“Don’t worry, we don’t think it’s a bad cancer,” she said with a smile.
After I regained my composure and started breathing again, out popped, “So, what’s a good cancer?”
Sharing bad news with patients is tough no matter how much empathy training you’ve had. As a communications coach, I teach people that what your body says can be more powerful than the words you use or the empathy you share.
I recently read the following instructions on delivering bad news: “First, stand when addressing the patient, so they know who’s in charge. Second, hold an x-ray or other prop to show this is serious and that you are the expert.” Wrong, wrong, wrong!
Here’s my advice:
1. Avoid the bully stance. If you’re standing while the patient is sitting, the patient is less likely to talk because your body language says “bully.” Instead, meet the patient on his level, whether sitting or standing. Sit at a 90-degree angle to the patient or side by side. If you do want to communicate “I’m the expert,” all you have to do is use a palm-down hand gesture. It’s more professional and less intimidating than standing. To encourage the patient to ask questions, you don’t have to say a thing. Just turn your palm up and make eye contact. With a gentle smile and nod, you’ve nonverbally told the patient that it’s safe to talk.
2. Drop the prop. A prop is great, but it doesn’t prove your expertise. What it does do, however, is provide a reason to break eye contact and help in delivering bad news. The first thing a patient does when hearing bad news is inhale quickly and momentarily stop breathing. At that point, the patient can’t hear anything, so stop talking and break eye contact. Look at the x-ray or even the floor, but not at the patient. By breaking eye contact, you’re allowing the patient to have an emotional reaction without feeling embarrassed or rushed. Wait quietly and listen, maybe add a slow reassuring nod. Watch with your peripheral vision for the patient to “start” breathing again. Comfortable breathing is the key indicator that the patient is once again able to hear and comprehend the news.
3. Third person is the best person. Use the third person when delivering bad news. For example, say, “The x-ray says…” not “Your x-ray says….” Say, “The cancer is…” not “Your cancer is….” Using the third person allows the cancer to remain autonomous. The word “your” implies ownership.
What you do and say has a huge impact on the patient’s prognosis, so choose your words wisely and your gestures carefully.