Someone recently asked me if in medical school we were taught how to talk to patients and deliver bad news. Did we have a course that showed us examples of how to tell someone they have cancer, or their loved one just died, or their newborn baby had Down’s syndrome? The answer to these, and all similar questions, as far as I can recall, is a resounding “no!”
If that surprises you it shouldn’t because we all know how blunt some doctors can be and how poorly they communicate with their patients. They seem rushed, uncaring, or just aren’t listening. They interrupt and cut you off, or ask a question that shows you they weren’t really listening. In the 1960’s, didactic learning was the emphasis. The good doctors were the smart ones who knew every detail of every medical condition. Whether they were able to gain rapport with the patient was insignificant. Whether they seemed to care and understand a patient’s feelings was not important.
I remember two specific instances when professors displayed how they interacted with their patients. These obviously had a huge impression on me because they’re still at the forefront of my consciousness. The first was a neurologist who had a man with severe staphylococcal pneumonia wheeled into the lecture hall to show us neurologic findings he had developed. The message the doctor gave us prior to the patient entering the room was to show no emotion, make no comment, and be unresponsive to any thing the patient said about his condition. He said we doctors should remain stoic and expressionless if the patient expressed despair or was seeking sympathy. This was the doctor’s way of emphasizing impartiality, or professionalism rather than compassion.
The second example was the psychiatry professor who brought into the lecture hall a young man with severe depression. He talked about how he felt worthless, didn’t care what happened to him, and didn’t want to live any longer. He talked about bizarre thoughts and ideas going through his head; that he just couldn’t cope. My inexperienced, naive self kept thinking the doctor should just tell this guy to man up, snap out of it, and get a better attitude—“get a life.” The main emphasis of the presentation, however, was how physicians, especially those treating mental illness, need to remain non-judgemental and not react emotionally and verbally to comments by the patient. Don’t respond to the patient’s rantings. Don’t judge his behavior.
Those instances stuck with me for all of my professional life, but the answer to the original question “were we taught how to talk to patients?” is still “no.” I learned by observing others—colleagues, attending physicians, nurses, chaplains. Everyone develops their own routine, their own delivery, their level of empathy, tact, and professionalism that is based on their personality, emotions, and life experiences. You learn to deliver bad news from observing others and linking their techniques with your own ability, understanding, and communication skill. It takes practice to get it right, and you don’t accomplish that every time.
So, NO, we didn’t have a course on patient communication (at least that I remember), but yes, we learned by observation of others. One’s baseline personality, ability to empathize, and communication skill have a huge impact on how effectively a doctor carries out what he has observed. Some doctors do an excellent job, but many others are very uncomfortable with this task. I think showing you care and using a compassionate tone of voice goes a long way. Bad news is never easy to deliver, but our reluctance to share it is sometimes affected by our own anxiety regarding the receiver’s response. We can’t let that influence our need to communicate the message. It must be delivered as professionally as possible.
