This document discusses best practices for breaking bad news to patients and their families by doctors. It begins by defining what constitutes as bad news, such as an unfavorable diagnosis, infertility, cancer, or death. It then discusses the importance of informed consent, empathy, and communication skills when delivering bad news. Specific strategies like SPIKES and BREAKS are presented for how to structure difficult conversations. The document also addresses anticipating and dealing with the strong emotions that patients and their families may experience, such as shock, pain, anger and guilt. It emphasizes allowing time and questions, while avoiding placing blame. The last sections provide guidance on coping with crises in obstetrics and infertility through counseling and setting new goals.
2. I Dedicate this PPT to my
Colleagues & Patients
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3. Professional life is like a game
Some time you win
At other time you lose
You have to take it in your
4. EVER SINCE THE
SUPREME COURT
BROUGHT THE
PATIENT – DOCTOR
RELATIONSHIP UNDER
THE AMBIT OF THE
CONSUMER
PROTECTION ACT
IN 1995, THE NUMBER OF
COMPLAINTS
AGAINST DOCTORS
HAS GONE UP in India
6. “Today , you will see that
MOST SUCCESSFUL DOCTORS
are those who have
Good
communication skills.
It pays to be patient to the
patients
7. Human Emotions are Most
Difficult to Predict ,
especially in a STRESSFUL environment
like
UNFAVORABLE DISEASE or
DEATH in a hospital
so…
Doctor need to be extra careful while talking
to patients & relatives
8. Concerns & Realities
Walk into the major LABOUR WARD of
any government hospital, and you’re
likely to find patients / relatives VERY
CRITICAL with treatment given.
9. In the CANCER WARD, families
of patients complain
• Doctors don’t offer much advice
• Alternatives are not detailed
• How to manage the debilitating pain
associated with the disease.
Concerns & Realities
10. “At times , physicians do end
up losing patients for being
“Rude & Uncaring”
11. What do you Think
is BAD NEWS ?
• What is bad news?
• How bad?
• What went wrong?
• How could it have been done better ?
• What if you were the patient or relative - how
will you take it ?
12. What is bad News?
It is any information which is
Likely to
ALTER DRASTICALLY
A PATIENTS VIEW
OF THE FUTURE all together …
13. VARIOUS IDEAS on BAD NEWS?
• Feeling of NO HOPE,
• A threat to a person’s Mental or physical well being
• A risk of Upsetting An Established Lifestyle or
• Where a message is given which conveys to an
individual fewer choices in her life
(ptacek & Eberhardt TL, 1996)
• “any news that drastically and negative alters the
patients view of her or his future” is bad news.
(Buckman, 1984)
14. What Constitute BAD NEWS in O/G ?
STIGMATIZATION HIV-----------------------------------------------------------------------------------------------------------------------------------
INFERTILITY
--------------------------------------------------------------
• Azoospermia
• B/L patent tubes
• IVF failure
UNFAVORABLE
DIAGNOSIS------------------------------------------- -------------------------------------------------------------------------------
Irreversible , un-treatable or non-
stoppable disease / side effects/
complications
CANCER-------------------------------------------
----------------------------------------------------------------------------------------
YOUNG AGE
Recurrence
Spread of disease
Late stage
----------------------------------------------------------------------------------------------
• STILL BIRTH
• NND in 1st
24 hrs
• Rec. Mole
• Rec. Pregnancy Los
PREGNANCY
DEATH
DEATH / DOT
15. Various Situations Faced by
Gynaecologists
Bad
Diagnosis
C
A
N
C
E
R
I
N
F
E
R
T
I
L
I
T
Y
Azoospremia
Still
Birth
B/L Block Tubes
DOT NND IVF failure
Death
in O/G
Rec.
Miscarriage
Endometriosis
16. Any of these Condition has potential to surprise the
Great gynaecologists by sudden occurrence.
This may occur in spite of taking all pro-active
precautionary measures.
Although awareness and readiness to face and tackle
all possible mishaps would minimize complications,
to a large extent.
However it cannot always be eliminated all together.
Bad News
17. INFORMED CONSENT
is vital for gynaecologists to fully make them
understand
Counseling / Video Recording
20. It is like death in police custody where
there is no help for patient & nobody knows
the facts except doctors & their team.
DOT/ Still Birth
Arrest
21. 1 Real Life Incidents
PGI Chandigarh
52 years, Doctor's aunt came with PM
bleeding. Patients had no co-morbidity
All tests were normal from pre OT area
patient was shifted on trolley and before
she could be transferred on
OT table - she was NO MORE
28. Cause of Litigations
is
Lack of Empathy
Lack of Communications
• Over work
• Over tired
• Explained before
Are Silly
Doctor’s
Excuses
29. Support Systems
• Denial
• Despair
• Anger
• Bargaining
• Depression
• Acceptance
Emotional Responses to a bad News
30. Breaking Bad News
is an ART
Doctors - today are
realizing that they have to
deliver Bad News
Diagnosis with care
31. Breaking some BAD NEWS for us!
Is the MOST DIFFICULT TASK !!
This ART – We All Have to Learn it
32. Soft skills of BBN are
NOT Taught
in Medical Colleges
YOU ARE LUCKY TO HAVE
GOOD BOSS / MENTOR !!
33. Doctors need to polish soft skills
to Deliver
“Tough”
Bad News
34. BLAT
• BUILD TRUST
• LISTEN ,
• APOLOGIZE,
• THANKS
“in our practice it helps us in dealing with
difficult situations and breaking bad news
Is our 1st
choice
35. ABCDE our second choice
A- ADVANCE PREPARATION
B- BUILD ENVIRONMENT / RELATIONSHIP
C- COMMUNICATION WELL
D- DEAL WITH REACTION
E- ENCOURAGE & VALIDATE EMOTIONS
36. Other Practical Approaches to BBN
SPIKES
Setting and listening skill
Patient perception
Invitation to give
Information
Knowledge
Explore Emotion &
Empathize
Strategy and summarize
BREAKS
B- BACGROUND
R- RAPPORT
E- EXPLORE
A- ANNOUNCE
K – KINDLING
S- SUMMARIZE
38. Keep a Bold Face !!
• Preserve maintain
reasonable
EMOTIONAL BALANCE
• Preserve a satisfactory
SELF – IMAGE and
sense of Competence.
39. What are we worried about…?
DOT/ Death/ Still Birth
• Breaking the news
• Damage to reputation
• Facing questions of relatives
• Fear of mob violence
• Handling police enquiry
• Medico-legal issues – arrest,
courts, case, judgment…
• Compensation amount
• Loss of confidence
• Stress in future cases
40. How to Handle The Situation…
Gather
Ask for help.
Relax
Review sequence of events
Do not adopt a “Blame Culture”
Proper documentation
No discrepancies in records
No comments by junior staff
Never worry, “Be concerned”
42. Communication Skills
Good communication by Sr. & Reputed
Consultant can prevent litigation
RELATIVES WANT to know TRUTH
Sympathetic approach
43. Anticipate Reaction of Relatives
& handle it well
Shock
Pain
Anger
Guilt
Depression
44. • Avoid aggression or putting blame on
relatives
• Staff should not contradict statements
made by consultants to avoid
misinterpretation by relatives.
• Do not refuse to give records
or refuse postmortem,
rather suggest it from your side.
Communication Skills
45. Being Sensitive to the
Relatives
While you proceed read the non-verbal clues;
face/body language, silence, tears
Allow for “shut down” (when relatives turn off
& stop listening) give time & space: allow
possible denial
Give opportunity to ask questions
Arrangements for taking away the dead body.
Registering the death
46. Strategies for coping crisis in
infertility/ IVF /obstetrics
Meaningful 1st
counseling of couple – biggest tip
Be mentally prepared to accept failure
Accept & Redefine goals
After crisis – problem focused BBN
1. EMOTIONAL DISCHARGE
2. Encourage CALM ACCEPTANCE
3. Be a PROBLEM SOLVER
4. Explain ALTERNATIVES
47. BBN in pregnancy / Infertility is
all together different game !!
“Their first reaction is disbelief, then
blame and anger ..
as a doctor, don’t say anything , just
hold their hand and let them vent their
anger . They generally come back and
talk to you after a while”
48. Relaxation technique &
psycho therapeutic counseling
Helplessness
doctor you are Great !! Now - I can handle the problems
related to my infertility / Pregnancy Loss
• Help her to speak - up
• Improve decision making skill
•Advice for treatment holidays
• Problem solving skill
• Benefits of physical well – being
• Nutrition.
• Spiritual counseling
Acceptance
49. BBN for “Ending Treatment”
* A patient – centered emotionally
focused approach is the key
* Let the patient set the agenda
•Help them to find meaning in life ,
Assist them in redefining goals
• To promote long term adjustment
in life by examples
50. Last, But Not The Least…..
Stop thinking about it constantly
Take a small break
Keep your morale & self confidence
intact
Learn the lesson it teaches
Even with simplest case or operation
it can not be
taken for granted that patient
will come out
Better of or even alive