Breaking Bad News and Discussing Death
Breaking bad news and discussing death

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Case Study

Shirley Smith, a 43-year-old elementary school teacher, sees her physician, Dr. Williams, because she has been feeling tired. In addition to a careful history and physical examination, the physician suggests some blood tests. The next day, Dr. Williams receives laboratory results that show probable leukemia. He knows that he needs to contact Shirley, but he feels uncomfortable and sad about what he has to tell her. He calls Shirley at work. The school office transfers Dr. Williams' call to the

Literature Review

  • “Death the Healer, scorn thou not, I pray,

  • To come to me: of cureless ills thou art

  • The one physician.

  • Pain lays not its touch

  • Upon a corpse.”

  • Æschylus. 525–456 B.C.

Each of us has a common sense understanding of what bad news is. However, Æxsschylus reminds us that “bad news” is contextual; even death stirs multiple emotions–sadness, tragedy, and, at times, comfort and relief. Folkman and Lazarus14 define bad news as that which engenders a feeling of no hope or threatens a person's physical or

A Clinical Approach to Giving Bad News

“A physician's own humanity may at times be the most powerful healing instrument.”15 Consider the following case example.

Summary

The ability to discuss bad news with a patient and family is a clinical skill that is essential to providing effective end-of-life care. Patients and families value direct, nontechnical explanations that are given by a physician with compassion and kindness. Patients and families value time to talk, express their feelings, and ask questions. Patients need the physician's humanity as much as the physician's technical expertise. As Loxterkamp30 stated, “…patients often demand just our presence.

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  • Address reprint requests to, Bruce Ambuel, PhD, Department of Family and Community Medicine, Medical College of Wisconsin, Waukesha Family Practice Residency, 210 NW Barstow, Room #201, Waukesha, WI 53188

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