Beyond breaking bad news: Helping patients who suffer
Michael W Rabow and Stephen J McPhee take you through a difficult task
Despite the fact that clinicians are responsible for delivering bad news, this skill is rarely taught in medical schools or residencies in the United States, and clinicians are generally poor at it.1–4 Experienced clinicians who have offered recommendations for delivering bad news will agree on many points.5–8Box 2 lists the clinician's most important goals for the initial breaking of bad news, as cited in the medical literature.
Box 3 summarises specific recommendations offered in the literature for delivering bad news, organised into a simple mnemonic (“ABCDE”). Experts also point out that clinicians invariably respond with their own feelings about the bad news.9
Breaking bad news is sometimes seen as a skill that clinicians can master with attention to the words, setting, and attitude with which they deliver upsetting information. Beyond this however, clinicians also are called on to help manage its consequences. This requires not just expert advice and training,