Response to some medical outcomes depend on the individual patient's circumstances. If you are not sure how the patient will regard impending news, wait for the patient's response before deciding if the news is bad. Let the patients decide for themselves.

When and Where News Should be Given

• Choose a time that is convenient for the patient.
• Meet in a place that is comfortable and offers privacy for the paitent and minimize interruptions.
• Set aside enough time to fully explain the news to the patient and to allow for questions from the patient and family members.
• Provide a supportive atmosphere by inviting family members or close friends to be present if the patient consents.

How to Deliver the News

• The news should be delivered in person
• Tailor the discussion to the patient's level of sophistication, but do not assume the extent of the patient's knowledge.
• Probe for a sense of the understanding during the conversation. The patient may not hear much after the initial information. Provide summary information that the patient can reveiw later.
• Convey a sense of hope, but remain truthful.

In Massachusetts, any statements, writings, or benevolent gestures relating to the suffering of patients involved in an unexpected outcome are inadmissible as evidence of liability. Even so, some types of apologies are better than others. An apology that includes such words as "I am so sorry that my treatment caused you harm" is inappropriate.

A sincere expression of regret following a poor outcome or upsetting experience, such as "I am sorry this happened" coupled with a discussion about future treatment options can demonstrate an empathic and caring attitude. Apologies can help to mitigate any anger the patient may feel, and communicate that you will work with the patient to improve the outcome.

Source

• Ptacek JT, Eberhardt TL. Breaking bad news: a review of literature. Journal of the Americal Medical Association. 1996;276:496.