Giving Bad News To Anyone Is An Art--Read On To Discover More---
Dr. James L. Woods came to our hospital today and as a member of our bereavement team, I showed up to welcome him.
Dr. Woods is a perinatologist and head of Ob/Gyn at the University of Rochester, New York.
He is well known for his contribution of teaching doctors how to give bad news to their patients, most notably, when a baby has died or is going to die, has a diagnosis that is life threatening, or any scenario that does not turn out as a parent hopes.
The practice of Obstetrics has the highest rate of malpractice in America.
Dr. Woods believes this is due to mis-communication, or in some cases, no communication such as, if you don't ask your patient what is on her mind, maybe she will forget her overwhelming loss: A good case of don't ask, don't tell.
But this no communication style of patient care just ends up making a patient very angry. She may say to herself, if he won't listen to me, my lawyer will!!
Dr. Woods is on the forefront of thought in medicine that if you listen to patients after a tragedy, they are less liable to sue.
One of the doctors in the audience was a medical student at Rochester years ago and Dr. Woods was his mentor.
He recalled a patient who had uncontrolled diabetes, was labeled as non compliant, was not progressing in her labor, so was prepped to go to the operating room for a Cesarean.
But another emergency prevented the patient from being the next in line for her Cesarean, so she had the urge to push, and a shoulder dystocia, one of the most serious Obstetric emergencies, began to evolve.
A shoulder dystocia is when the baby's shoulders get stuck and can result in seizures, palsy and death.
The attending physician was not skilled at handling this kind of emergency. The baby finally came through the birth canal, but within twenty-four hours, developed seizures, and died.
Dr. Woods gathered the family together and listened to everything they had to say.
He gave them the facts about why the baby had died.
He was empathetic.
He allowed the family to express their anger and grief and encouraged them to speak their truth, as they saw it.
He repeated back to the family his own explanations.
And he asked the family what they thought he said.
Then he documented the conversation in the medical record.
Because of this holistic and humanistic approach, the family did not sue, at least that's how I see it.
And when a doctor or nurse is sued, they are never the same again. After going through emergencies on the unit, debriefing sessions are imperative for those who endured the shocking experience.
I believe debriefing sessions would go along way towards preventing Post Traumatic Stress Syndrome because when out of control situations happen, nurses and doctors make a plan to leave their respective professions, and will not be happy until they do.
Debriefing sessions would prevent good and capable people from bailing out of medicine.
Nevertheless, we are experiencing a serious crisis in medicine because doctors in particular just aren't comfortable talking to their patients. The average time a doctor listens before interrupting is eighteen seconds.
Talking to a patient with one hand on the door is a bad habit, making a patient distrust her doctor even more than she already does.
The crisis can be averted by listening, pulling up a chair, getting eye to eye, and really giving your gift of attention.
We do not do this to prevent a lawsuit, although this is precisely what it does.
We do this because listening is a practice that brings relief to everyone.
Paying attention is a skill that can be taught and honed. Paying attention is a corollary of concentration, where you keep your mind centered on the object of attention, allowing distractions to fade away.
Much has been written and discussed about the difficulties surrounding staying centered on one's attention when TV, computers, cell phones, iPods and rap music are screaming in the background.
We live in ADHD times.
But recognizing this, and vowing to overcome these distractions is the first step to mastery.
Empathy, concentration, attention and listening go together allowing you to share the experience of another human being. These all contribute to the creation of the sacred space that ideally surrounds every patient encounter.
In fact, every human encounter cries out for this kind of enlightened caring.
The most beautiful gift we can give is authentic attention, a listening practice that encompasses all the senses, including the sixth sense.
We all starve for this in these modern times.
This gift, if given, will be returned in ways not possible to fathom.
But let us begin to give it.
