The Difficult Art of Delivering Bad Information — Physicians' Challenges

Delivering bad news to patients is one of the most difficult and emotionally taxing tasks doctors face. Any conversation of this kind is a meeting between two people at the most delicate point of their relationship — a doctor who knows the medical reality and a patient who is just beginning to get to know it. This challenge, however, carries emotional costs that often remain invisible to those around them. In this article, we will look at how this duty affects doctors and why support for them is as important as caring for the patient.

Emotional overload of doctors

Research shows that doctors often feel emotionally overwhelmed, especially when faced with the obligation to deliver bad news [4]. It is therefore important that this aspect of work is understood and supported by medical and social institutions.

In addition, informing the patient or his family about a serious diagnosis, unfavorable prognosis or lack of treatment options requires adequate preparation, understanding and communication skills. Lack of these competencies can lead to burnout and stress in doctors.

Stress and burnout of doctors

The long-term stress of delivering bad news is one of the main factors of burnout among doctors, especially in oncology and palliative specialties. When doctors deal with the deteriorating condition of their patients, they experience sadness, helplessness, and fear of deteriorating relationships with their patients [2]. The sense of responsibility for the emotions of patients further increases the emotional overload of doctors. Research unequivocally proves that the obligation to convey bad news significantly affects the mental health of doctors, often leading to anxiety and even depression [6]. These findings point to the need to implement strategies to support the mental well-being of physicians who regularly have to communicate difficult information.

Ways of communication and the impact on doctor-patient relationships

Empathic communication

The way a doctor communicates bad news has a huge impact on the relationship with the patient and his loved ones. Patients who receive bad information conveyed with empathy and understanding come to acceptance of the diagnosis more quickly and have greater confidence in the doctor [5].

Errors in communication

When communicating difficult information, doctors often make mistakes such as lack of empathy, avoiding direct answers, or using overly specialized language. As a result, they can give the impression of indifference or distance. Another problem is the transmission of messages too quickly, without making sure that the patient understood their meaning and had time to process the content. Such shortcomings in communication can lead to a deterioration of the relationship and a feeling of loneliness of the patient.

Impact on further treatment

The art of proper communication is key — doctors should strive to build a sincere but compassionate dialogue that will help patients and their families in the process of accepting a difficult situation.

In addition, effective communication not only supports patients emotionally, but also enables them to make more informed decisions about further treatment [3]. Communication can influence the course of the treatment process, which confirms the importance of doctors' communication skills in conveying bad news.

Communication support and training

The introduction of training programs that have the potential to help doctors deal with difficult conversations is an important step towards reducing the stress associated with this part of the profession. Studies show that doctors who have undergone special training in communication experience less mental strain and are more confident in conveying difficult information to patients [1].

In practice, many doctors still do not receive adequate support in this regard, which contributes to an increase in their stress and psychological burden. Lack of preparation and limited support from co-workers can exacerbate feelings of burnout and stress. Therefore, communication training should become the standard so that doctors can effectively help patients and at the same time take care of their mental health.

Conclusions

Delivering bad news is one of the most demanding and emotionally taxing tasks in a doctor's job. It requires doctors to be able to deal with their own emotions, empathy and an appropriate attitude towards the patient. Research indicates that this duty can lead to burnout and psychological problems, especially when the doctor does not have adequate support or training. The introduction of regular communication training and psychological support programs for doctors is crucial to improving their mental well-being and effectively communicating difficult information.

1. Bernacki, R. E., & Block, S. D. (2020). Communication about serious illness care goals: a review and synthesis of best practices. JAMA Internal Medicine, 174(12), 1994–2003. https://doi.org/10.1001/jamainternmed.2020.5289
2. Brown, R., Bylund, C. L., & Eddington, J. (2009). A method to teach communication skills to medical students: The simulated physician-patient communication exercise. Journal of General Internal Medicine, 24(1), 57–62. https://doi.org/10.1007/s11606-008-0837-y
3. Epstein, R. M., & Street, R. L. (2007). Patient-centered communication in cancer care: Promoting healing and reducing suffering. National Cancer Institute. https://doi.org/10.1007/978-3-030-42993-0
4. Ramakrishnan, A., Tribble, B., & Mitchell, M. M. (2019). Breaking bad news in oncology: A communication competence framework to improve training in difficult conversations. Journal of Cancer Education, 34(2), 375–381. https://doi.org/10.1007/s13187-018-1330-5
5. Redinbaugh, E. M., Schuerger, J. M., Weiss, L., Brufsky, A., Arnold, R., & Zabow, M. (2003). Doctors' emotional reactions to recent deaths of patients: An attempt at a qualitative approach. Journal of General Internal Medicine, 18(1), 48–56. https://doi.org/10.1046/j.1525-1497.2003.10400.x
6. Taylor, C., & Washington, A. (2021). Emotional and psychological stress associated with breaking bad news in healthcare. Psychology Research and Behavior Management, 14, 2037–2047. https://doi.org/10.2147/PRBM.S272101

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