Good news: Concealing bad news reduces physician stress

When bad news arises in the clinic, many physicians begin to show signs of stress: increased heart rate, anxiety, ill temper, etc. The authors of a recent JCO article suggest that concealing bad news is less stressful for physicians. They base their conclusions on experience, literature review and a brief experiment they conducted with medical student volunteers who were asked to either conceal or disclose information about diagnosis and prognosis of a young patient-actor with a new, inoperable brain cancer. They compared the results to a control group who had an interview about dietary habits. They discovered that the medical students who were required to disclose information had higher levels of anxiety and worse mood and seemed to perceive the experience as more threatening than the control group. The group, which concealed the bad news, appears more psychologically and physiologically (heart rate decrease) comfortable compared to the disclosure and control groups.

So, do we really hide bad news to make ourselves feel more in control? It does not appear to be limited to oncologists: hospice physicians provide frank survival estimates to their patients only 37% of the time.

The authors argue the reason is control—physicians feel out of control when they are uncertain how a patient will respond to bad news. They are uncomfortable dealing with the patient’s, and their own, emotions. They conclude that concealment provides a more predictable emotional response and is easier to handle. I would add that, in our oncology world, we are under great time pressures and many worry that openly communicating bad news may take much more time than they have. Or that there is not the time to “do the job right.”

I am evolving in my practice and, while I do not like giving bad news, I am getting comfortable with it. I have learned to practice and try different approaches and observe how the encounter goes. I advanced my communication knowledge through additional training at programs like OncoTalk, which genuinely transformed the way I interact with patients.

While I have admittedly an easier time giving a patient bad news than telling my wife I’m going to be home late—again—it’s because I have a concrete skill set for dealing with emotion, transitioning to palliative care, running a family meeting, and other tough topics in the clinic. Having greater comfort with difficult conversations has improved my satisfaction and time efficiency in the clinic.

Tony Back, MD has said:

“The way you communicate is part of your work as a healer. You are not born with communication skills—you learn them.”

While concealing bad news may temporarily relieve our stress or improve our perception of control, it also inhibits our relationship with our patients and increases the pressure on the next conversation. I find that being open and honest early on makes everything down the road simpler. I would encourage anyone to seek out additional knowledge in difficult conversations—I’m certainly happy I did.