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Kaleidoscope of the Heart: Deliver bad news with honesty, sincerity

Rika Kayama

After I consult a patient for the first time, I tell them, "Let's also do a medical checkup just in case." I conduct a physical examination including blood tests and use computed tomography (CT) scanning. "You'll be able to confirm the results next week," I say before sending them off.

    One week later, the same patient returns to the waiting room. I come across them in the lobby. "The medication is helping me go to sleep," says the patient with a brighter facial expression compared to their initial visit. "That's great," I reply and head back to my office.

    I turn on the laptop and look through the results of the CT scan. There is a shadow that disturbs me. I contact a physician to make sure. "Oh, this could be cancer," says the physician. "Please tell the patient to visit my clinic."

    My heart sinks. This patient is waiting for their turn in the lobby with a relaxed face. They thanked me for being able to sleep, but the finding of the inspection was not so good. How could I possibly tell the truth?

    Delivering bad news is one of the most difficult problems for a doctor. We all want to deliver good news that "there aren't any problems," to make patients feel content. In addition, we also feel happy if they thank us. However, there are times when we have to deliver bad news. We doctors face quite a few situations in which we have to directly convey something that will upset our patients, including results that were not good or recommending hospitalization.

    I have an inclination to speak fast in these situations. I also tend to make various kinds of remarks beforehand like, "Well, you don't need to worry but," possibly in order to reassure myself. Of course, this is not a good way to deliver such news.

    It's important to speak slowly and calmly with a serious but not too pessimistic look when announcing bad news. "I hate to say this, but the results this time were" as I offer an explanation. I then offer "to do my best" to get them through the treatment together. You should not force a patient to decide what action to take on their own, and respect their will.

    This isn't just limited to a medical setting. In situations where one has to deliver bad news to family, colleagues and friends your human qualities and feelings toward others are tested. I hope to look somebody directly in the eyes and properly communicate with them, even when delivering bad news.

    (By Rika Kayama, psychiatrist)

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