Giving bad news, especially if there was an error in care, remains one of the toughest experiences for any of us as health care providers. A study of the SPIKES protocol, published in the Annals of Oncology, showed that patients still need more time to talk, often repeatedly, about the details – even if a protocol is used to deliver bad news. And even though we’ve moved beyond the era of attorney-driven “do not divulge” instruction, we still struggle to provide understanding and empathy.
A few observations, as someone who has worked to improve our communication skills in education:
- Communication and empathy are two of the most important skills physicians and all health providers need to be successful in building teams, sharing expertise, and most especially when “breaking bad news.” We should not be surprised that physicians as a profession do a poor job at this. We still accept students based on science GPA, MCATs and organic chemistry grades, yet somehow we are amazed that doctors are not more creative, communicative and empathetic.
- While patients want to trust their doctors, doctors are often advised by hospital and practice attorneys to “say less” when delivering bad news. So to the patient, the doctor she trusted has now “clammed up.” The data shows that maintaining trust requires allowing the patient to express her anger and disappointment even if it is uncomfortable for the physician.
- On a personal note, having delivered over 2,500 babies, the patients that followed me through three states are often the ones that suffered a stillbirth or other horrible outcome, because I made sure that I was present for them. While they were initially angry and even sometime blamed me, they realized that as a physician, I was there through both good and bad times. We need to spend more time during medical school and residencies discussing this issue.
- Sidney Kimmel Medical College has been a leader in this regard, creating the Jefferson Scale of Empathy, the largest database on medical student attitudes toward patient communication and empathy spanning over 30 years. To transform communication, we need to push admission standards nationwide to accept more students with emotional intelligence. We need to ensure the Jefferson Scale of Empathy is acted upon in medical schools nationwide. And we need to build a culture in health care practices that ensures we are there for our patients, regardless of how uncomfortable we may be.
- We should enhance our own systems that prevent medical errors. We know so much more now—that error is usually caused by a breakdown of team communication that the “culture of blame” doesn’t work, it never did. Instead of blaming doctors, nurses, pharmacists and other providers, we should be emboldening those who are working to reduce error. It is not easy. To reduce error, we need inter-professional team training, helping our team learn behavioral and communication skills. And we need an engineer’s eye to fixing health care procedures that can easily be too fragmented—little bits of information in the wrong place. What’s exciting about the future is the energy I observe to prevent errors and a willingness to admit mistakes.
It’s more than time to mend the errors of our erring ways.