Breaking Bad News: Learning Through Experience

Abstract

She sits in bed, propped up by two pillows, wearing a white hospital gown, staring out of the window. Her fingers pick at something—is it a tissue? —listlessly, distractedly. I’ve been told to see her and “get a history.” I’m nervous—she doesn’t look well and certainly is in no cheerful mood to talk. But I do as I’m told, and approach her with a smile: “Hello, I’m a medical student; do you mind chatting to me about why you’re in the hospital?” She turns and wearily looks me up and down— was my cheerfulness too forced? “Oh, I suppose so, if you must. Not much else for me to do, is there?” So I pull up a chair and we get started. Dianne tells me that she noticed a lump on her neck some weeks ago, and dismissed it at first, thinking, “must have knocked myself on something,” but when it didn’t go away, she visited her local doctor. Before she knew it, he ordered some tests, and had her admitted to the hospital overnight for a lymph node biopsy. And here she was—it was midmorning—anxiously awaiting her test results. “They said it could be lymphoma,” she told me, “which is a death sentence, isn’t it? My friend’s mother had a blood cancer a couple of years ago, and it was horrible—all her hair fell out, she was so sick. Those last few months. . .she was in so much pain.” And then she burst into tears. “I’m going to die of cancer,” Dianne sobbed, “I’m so young, I have two children. What is my husband going to do? And what about work—I can’t afford to take time off!” Desperately, I offered up the box of tissues by her bed— wanting to get out of the room and feeling completely helpless. “Time out! Let’s leave it there for a minute. Tell me, Dianne, how are you feeling?” Our moderator cut in. “And you, Stephanie, what do you think about the way you approached this patient?” I was in a simulation. Dianne no longer had a lump and had wiped away her tears, revealing the actor beneath. “I felt blocked,” said the actor. “Your offering me a tissue was an indication that you didn’t want to listen to my problems, you just wanted me to stop crying!” I agreed, but for different reasons—I had no idea how to help a very distressed patient deal with terribly bad news and was actually very upset myself. WHY IS BREAKING BAD NEWS SO DIFFICULT?