BLOG: Seven ways to get better at delivering bad news
As a rehabilitation psychologist at a comprehensive acute rehabilitation hospital, I work closely with a team of specialists to provide integrated care to people who have suffered spinal cord injury and disease.
In addition to assessments and individual and group therapy, I often provide strategies on how to deliver bad news such as informing a spinal cord injury patient that prognosis for walking again is quite poor.
Similarly, optometrists might be counseling patients about loss of visual function or a condition that will threaten their sight in the future. These are stressful situations for both provider and patient — made even more stressful right now by the pressures of a global pandemic and weak economy. Here are seven proven strategies for doing this well.
Remind yourself to think holistically. Patients are more than just their disease or present illness. They want what we all want — quality of life, independence and hope for the future. Simply by reminding ourselves to think about our patients as people we can be more compassionate and set a better tone for our interactions with them.
Consider how racial and other disparities intersect with disability. For many people, a disabling condition or functional loss intersects with pre-existing systemic disadvantages, such as lower access to care and transportation, poor health literacy, lack of family support and accessible housing, and medical mistrust. Be aware of these factors and elicit information from the patient about barriers to success.
This can be done in an open-ended and nonjudgmental way: “What do you think might get in the way of doing your vision therapy when you leave here?” Based on the response, you can activate resources, make referrals or break down information so that it is better understood.
Be aware of provider power. There is already an inherent power differential between patient and provider, and that is compounded when the patient has some functional loss or is fearful or anxious about their diagnosis. Whenever possible, equalize the power differential by seeking the patient’s input and empowering them to make choices about their goals or their health care options.
Ask open-ended questions. Provide reflections and summaries of what they are saying. Talk directly to patients at eye level and use open posture and normal volume. Simple, common greetings and gestures go a long way.
Make psychologists part of your team. Get to know the rehabilitation psychologists in your community so that you can make referrals when needed. Patients may be defensive about a mental health referral (“Does the doctor think I’m crazy?”), but explaining that this a routine part of care for certain diagnoses (ie, traumatic brain injury) and putting the emphasis on rehabilitation can significantly decrease any stigma.
Focus on “and.” When I have to have a tough conversation, I try to pair the bad news with the good, making sure that I give the patient both the truth and hope.
For example, I might say: “Right now, you aren’t able to walk. To be honest, that might not improve. However, there are some things that are within your control. You can adapt to this and maintain some independence, although you might have to learn to do things a little differently.” Adapting for right now does not mean that you are giving up hope. These both can exist simultaneously.
Provide empathy and let the patient grieve. Too often, we associate grief only with death. But there can be significant grief over loss of function, independence and aspect of identity too. Maybe the diagnosis means your patient can’t fully participate in their chosen profession. Maybe it means they won’t be able to drive. It’s important to normalize the grieving process and allow your patient to process their feelings about the news you are delivering.
Your goal may be to immediately move to a treatment discussion, but the patient may need time to cry or disengage before they are able to make a plan for moving forward.
Put your own mask on first. Medical doctors, optometrists and psychologists are all in “helping” professions, which means we are also at risk for burnout. Burnout can take many forms — physical aches and pains, more frequent errors, sleeplessness or irritability — and can affect the quality of the care you provide. I like to encourage colleagues to regularly engage in radical self-reflection.
Understand what burnout looks like for you and what method of self-care will actually help you. For some people, a few days at the beach might do the trick; for others, maybe it is more regular exercise or meditation. Create a COVID-19 plan to help you feel more in control during these uncertain times. Regardless, secure your own well-being so that you can continue to help others.
For more information:
Mana K. Ali, PhD, is the attending psychologist on the spinal cord injury/disease unit at MedStar National Rehabilitation Hospital (NRH). Ali conducts psychological assessments, including spinal cord stimulator trial evaluations, and provides interventions to support mood, adjustment to disability, health behaviors such as pain management and sleep hygiene, and overall quality of life. Ali also serves as the director of training for the Rehabilitation and Pain Psychology Postdoctoral Fellowship and is co-chair of the diversity, inclusion and anti-racism committee at MedStar NRH.
Ali will teach a course on self-care and burnout prevention at the NORA virtual annual conference, Sept. 12-13, 2020. For more information on the conference, please visit: www.nora2020.com.
Disclaimer: The views and opinions expressed in this blog are those of the authors and do not necessarily reflect the official policy or position of the Neuro-Optometric Rehabilitation Association unless otherwise noted. This blog is for informational purposes only and is not a substitute for the professional medical advice of a physician. NORA does not recommend or endorse any specific tests, physicians, products or procedures. For more on our website and online content, click here.
Collapse