Communication is fundamental to the role of the doctor. It includes routine verbal communication (e.g. history taking, updating relatives, handovers, and requesting investigations from specialists), written communication (e.g. prescriptions, updating the clinical notes, and discharge summaries), breaking bad news, and ‘challenging’ interactions such as dealing with an angry relative. Questions within this section assess your ability to communicate effectively with patients and colleagues. Effective communication requires understanding and being understood. You will need to demonstrate an ability to negotiate with colleagues, to document information within the medical notes clearly and concisely, to gather information from patients, and to listen to angry relatives. As always, your responses must adapt to the needs and context of each situation, while always remembering to demonstrate empathy and compassion. ● Listen to patients, relatives, and colleagues. They are trying to tell you something. ● Explain your position carefully after listening to the other side. ● Adapt your style as far as possible to the person with whom you are communicating. ● However strongly you feel, poor manners will never get the job done faster. Foundation doctors should not usually be left to ‘break bad news’ in the classical sense of a new cancer diagnosis in clinic. However, bad news can take many forms and it is likely that you will find yourself going through the ‘breaking bad news’ sequence many times during the foundation programme. For example, the following scenarios are all bad news to varying degrees. Some patients will take such developments in their stride and others will rank them amongst other significant life events. ● An incidental ‘nodule’ found on a CT chest that might be benign but will require a follow- up scan in three months. ● An elderly man who has become very unwell and is unlikely to survive while you are on call. You have been assigned the task of calling his wife, providing an update, and suggesting she come to the hospital urgently. ● The fact that investigations have all been normal and they are being discharged without a diagnosis for their persistent debilitating abdominal pain.
Breaking Bad News in Ethnic Settings: Perspectives of Patients and Families in Northern Sri Lanka
