Kavya KurkalSeth GS Medical College

CONVEYING SENSITIVE INFORMATION TO THE

PATIENT AND THE FAMILY

WHAT NOT TO DO

6 STEP PROTOCOL1. Getting started2. What does the patient know?3. How much does the patient want to know?4. Sharing the information5. Responding to patient and family feelings6. Planning and follow up

Taken from ‘ How to Break Bad News: A Guide for Health Care Professionals’ by Robert Buckman

DEATH

For the benefit of the patient’s family and friends

WHY?

For the benefit of the doctor

For the benefit of the medical student

HOW?Here are a few basic steps to follow:

PREPARATION• Should know the history of the case• Should be able to explain in simple terms• Should be armed with answers to all possible

questions• Should remain calm and composed• Should not appear impersonal or disinterested

METHODS:There are two methods available:

In Person Telephonically

CONDITION UPDATES:

• Many families express anger and feelings of helplessness• Keep family updated during

resuscitation• Balance the needs of the patient and

family

RESPONSIBILTY OF COMMUNICATING DEATH

It is the responsibility of the physician who has been

treating the patient and this responsibility should not be delegated to anyone else unless absolutely necessary.

WHEN IS THE ‘RIGHT’ TIME?

There is no such thing as the ‘perfect’ moment.Try to break it down gently . Do not be in a hurry or abrupt.

MANNER OF CONVEYANCE

• Medical facts are less important than compassion• Do not go into the technical details• Give them time and space• It is their right to ask as many questions as they

want• It is left to the discretion of the doctor as to how

much information to divulge and to maintain a balance

• Try to inform all the family members in a group

FAMILY REACTION

DENIALGUILT

ACCEPTANCE

SORROW

ANGERDEPRESSION

VIEWING THE BODY

• Necessary evil• Prepare the body• Families of mutilated patients should be warned• Viewing can done individually or in a group

privately• If patient is a child, wrap in blanket and give

parents opportunity to hold child

CONCLUDING THE PROCESS

Effective communication continues beyond this as there are a few issues left to be dealt with by the family. The family members should be encouraged to contact the doctor if any queries arise.

• Mortuary• Autopsy• Tissue and organ donation

Let the family know that they can stay at the hospital for as long as they want

DEATH OF A CHILDIt is a particularly sensitive situation.

• Give parents enough time to hold child• Religious preferences and ceremonies• Information to nursing mothers• Informing the child’s sibling• Offer to preserve momentos

RED FLAG SIGNS

AFTER DEATH

• The practice of using the newly dead for the purpose of medical research and advancement has met with increasing controversy

• Problems of disclosure and informed consent• Difficult to approach a grieving family• Other ethical issues arise from cultural differences

in treating the body of the newly dead• Currently no universal guidelines or official

policies regarding this practice exist.

ROLE OF THE MEDICAL STUDENT

• Importance of providing appropriate and adequate training to medical students in patient communication

• Students should be allowed to accompany the physician while disclosing sensitive information

• Students should be encouraged to discuss the experience with the physician

• Student must not be made to convey information to the family directly

• The houseman should actively participate in such conveyance as part of his training albeit under supervision initially.

CONCLUSION