Breaking Bad News - Free Essay Example

Introduction

In their daily career lives, medics often encounter situations where they have to break the bad news to their patient or the patient’s family. The process is usually a challenging one, and one may never get quite used to it. Its difficulty is often amplified by other factors such as the physician’s conscience or the patient’s misinterpretation of the doctor’s words. The film Being Mortal presents a variety of patient and doctor interactions. The COMFORT model provides a more detailed framework analysis of these scenarios.

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Communicating is the first and arguably, the core competency of the COMFORT model. Not only is it based on verbal communication but also nonverbal, adaptive, and dyadic aspects (Villagran et al., 2010). Dr. Kathy Selvaggi shares her experience on how breaking bad news can be difficult. She says, “oftentimes what we say as physicians, is not what the patient hears.” For her, the patient understanding of her bad news and correctly interpreting them is the biggest challenge.

Orientation Process

Orientation is a process by which a doctor explains to a patient and his family about his condition. The physician should manage to do this while radiating some realistic hope to his patient. The process is often constrained by the patient and family imaginations, degree of health literacy, and sometimes their perception of hope (Villagran et al., 2010). In Being Mortal, Dr. Kathy Selvaggi and her oncologist partner orient a cancer patient on how her condition has gotten worse. While trying as much as they can to give her hope, the patient says that all she wants is “to take the baby to Walt Disney.” She makes it harder for doctors to explain to her how much of a short time she has got left. However, Dr. Selvaggi manages to comfort her by saying that they would try to make her remaining time on earth as high quality as possible.

Mindfulness is a weighty aspect of the physician. Normally, the doctor is expected to show their presence in medical interactions and portray a healing aura or deep empathy with patients. In most cases, doctors fake empathy and connection for the sake of inducing better understanding. Mindfulness is the ability of the doctor to demonstrate his presence both physically and emotionally. What makes it hard is the fact that it should be natural (Sparks et al., 2007). In the patient-doctor interaction in Being Mortal, Dr. Selvaggi portrays mindfulness, albeit with some challenges, that enables her patient to feel like she has the best doctors with the best interests for her.

The patient’s family is a unit of care; thus, it must be included in steps involving a patient’s care. It is not required that the family be involved in the decision-making process unless the patient is a minor, but it is necessary. A doctor ought to create opportunities where the family can chip in. The family is also key in managing a patient’s ability to accept bad news. They offer the mindfulness and empathy that might be missing from a physician (Villagran et al. 2010). Dr. Aymen Elfiky’s cancer patient’s husband in Being Mortal plays a vital role in the successful reception of bad news. While the patient is so emotionally involved in the depressing news, the husband asks questions about his wife’s prognosis. He also holds her hand and gives her assuring nods to make his presence more substantial. The patient seems more reassured and more relaxed.

Ongoing Dialogue

Doctors have to develop an ongoing dialogue about care with their patients. Patients need to feel warmth and non-abandonment from doctors (Sparks et al., 2007). Doctors can achieve this by articulating their communication, providing treatment options and alternatives, and showing patients that they feel their pain. In Being Mortal, this was challenging, especially for Dr. Aymen Elfiky. He only finds it easy to describe his patient’s worsening condition but cannot clearly express his empathy. Dr. Kathy makes the process easier for him using her impressive ability to connect with the patient through her comforting words and reassuring body language.

Reiterative communication is a repetitive aspect of communication, in which although the message remains the same, it adapts with each interaction to meet the needs of the receiver. It is a crucial aspect of the patient-doctor relationship (Villagran et al., 2010). It is important in explaining diagnosis and prognosis. Oncologist Aymen Elfiky has a 2-year cancer patient, to whom he communicates reiteratively about her condition. Elfiky says the most challenging aspect of reiterative communication is that it reminds him of how he has failed to help the patient medically. He always wishes that he “could do better.”

A patient is most likely to receive care from different physicians with various specialties, technicians, nurses, and other hospital caregivers. These people who focus on the well-being of a patient form a team (Sparks et al., 2010). Dr. Aymen Elfiky and Dr. Kathy Selvaggi are part of the team that provides and care for a cancer patient. Dr. Elfiky is an oncologist who regularly checks up on the patient, updates the patient on her condition, and provide treatment option. In cases of breaking bad news, Dr. Selvaggi is a Palliative Care specialist who makes the process more manageable. The challenge of having such a team is drawing boundaries. Sometimes, Dr.Elfiky might forget and start handling Dr. Selvaggi’s work, which can confuse the patient’s part.

Dr. Atul Gawande’s father dies due to a mass in the spinal cord. The common saying that “Doctors make the worst patients” is true in Gawande’s case. The three doctors try to debate on which is the best solution of the patient, and often, this argument is emotionally involving. Instead of leaving matters to Gawande’s doctor, they bring many complications. Even when they receive news of other complications, it is challenging for them because they feel like failures, unable to come up with a viable solution.

Conclusion

Breaking bad news is a normal function of a physician. It is bound to be met by certain challenges, although the doctor grows in the field and learns appropriate communication skills to combat those challenges.

References

Gawande, A. (2020) Being Mortal. Documentary Film. Retrieved from:
https://www.youtube.com/watch?v=lQ hI3Jb7vMg.

Sparks, L, Villagran, M. M, Parker-Raley, J, Cunningham, C. B. (2007). A Patient-Centered Approach to Breaking Bad News: Communication Guidelines for Health Care Providers.

Villagran, M, Goldsmith, J, Wittenberg-Lyes, E, and Baldwin, P. (2010). Creating COMFORT: A Communication-based Model for Breaking Bad News. Routledge. 59(3). 220-234.