When the Doctor Has Bad News

Some doctors aren’t trained to deliver bad news well — but loved ones can help. Here’s what you should know and what you can do when your doctor has bad news.

My mother swam every weekday for years, kept her figure, and ate salads. “But she’s so healthy!” was the standard response among her friends when, in her late 70s, we learned that she had an especially difficult cancer — of the bile ducts — which had already spread.

She persisted in thinking that she would survive the illness, although she never had a chance. I knew the truth only because I asked her doctors for specifics during a private telephone call and presented them to an oncologist who wasn’t treating her, the father of a college friend. He said my mother’s doctors didn’t lie — but they also weren’t frank or explicit.

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Oncologists shoulder the job of delivering bad news thousands of times over a career, with very little training, although some medical schools teach students a mnemonic called SPIKES, a six-step protocol for delivering bad news.

If you are accompanying a friend or family member to a doctor’s visit during a frightening situation, you can help tactfully guide the doctor.

Be sure the meeting takes place in a quiet, private area. You might give your loved one a cup of hot coffee or tea to hold. The warmth is comforting and encourages the perception of other people being emotionally warm, generous, and caring.

If you suspect your loved one needs more time, you might say, “We need a minute.” Many doctors keep talking while a patient is too stunned to hear much at all. Having a moment to let the news sink in always helps.

Many doctors adopt military metaphors, for instance, calling the immune system a defending army. The idea goes back as early as the 1600s when the poet John Donne wrote of illness as a cannon that “batters all.” One study found that physicians speaking to patients with advanced cancers used metaphors in nearly two-thirds of their conversations. The patients regarded doctors who used more metaphors and analogies as better communicators.

You can’t be sure how your loved one will react, but you might let a doctor know tactfully if you think fighting metaphors will backfire. Seeing cancer as a “challenge” rather than an “enemy” was linked to less anxiety and depression three years later, in a study of 1,012 Canadian breast cancer patients. Many patients feel obligated to be upbeat. Fighting metaphors may encourage them to hide their distress.

Recognize that doctors can also be emotionally overwhelmed in these situations. I was surprised at how much discomfort I saw in my mother’s doctors. Next time I deal with a family member’s bad health news, I hope I will remember to try to signal with my body language that the doctors are doing okay, that I know it’s not their fault.

As a third party, you can be a bridge, which may be essential when decisions must be made.

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