Is a Personal Visit Always Best?
Doesn't basic humanity demand that bad news be delivered by the doctor in person rather than, say, over the phone? The answer is: It depends. As Medscape Medical News recently reported: "Communicating bad news that a biopsy result indicates malignancy by telephone may be better than delivering the news in person, a team of researchers from the University of Michigan, in Ann Arbor, suggests."
"Telemedicine approaches can potentially relieve much of the anxiety associated with in-person consultations while delivering bad news in a timely, compassionate, and patient-centered manner, the researchers wrote in the November issue of JAMA Oncology. Getting bad news over the phone, they contended, can give patients time to absorb their diagnosis and take greater advantage of their next in-person consultation.
Not every doctor is convinced that delivering bad news by phone is a good idea, however, even though it may have some practical benefits. "Patients, especially in cancer settings, have many unmet needs in terms of impact of the communication, their emotional response, and so on," Philip Bialer, MD, an attending psychiatrist at Memorial Sloan Kettering Cancer Center in New York, told Medscape, "so my one concern about giving bad news just with telemedicine is that it disregards the humanistic aspects of medicine that are more likely to happen in person."
"At the very least, if we are going to be conveying this sort of information through telemedicine, I think a video needs to be included, too, such as Skype, so there is some visual contact," Dr Bialer contended. "It's not as good as in-person contact, but at least there is some visual contact."
"I totally get that waiting for biopsy results heightens anxiety," Dr Back wrote in an email response, "so I'm in favor of giving people access to the news as soon as possible. But it's also the case that getting bad news isn't just about the news—it's about what should happen next. So I'd want to make sure that rapid access to the news is matched by rapid access to the rest of the treatment-planning process and care process. There are aspects of treatment decision-making and providing care that really do require face-to-face contact. Even with telemedicine, we can't do it all virtually. Delivering bad news in cancer care is only the first step in a complex process."
Alicia K. Morgans, MD, MPH, an oncologist at the Vanderbilt-Ingram Cancer Center in Nashville, Tennessee, who has delivered bad news to patients with cancer, agrees that "delivering biopsy results via telemedicine might be helpful, especially in cases in which patients are separated from their doctors by distance or when there are scheduling conflicts." But, she told Medscape, "it must be done by people who are very well-trained to deliver bad news in that kind of situation."
However, for patients with whom she has long-term relationships, "as I deliver bad news, I want to be with them to read their faces," Dr Morgans says. "I want to be with their families to make sure that I understand and can answer all of their questions, concerns, and anxieties that they have."
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Neil Chesanow. Delivering 'Bad' vs 'Serious' News to Patients - Medscape - Jan 27, 2016.