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Sometimes our word choices turn good news into bad news
Clinical Question
Do our language habits prevent us from delivering good news to patients?
Bottom line
The author of this commentary suggests that delivering good news may be even more difficult than breaking bad news. We tend to think that patients always want a diagnosis, when what they really want is reassurance and relief from symptoms. As a result, negative test results that don't move us along the diagnosis trail can still be good news to patients. Think about how "I can't find anything wrong" sounds—it's heavy with the implication that there's something "there" that just hasn't been found yet. But "Great news: Your scan was normal" has a whole different feel. To avoid the spiral of anxiety about normal test results that may drive further testing, the author suggests that we begin the consultation by ticking off normal results as they are found (eg, "Your chest sounds healthy"), which still leaves room to give bad news if warranted. For more on policing medical language see this Daily POEM. 5
Reference
Danczak A. Breaking good news: an essential skill for avoiding too much medicine? BMJ 2018;362:k3843
Study design: Other
Funding: Self-funded or unfunded
Setting: Not applicable
Synopsis
I picked up my car once from service, and the service advisor said, "I couldn't find anything to charge you for"… revealing, I surmised, her frustration at not having an excuse to hold my credit card. The author of this little nugget questions whether we don't do the same thing in medicine, wondering if, in our zeal to diagnose or at least explain, we can turn good news—the lack of identified pathology—into bad news. Focusing on delivering good news—negative findings—can be reassuring for patients even if they don't lead to a diagnosis. This approach also allows for attention to symptom control despite a lack of findings and an unclear diagnosis. Try policing your words for a day to change those negative scripts into positive messages.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
It is critical to break good news as well as bad news in an appropriate manner. I try to word results as such: well, your kidneys are functioning well; cholesterol excellent, heart sounds strong, CT shows a nice normal looking brain (or if I know the patient well...yes, your CT indeed confirms you DO have a brain) etc.
cognitive behavioral therapy for all of us
Wise words that bear repeating. Reassuring and not didactic review. Thanks for sharing this
very important. I like it
Thank you for this great POEM! Appreciate seeing studies that look at qualitative elements of how we practice medicine. Iatrogenic suffering is a growing concern for both patients & drs. A lot of it can be avoided through better communication skills.
We always pay attention in breaking bad NEWS. But I never thought breaking good news has bad infect on patient. After reading this article I found out it has. So now I will be careful with delivering good news. I will always try to use the right words.
AS A NEUROSURGEON DEALING WITH UNSPECIFIC PERSISTENT PAIN REASSURING IS VERY IMPORTANT , ONE SHOILD ADMITH TO PATIENT WHICH REAL AND ASSURE THE PATIENT ABOUT SELF TREATMENT AND PROGNOSIS AND ALSO WE SHOULD ADMIT THAT DESPITE EXTENSIVE RESEARCH WE DON,T THE CAUSE AND EXACT WAY OF IT,S TREATMENT BUT WE KNOW PROGNOSIS WE IT WILL BE FORGOTTEN IN FEW YEAR BUT WE CARRY OUT FOR FEW YEARS WITH PATIENT SEE THEM WHEN THEY WANT OR AS SOON AS POSSIBLE AND ANSWER THEIR QUESTION NO MATTER IF REPEATING OURSELF.
good poem
Excellent
Really interesting article. Something to consider when choosing how to discuss results with patients.