Makindo Medical Notes

💬 Breaking bad news is a core clinical skill. It requires preparation, empathy, and clarity. Doctors often face this challenge in contexts such as cancer diagnoses, chronic illness, treatment failure, or unexpected complications. Handled well, it can preserve trust and help patients process difficult information.

📝 Key Steps in Breaking Bad News (SPIKES Model Inspired)

• Preparation:
  • Ensure privacy and a quiet setting 🔕.
  • Review notes and understand the medical facts first 📑.
  • Anticipate likely patient questions and emotional responses.
• Initiating the Conversation:
  • Introduce yourself and your role 👩‍⚕️.
  • Establish rapport and assess the patient’s current understanding.
  • Example: “Before we discuss the results, can you tell me what you already understand about your condition?”
• Delivering the News:
  • Use clear, jargon-free language 🗣️.
  • Give information in small chunks, checking understanding as you go.
  • Example: “I’m sorry to tell you that the scan shows the cancer has returned.”
• Responding to Emotions:
  • Pause — allow silence and space for reaction 🤐.
  • Acknowledge feelings: anger, disbelief, sadness.
  • Example: “I can see this is very upsetting. It’s okay to feel this way.”
• Exploring Concerns:
  • Encourage open expression of worries 🙋.
  • Example: “What worries you most about what I’ve just told you?”
• Planning and Follow-up:
  • Outline treatment options and next steps 🧾.
  • Offer follow-up appointments and support services.
  • Example: “Let’s talk about what we can do next and how we can support you.”
• Closing the Conversation:
  • Summarise the discussion 🔄.
  • Check understanding and encourage questions.
  • Provide written info and contact details 📞.

⚠️ Common Challenges

• Emotional Reactions: Shock, denial, anger, or tears are normal. Stay calm, empathetic, and supportive.
• Silence: Don’t rush to fill the pause. Allow patients time to process 🕰️.
• Difficult Questions: If you don’t know, admit it honestly. “That’s a very good question. I don’t have the answer right now, but I will find out for you.”

🤝 Role of Support Systems

• Family/Friends: Encourage a supportive companion during the discussion 👨‍👩‍👧‍👦.
• Healthcare Team: Coordinate with nurses, CNSs, and palliative care for continuity of care.
• Psychological Support: Offer counselling, support groups, or chaplaincy where appropriate.

📚 Summary

Breaking bad news requires structure, clarity, and compassion. Using frameworks like SPIKES ensures that both the emotional and informational needs of the patient are addressed. Remember — empathy and honesty preserve the therapeutic relationship even in the most difficult conversations ❤️.