How to Deliver Bad News to a Patient?

Matthew D. Beal, MD | Cara A. Cipriano, MD, MSc | Joshua C. Patt, MD, MPH, FAAOS, FAOA

March 10, 2021

As match day approaches, I think about the hundreds of personal statements I read and the passionate students we interviewed this year.  All applicants shared the desire to help people improve their function which is a core element of our profession. We heard countless inspirational stories of the applicant’s own injury, a grandparent regaining their independence after a joint replacement, or a patient from their sub-internship recovering from devastating orthopaedic injuries.

Without question, these are the stories that make us all love what we do professionally, but not every outcome is a success. Learning how to deal with bad results and complications will sustain you during the most challenging times as an orthopaedic surgeon. Your own well-being, confidence, and sense of purpose will be challenged by complications and unhappy patients. Knowing how to deliver bad news requires that you practice empathy, communication, and self-preservation.    

Empathy is an essential trait that every compassionate doctor needs to demonstrate in the face of bad news. It is defined as the ability to relate to or share the feelings of another person, as if imagining yourself in their situation. Take the time to listen to the patient and acknowledge what they are experiencing. Share in their sadness or frustration but avoid turning the conversation to yourself or your own experiences. Express that you will do what you can to help and start developing a plan to move forward. This is one of the best ways to show that you truly care about what the patient or family is going through.

Communication is a core element of patient care. It is one of the most important things you learn in training, so recognize and observe the attendings that do this best. Communication is more than talking; it is about taking the time to listen and ensure understanding. This is important up front, during the process of informed consent, so that patients have appropriate expectations and are comfortable with the risks inherent in their treatments plan. Communication is just as important when delivering bad news. For many physicians, the natural tendency is to be defensive about a complication, or anxious about a new cancer diagnosis or post-op infection. We may find ourselves wanting to sugar-coat the truth to avoid distressing the patient. However, if your message is not clear, you risk leaving them confused and anxious, which is usually worse than understanding the reality of a situation and making plans to deal with it. When delivering bad news, you must be direct as well as kind.

Self-care is the final component of delivering bad news that a physician (or any caregiver) must practice. Poor outcomes can be devastating to us because we care about our patients and feel responsible. Surgeons can become second victims, or “healthcare providers who are involved in an unanticipated adverse patient event, medical error and/or a patient related injury and become…traumatized by the event.” ( ). Dealing with a complication, or even communicating a cancer diagnosis for the first time, can affect you to your core. In some situations, physicians may feel helpless; in others, they may blame themselves. Mature coping skills are needed to accept outcomes and move on. Debriefing with your mentors or partners is often very helpful. Be honest about what you could have done differently; instead of blaming yourself for the past, resolve to do better in the future. Remind yourself of your commitment to help patients, and that a certain number of complications will inevitably occur as long as you pursue that mission. This process of self-care can help you to learn, restore your sense of purpose, and continue practicing in the face of a poor outcome.

DISCLOSURES: Dr. Beal AAOS: Board or committee member, American Orthopaedic Association, Board or committee member, Medacta: IP royalties; Paid consultant; Research support, National Institute of Health (NIAMS & NICHD), Zimmer, Stryker, Mako Surgical: Research support, Zimmer: Paid consultant Dr. Cipriano KCI: Paid consultant, Link Orthopaedics: Paid consultant, Musculoskeletal Tumor Society: Board or committee member Dr. Patt American Orthopaedic Association: Board or committee member, North American Spine Society: Board or committee member.

Read the AAOS Code of Conduct for Discussion Group Terms, Conditions and Disclaimers HERE.

Copyright© 2021 by the American Academy of Orthopaedic Surgeons

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