By Charlotte Huff
Delivering Bad News
Are there better ways for doctors and patients to discuss tough topics?
By Charlotte Huff
Biren Saraiya strives to pause and reflect, sometimes midstream, when he’s sharing dispiriting medical information with one of his patients. “Just to slow down the conversation, even in my own mind,” he says. The New Jersey oncologist watches for cues, verbal and non-verbal. Is the patient making eye contact? What is she doing with her hands? Does the question she asked reflect what she really wants to know?
This level of sensitivity isn’t necessarily innate. Saraiya, who completed his oncology fellowship last year, says that he tended to focus too much on chemotherapy regimens and other scientific details until he completed a communication program for oncologists, called Oncotalk.
“I had my own agenda when I went into the room,” says Saraiya, who works at the Cancer Institute of New Jersey in New Brunswick. “That’s all nice, but the patient may not actually hear what I have to say.”
In recent years, medical schools and residency programs have placed a heightened emphasis on physician communication. Communication skill is one of the competencies required of residents by the Accreditation Council for Graduate Medical Education. For oncologists, more than some other specialists, patient communication includes a recurring theme: the delivery of bad news. Seattle oncologist Anthony Back, Oncotalk’s principal investigator, estimates that one-third to one-half of a typical oncologist’s day is spent providing some depressing news: a diagnosis itself, an unsuccessful chemotherapy treatment, or the transition to hospice care, among other topics.
Those uncomfortable conversations can challenge even experienced oncologists, according to Back and other clinicians who study physician communication. Amid significant time pressures, an oncologist must somehow find a balance between presenting accurate medical information and not squelching a patient’s hope. Then add to those elements a potentially volatile mix of personalities and emotions—the oncologist’s as well as the patient’s. When a patient’s health deteriorates, the oncologist can feel a keen sense of failure, says Lidia Schapira, an oncologist at Massachusetts General Hospital in Boston. Plus, she says, “there is a personal sense of loss.”