The Difficulty of Delivering Bad News

by Academy of Clinical Excellence on September 22, 2010

Photo credit: Perna, Algerina, Baltimore SunMiller-Coulson Academy of Clinical Excellence member, Mark Duncan, M.D., spoke to the Baltimore Sun about the difficulty of delivering bad news within the context of the Johns Hopkins Hospital shooting last week:

Delivering bad news one of medicine's great difficulties Hopkins shooting highlights the complexities doctors face in talking with patients, family members

September 20, 2010

By Childs Walker and Scott Calvert, The Baltimore Sun

...However, the incident touched on an issue of great interest and concern to the medical community — the complexity of relaying emotionally rending news to patients and loved ones who might already be under stress.

"An incident like this does make one reflect on how we do it," says Dr. Mark Duncan, a veteran cancer surgeon at Johns Hopkins Bayview Medical Center. "It's probably one of the more important things we do in the job."

Duncan says he typically sits down with a patient's loved ones, offers empathetic touches on the hand or shoulder and answers every question that arises. Most of the time, recipients are accepting, even gracious."

At the end of the encounter, the family will thank you profusely," he says. "Often far beyond what you think you merit. It's just the fact that you're there with them, that you care."


Such exchanges are far more common than misunderstandings or emotional outbursts, says Duncan, the Bayview surgeon. Trouble is more likely in trauma situations, when a surgeon hasn't had time to build rapport with the patient or family. Sometimes he tries to have a nurse or another doctor at his side to avoid the chance of a one-on-one dispute.

The good news, Duncan says, is that the medical community has come a long way in recognizing the importance of communication with patients.

"It's easy to get excited about a six-hour surgery with all kinds of technical wizardry," Duncan says he tells young medical residents. "But lending comfort and understanding to someone who is not going to be cured is a tremendous opportunity to deliver care."

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