Viewpoint: How to break bad news positively

October 15, 2009

Sometimes in practice, we may see someone for whom we can offer no cure.

Once, at a dinner with a group of medical professionals, the topic of revealing bad news came up.

One story involved a surgeon who removed a tumor. The surgery was performed perfectly and the lesion was removed in its entirety. A few lymph nodes, routinely sampled at the time of the operation, however, showed metastatic cells, but not the kind of cancer for which the operation had been performed; the patient had a separate and unknown primary malignancy in his body. The patient called to get the results of the pathology report, and the surgeon had the difficult task of sharing the good news (entire tumor removed) with the bad news (a second tumor lurked within).

A third story about breaking bad news involved a pediatrics resident. While the family waited anxiously, a team tried to revive a child in cardiac arrest. Finally, after an hour, the resident came out to the family and announced, "I'm sorry, but we had to call the code."

Then he left. In his wake was a family who had no idea what had happened, and, specifically, they did not know that their child had died.

Convey hope for the future

How we ophthalmologists communicate to patients for whom we currently possess no effective therapeutic options may make a big difference. No doubt you've read the stories of families taking their children, at great personal expense, to countries to receive stem cell injections into their foreheads to treat septo-optic dysplasia, for example.

My guess is that these stories reflect the type of desperate lengths to which some patients will go if given bad news without an expression of the hope that biomedical science offers for the future.

Reference

China's controversial stem cell treatment helps blind girl see.http://www.findingdulcinea.com/news/science/2009/march/China-s-Controversial-Stem-Cell-Treatment-Helps-Blind-Girl-See.html/

Peter J. McDonnell, MD director of the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times.

He can be reached at 727 Maumenee Building 600 N. Wolfe St. Baltimore, MD 21287-9278 Phone: 443/287-1511 Fax: 443/287-1514 E-mail: pmcdonn1@jhmi.edu