Article Date: 6/1/2004

Are You a Good Bearer of Bad News?
A glaucoma patient and support group leader offers a dozen ways to soften the blow.
By Edith Marks

"I'm sorry, you have glaucoma," my doctor told me. "We can start you on medication and you can have surgery, and then you still might go blind."

Not only was I surprised at the glaucoma diagnosis, but I was absolutely shocked at the suggestion that I'd go blind. This wasn't news I was ready to accept. And because of the way this bad news was delivered, I didn't realize that vision loss would be very gradual. I just heard "blind" and thought it might happen tomorrow.

This doctor didn't have a very tactful approach, but he's not alone. I run a support group for glaucoma patients, and I've found that about one in four people deals with bad news delivered insensitively, even from the most talented doctors. If you're working on your bad news skills, these 12 suggestions will help.

1. Suggest bringing a companion. If you think a visit might result in bad news for a patient, recommend that he or she bring along a spouse, friend or family member. When people hear bad news, they're often still trying to digest it while you're explaining the diagnosis and treatment options. When they leave your office, they probably won't remember part of what you told them, but their companion can fill them in and answer questions later.

2. Be tactful. This seems obvious, but as you can see in the example from my experience, tact doesn't come naturally to everyone. To make sure your words are sensitive, you might practice in advance and run your approach by a colleague. Remember the major impact that your words have on patients. A caring delivery sets the tone for a person's attitude about the diagnosis and treatment.

3. Show self-confidence. When patients are in a vulnerable position -- possibly reeling from bad news -- it's comforting for them to feel confident in their doctor. If you waver, they'll sense it. If you project confidence in your abilities to help them, they'll be confident in you, too, and they'll be more enthusiastic about treatment.

4. Deliver bad news with encouraging news (no matter what). Sometimes a diagnosis that sounds like bad news can have an encouraging prognosis. Other times, there's little you can do to help your patient's vision. Whichever type of case you're dealing with, it's very important to include some encouraging information when you break the news. Try, "Here's the situation, but we're moving ahead very fast, refining techniques and developing medications for this problem."

And be conscious of your demeanor: A doctor's long face or negative body language says, "We won't be able to do much for you."

5. Explain everything completely. A woman in my support group told me, "My doctor doesn't tell me anything. He doesn't tell me what's going on with my eye." She had cataract and glaucoma surgery; when she emerged seeing nothing, he told her she needed another procedure. Without being prepared for the surgery's consequences, she was absolutely lost and had no confidence in her doctor. And she's one of many people who come to me for explanations that their doctors don't offer.

Some people don't want to know everything, but it's best to assume they do. Don't decide just because someone is old or upset that she doesn't want the details, including the diagnosis and treatment strategies. A detailed explanation of a procedure often isn't as difficult as the patient imagines. "He's going to put a knife in my eye" is a much more frightening thought than the reality of the surgery experience. If you tell people what's happening, they'll be more relaxed, confident and cooperative.

6. Avoid assigning blame. People make lifestyle choices that affect their sight, and of course, age and heredity determine many problems. But it's not the patient's fault. Make sure they understand this. I had a doctor who felt frustrated every time a new medication didn't work for my glaucoma, and he made me feel guilty. He was a good physician, but his attitude eventually made me feel bad enough to find someone else.

7. Listen. Patients want to feel taken care of, not discarded. Even if you deliver the same news to many patients, keep in mind that each one is an individual. Each patient has a different life, so the impact of the diagnosis will vary, and so will the patient's questions.

8. Tell patients how they can help themselves. If you tell patients what lifestyle changes they can make and how they can learn more about their problem, you'll make them feel more confident and in control of the situation. They'll learn more and try harder.

9. Lend support. Recommend a support group for your patients. Patients are comforted to find others with the same concerns and to get suggestions about dealing with their vision problem. Doctors should be an active, vital part of patient support, periodically attending support groups to answer patients' questions. In the case of glaucoma, I recommend that doctors start support groups to educate their patients.

10. Guide patients toward learning more. Patients will have questions, so be sure to have facts on hand, even about topics like taking vitamins. Not only does it help to have pamphlets, but it's also a great help to recommend books for patients with various health problems. Books written from a patient's perspective can offer the same kind of comfort as a support group.

11. Offer them seconds. After delivering the bad news, offer to help your patients get a second opinion. Generally, patients would prefer that you recommend another doctor and pass their file along. If you don't, the patient will get a second opinion and hide it from you. You'll both benefit from your gracious attitude.

12. Call the next day. Many dentists have a policy of making follow-up phone calls the day after a major procedure. You should do the same the day after delivering bad news. The call is reassuring, it inspires confidence in you, and it gives patients the opportunity to ask questions that come to them after they leave your office.

It's all in the delivery

No one likes to be the bearer of bad news, and I'm sure it's not your favorite part of patient care. But your delivery skills can make all the difference. With your sensitivity and preparation, your patients will find bad news much easier to take.

Edith Marks is the author of several books, including "Coping with Glaucoma." Living in New York City, she coordinates meetings of the New York Glaucoma Support and Education Group and edits the organization's newsletter. Her second book about glaucoma will be published in 2005.


Optometric Management, Issue: June 2004