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Train of Thought...
August 2004 - "Good news" and "Bad news"

This last month or so has found me mired down in bad news. Friends, family and colleagues have all been recipients of bad news on the health front recently. I have also been in the position of having to deliver bad news myself. There were days when I wondered when it will stop and where the justice lies in life.

We work with people day in and day out who are often dealing with their own bad news on the health front - newly diagnosed problems or coping with the ongoing consequences of old diagnoses. Many are the times that I ask myself how I would cope were I in their position. I certainly try hard to be aware of the "patient's space" during the time I spend with them making them do tiring and often unpleasant tests. Whilst I not infrequently wish I could pick them up by the scruff of the neck and shake some sense into them, I so far, have been able to resist the temptation.

The last month has reinforced my empathy for our patients. They are not visiting us out of social obligation or by any form of choice. They are also most certainly not universally stupid, deaf or malingerers. On the other hand they are putting a huge act of faith in us to treat them well, to respect them and to ensure the quality of the work we do FOR THEM is the highest we can attain. Their future depends on the decisions made by the Doctors reviewing the data we provide. This is a sobering thought and it is good to be reminded of this responsibility we share from time to time.

Delivering bad news is in many ways harder than receiving it. Making the decisions that lead to having to do this is not easy in itself but it pales beside the actual delivery. The delivery must be made as quickly as possible but only after you are comfortable with the fact that the right decision has been made. If you lack that conviction then you will make a complete botch of the delivery. It is absolutely essential that your delivery is built on honesty - honesty in your reasons and allowing and dealing with honesty in the responses to your news. Any lack of honesty on your part undermines everything you say and will ensure a bad outcome all around. This is not easy under the best possible conditions! It is a good idea to discuss issues later rather than at the time of delivering the news since a state of shock will likely ensue and much of what is said will not be taken in.

Of course, what was bad news for one, resulted in good news for another and it was a pleasure to be able give someone an opportunity to grow and develop. It could also be said that the experiences of the last month or so have also had positive spinoffs. I have seen the inspirational ways people have responded to their challenges, my approach to patients has been improved and my way of dealing with the delivery of bad news has been refined and, dare I say, enhanced.

It is important to remember always, that no matter how cloudy it may be, the sun is still shining. You merely have to open your eyes and your mind to see it.

Till next time,

Kevin

August, 2004

kevin.gain@health.wa.gov.au

 

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