-deliver.com, or e-mail him at sadubato@aol.com.

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