How Should Providers Deliver Bad News?

Delivering bad news is always hard, but certain communication techniques can make the experience less difficult for the patient and family. Dr. Michael Haglund, a Professor of Surgery at Duke University Medical Center, demonstrates a bad example and a good example of how providers deliver bad news. The video is based on the work of Dr. Neil S. Prose and filmed with actors playing the role of the parents of a young child.
This video was produced by Firestream Media with a grant from the Duke Graduate Medical Education Innovation Fund. For more on how the creators used this video as part of a program on physician-patient communication, read this article in the Journal of Surgical Education. www.jsurged.org/article/S1931-...

[@leobear1390]

I'm sorry I know this isn't funny but the absurdity of the doctors mannerism in the first example made me laugh, it was so unfitting for the subject he was discussing.

[@nurseness86]

Ok, an Oscar for the mom please!

[@simplyme7821]

This video really hits home with me. Five years ago, I woke up and I found my husband crawling around on the floor. I had no idea what had happened to him. He was out of it so, I called an ambulance. My daughter drove me up to the hospital and by then they had done an MRI. I was standing by the foot of his bed and the head neurosurgeon introduced himself to me. I asked him what had happened and he said that my husband had hit his head and it was bleeding and his brain was swelling. I asked him where it was bleeding and he said that it was more of a shotgun pattern and that he was bleeding in more than 25 places. He said he stopped counting at 25. Then he asked me if I had any questions. My husband was slipping into a coma by the minute. I asked, do you need to do surgery? He said, no. His brain is bleeding in too many places and there's nothing I can do. Any other questions? The head neurosurgeon and I were now sitting eye-to-eye. He looked impatient but, I would not break eye contact with him so, he just sat there. We looked into each other's eyes for a good 2 minutes and then I said to him, has anyone ever woken up from this kind of injury? He stared into my eyes and he shook his head no. Then he got up and walked to the door. I looked over at him as he was just about to leave the room and I yelled across the room, then you don't know God and you don't know Mark! He just walked out and shut the door. They took him out of Surgical ICU and put him in another room. I came every morning at 7 a.m. and I left every night at 7 p.m. Every day, his body was making phlegm that was thicker than rubber cement and he was choking on it. I saw the nurse take a long suction tube to clear his throat and the tube got clogged immediately. Then she just left the room. He started choking every 5 minutes and when the nurse came in I asked her how to unclog the pipe. She handed me a cup of hot water and said, put it in there and it will clear the tube. I stood next to him and suctioned him every single time he started choking for 12 hours a day. At night, I would tell the nurse that I would be back in a few hours and not to call me and say he died because I would know he choked to death. After 4 days, they finally realized that this man was loved and I wasn't going anywhere. They rushed him back to the SICU and put him on a ventilator. All I had to do was to go back everyday and talk to him. I asked God to heal him. I never saw the neurosurgeon again. They were just waiting for him to die. I kept saying, I love you, please open your blue marble eyes. And, 3 weeks later, he opened his eyes. They said he would never walk again and if he did to bring him back because he would be like Lazarus. I woke up one morning 6 months later and he was coming in the back door. I asked him what he was doing and he said he had mowed back lawn. They said he would be a vegetable. I started out doing 12-piece Snoopy puzzles with him and a year later he was reading me the Estheology of Religion and explaining it to me. I know I spelled that wrong. Anyway, I experienced the wrong way to tell somebody that someone is going to die. Given no hope, I went and found my own hope. That was years ago and unfortunately a year ago on his birthday, he went in the kitchen and I didn't hear him so, I went in to see him. I found him on his knees. I laid him down and said I love you. His eyes were round and blue and he mouthed, I love...and, he died with my hands on his chest. I have been all alone ever since. But, if I had listened to that doctor and given up years earlier, I would have missed the best years of our life together. If you read this far, thank you. I miss my best friend. Sincerely, Carly 💜

[@MitchellWiggs]

As absurd as the first example is, I’m actually really surprised to learn that a tumor can cause sneezing and flu like symptoms lol

[@harrysmith747]

Providers need this training because once you deal with horrible stuff EVERYDAY, you become immune to it. You mean well, but you just get used to it.

[@CaptchaNeon]

Little Jimmy about 4 years old?! Yeah just past him.. Dude, doctor is stone cold. That made me laugh because he was treated like some statue you see everyday that you walk past.

[@holliewestbury2900]

I auctally had a brain tumour before but It was not cancerous. I had a 6 hour operation in 2015 and now I'm back to normal! Then I had a puppy for being so brave! 😷😄🐶❤

[@flyingwithllamas]

I've worked with surgeons for 30 years, some are amazing surgeons but dont have the best bedside manner. However, striking the balance of being clear and precise but not patronising is a fine line which comes with experience. The best thing to remember is that we treat our patients how we would wish to be looked after ❤

[@madmarcii4206]

i have survived 26 surgeries for cancer since the age of 11yrs, was hospitalized for 3 1/2 months after a bad car accident at 13yrs old, i was the 23rd female victim of a repeat offender who stabbed me repeatedly with an ice pick and scissors at age 35. at age 46 i suffered a bleeding aneurysm 2 brain surgeries and shunt implant in my head. so i have dealt with doctors, nurses, emt's and ambiance drivers my whole life and nothing is worse or more scary than being treated poorly by them. i have tattoos and colored hair and am on pain management meds. the pre judgement i get from some of these people is unexceptionable and heart breaking and has almost killed me. i was lucky enough to stay alert while having an aneurysm (in my circle of willis communicator artery ) to the hospital. i told them over and over i was having an aneurysm and they wouldn't believe me. they assumed i was just there for drugs. as time passed death was growing near i finally passed ou and that's when they finally did something and ended up shipping me to a bigger hospital to save my life. you people who work in the medical field need to remember that we are scared, in pain and sick and you are the only thing that brings us comfort. when you fail us it's devastating at our most vulnerable moment. i have too many bad stories to share about being treated poorly in hospitals and by doctors. but i do have a handful of good experiences too. unfortunately the bad outweigh the good.

[@OldLibrarylady]

My husband was in the hospital after a long battle with cirrhosis of the liver and I knew he was close to the end. The charge nurse called me to sign a DNR because he wasn’t lucid. I got to the hospital and walked up to the nurse’s station, introduced myself to the nurse and explained why I was there. I was also alone. She held up a finger and made me wait while she finished some paperwork. Then she put down her pen, looked up at me, and said “He passed away”. I broke out in tears and sobs. She shushed me and pushed me into his room. I wish I had gotten her name and reported her. This was cold, disrespectful, and uncompassionate. I needed a little support and she blew me off.

[@Winston0Boogie]

The doctor is such an emotionally distant and insensitive ass that I can't stop laughing. "He's in a bed. I don't know which bed he'll be in though."

[@FeralWench]

Unfortunately, I've experienced these two types of doctors. When I was very young, I needed surgery on my foot due to my disability, and required a cast for a few weeks after. When the doctors took off my cast, my big toe was very dark and looked like it had become infected or the skin died. Of course, my mother freaked out and he briefly told her that they'd try to heal the area but he wasn't sure if it would need to be amputated. My mother was in so much shock, that she had a hard time controlling her emotions (as any mother would). As the doctor left my room, we heard him mutter, "I don't care if she loses her fucking toe". Imagine saying that about a scared little girl who just wanted to be able to walk.

[@hassanhamadnalla2067]

excellent, breathtaking performance from the mother!

[@NorthStarPNW]

Something the doctor could have added around

[@sarahcrain8083]

This hits home. May 31, 1992 I told my son's neurologist that my four year old son had a brain tumor. Safe to say, by the look on the doctor's face. He thought I had lost it because nothing would control my son's seizures. Follow up MRI confirmed my greatest fear. The diagnosis was epidermal brain tumor. Surgery was done on August 10, 1992. It turned out to be a right cerebullar pontine angle arachnoid cyst. MRIs could not distinguish solid masses from cyst. Had I not spoken up, where the cyst was located, without surgery would have been fatal. It was compressing the brain stem, 6 cranial nerves and the pons at the base of his brain.

[@jenniestonier9079]

So grateful you are providing this...unfortunately with over nearly 40 years in the health care system it is rare to find folks with the skills to communicate difficult news EVEN when they are compassionate people.....this stuff is a real blessing....thanks

[@vishalSharma-ol9fl]

And the youtube Emmy for the best supporting actor female goes to...........

[@Raidnaomemata]

Very nice! That's a situation many doctors have problems with.

[@HighTreason007]

I remember when my dad was dying, me and my mom were heartbroken in the hospital when the doctor gave us the prognosis (death). Of course we were crying and asking the physician wasn't there anything more he could do? He looked at my mom and basically said he's dying and there was nothing to be done and to get over it. The way he said it was so malicious it was like a gut check to both of us. I saw what little hope my mother had in her soul, ripped from her like the root of a tree...it hurt me so bad and it took her and three of my uncles to keep me from assaulting this doctor...i couldn't believe it...i still cant. 😢

[@wakeupscreaming9883]

I never understand why health providers ask "do you have any questions?", especially when patients or family have just been bombarded with completely shocking news.