Dr Suresh is a GP and skin cancer doctor in Brisbane, and patients can book with him at this link

I often get asked by patients – not those I’ve just broke some bad news to of course – what it’s like to tell someone a bad diagnosis, to give them the news they are dreading.

It’s something that unfortunately as a GP I have to do quite a lot. We aren’t really taught in medical school about how to break bad news. We weren’t really taught that much in our GP training either. Well we are, but we’re not really taught. It’s all textbook stuff. Unfortunately textbooks don’t often translate to real life very well. So it’s something that you tend to learn on the job as you gain more experience. You try to observe your senior doctors, your mentors, to learn from them. How are they doing it? What did they say? What was their body language?

Sometimes though, probably more often than not, it’s left to the most junior doctor with probably very little experience, and often very little information, to break that bad news. It really shouldn’t be, but it often is. This is bad for many reasons. Often that doctor will have had very little real experience in doing this. They may have just come off a night shift and be absolutely exhausted. They may be in the middle of a very busy ward round or surgical assisting list, and they may feel rushed and pressured. Worse still we a junior doctor we often have very little information. They may even be the on call doctor and have next to no knowledge of that patient at all. All this means is that they can’t answer the inevitable deluge of questions that will follow.
The only thing worse than being told bad news, is being told news and then not having any of your questions able to be answered and being told ‘sorry I don’t know’.

Now saying sorry is something we do quite a lot. It’s the sign of a good doctor. Humility, not hubris. That’s what we want. But if you are on the receiving end of ‘I don’t know’ to every one of your questions, well that’s just really unpleasant.

So it’s not nice for patients or their families. But what about for the doctor?

As I said, breaking bad news is something that unfortunately as doctors we have to do more than we like. We’d love to never give bad news, but it comes with the job unfortunately. So what does it feel like? How do we do it? How do we cope with having to give people sometimes devastating news. Well every doctor will do this differently. I’ll tell you what I normally do.

So before I call the patient in, I’ve got all their information to hand. I’ve gone through their scans, their bloods, their letters. If they need a referral to another doctor I always try to organise that before I see them, so that when I do I can give them options. I will usually try to reserve an appointment slot for them with that specialist so that I can present it to them, taking some of that immediate pressure off them.
So then I’ve prepped. I will call the patient in, and sit them down. I will have a quick chat, small talk if you will. You may think this is beating around the bush, but actually there’s evidence to suggest that doing this is beneficial. being more personable, more approachable, basically a nicer person, well that’s never going to be a bad thing.
I will then give them the news.
You could hear a penny drop most of the time. Silence. Confusion.
Time. I give them time. Time to absorb what I’ve just said. Sometimes that’s quick, sometimes long. We sit there, in silence, but my body language says ‘i’m open, i’m here, if you need a hug i’m ready, and when you need let’s continue’.

Now they never absorb it fully. Not in that consult, but once they give me that cue they are ready to continue then we will. I’ll give them the info we have. I’ll answer the questions they have, as best I can. I won’t have all the answers, but I’ll have options. And after all this is done, I’ll offer a follow up. This is to give them time to absorb that terrible news, digest it, and come back with all those questions they really want answered but just couldn’t think of. I usually advise my patients to write a list, that way when they come back they won’t forget all those questions they wanted answered.
We finish the consult. The patient leaves. We know the patient feels like shit. They are most likely devastated. But how do I feel? What do I then do?

Well I dutifully make my notes. I document our discussion. I check those boxes that need to be checked. I arrange those reminders for follow ups. All that behind the scenes stuff that still needs to happen. Then when that’s done, I will have a moment. Quiet contemplation. I don’t usually cry, although sometimes it’s just so sad that I will. We may not always seem like it, but doctors are human beings too and we certainly feel. We carry those emotions. They won’t be to the extent the patient feels them, but we will still feel sad and upset. We will probably feel sad the whole day. Probably for days if not weeks after. Like the patients we will be hoping that somehow we just got it all wrong and it’s not true, despite knowing that it is.

Dr Suresh is a GP and skin cancer doctor in Brisbane, and patients can book with him at this link


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