As a radiologist, one of the most important – and sometimes difficult – things you will do is deliver news to a patient. Some revelations will be good; some will be bad. Others could include taking responsibility for unintentional errors. Your no. 1 primary goal is making sure the patient understands what you’re saying.
Knowing how to handle these discussions is imperative to providing quality patient care and improving patient satisfaction, said Stephen Brown, MD, a Harvard Medical School associate professor of radiology and practicing radiologist at Boston Children’s Hospital, at RSNA 2015.
“Whether it’s good news, bad news, or revealing an error, these discussions can occur across a continuum,” Brown said. “Ultimately, the skills required for one are required for all of them. They are similar and overlapping conversations.”
When disclosing findings or a mistake to a patient, he said, the most important thing to consider is how you might want to receive the news. Remember these conversations are two-way discussions – you can’t simply impart information and walk away. Anticipate a patient might exhibit a wide range of emotions, ask a lot of questions, or sit silently to process the information.
Part of your role, he said, is to make the patient feel cared for, heard, and respected while you try to develop a plan that will accommodate his or her wishes. In some cases, mnemonic devices can help you remember the framework for navigating these conversations. For example, SPIKES stands for: setting and listening skills, patient perception, invite patient to share information, knowledge transmission, explore emotions, and summarize and strategize.
A mnemonic device can really only be guide, however, he said. Scripting these conversations is impossible.
“Just like live musicians that improvise with harmony, melody, rhythm, and choral progression, you must be able to incorporate sensitivity, comfort, compassion, empathy, and appropriateness into these discussions,” Brown said.
Both nonverbal and verbal communication skills are important when delivering good or bad news, he said.
Non-verbal: Create a seating arrangement that makes it easy for you to look at a patient. If it seems appropriate and all parties are comfortable, physical contact, such as a hug, can be helpful. And, feel free to show emotion in a professional manner.
Verbal: You can deliver news in a straight-forward way, providing all details upfront, or you can reveal findings slowly. Regardless, he said, set the right tone by speaking softly and slowly. Introduce yourself and learn the role of everyone in the room. Find out what the patient might already know about his or her condition, but anticipate that he or she might be more urgently interested in hearing your news than discussing what is already known.
You’ll likely encounter stumbling blocks that can get in the way of smoothly delivering information. Knowing what they are could help you side-step them, Brown said.
• Technical jargon: Frequently, physicians use technical, medical terms as a way to shield themselves from any emotional discomfort that comes with delivering imaging results. Be sure to speak in terms a patient can understand.
• Silence: Get comfortable with pauses in the conversation. Giving a patient time to quietly process what you’ve said – particularly if you’re disclosing a cancer diagnosis – could not only improve the conversation, but also open the door for better patient care. Once a patient has dealt with any initial blows, he or she will be in a better position to have a two-way conversation with you.
• Inappropriate decorum: Be aware of how you enter a room, who’s behind the door, and what information you will deliver. Don’t walk in smiling, laughing, or discussing other activities, such as sporting events.
• Mistakes: If you accidentally say something insensitive or have poor word choice, apologize. And, if you don’t know the answer to a question, say so. But, offer to help find out the information.
Even still, he said, there will be barriers to effectively disclosing good or bad news. Stress, poor time or space constraints, apprehension and anxiety, medical and legal fears, and cultural misunderstandings can keep you from having an effective conversation.
Perhaps the most sensitive conversation you can have with a patient is one in which you reveal an error. Although you might want to, never walk into a room with a patient and simply announce the mistake, Brown said. Instead, consult your risk management team and hospital leadership. In addition, consider speaking with someone who has experience in delivering this type of news.
When you do reveal the error, he said, be in the moment with the patient.
“Be empathetic, compassionate, state the knowns and unknowns, and do not speculate,” he said. “Issue a formal apology or regret and explain the next steps so the patient knows you’re going to investigate what happened and how.”