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10 October 2011

Breaking bad news : Part of the medical profession

Dr Shrijana Shrestha

As medical professionals, we come across many life events, watch them very closely, share and feel them. Many times there are happy moments like the birth of a new baby or recovery from an illness. The arrival of a new one is a big life event that we share with the proud parents and family members. When a sick patient, recovered from illness, leaves with a big smile of gratification on his/her face, we’ll have an even bigger smile on ours. This happiness is contagious and at the same time very volatile, in that it goes away after a short span of time. It comes and goes, but it is not the same each time it comes.

The other side of the story is that we also become part of many sad events; we observe and feel the pain, the losses and the demises so closely that at times the events stick to our hearts and souls for a long time. Such painful feelings remain longer within us than the positive ones. Medical professionals and doctors are not a different species on earth; they too are disturbed by these events, considering how deeply they are involved in the process. They might even become upset and depressed, thereby affecting their personal and family lives. No wonder friends and family members sometimes misunderstand these feelings. If you are back home after writing a death certificate and there is a party going on at your house, imagine how difficult it must be for the doctor to balance the different aspects of his/her life. These are not one-time issues and not all events are the same. It can be very difficult at times. Besides, doctors have family and friends, birthday parties, celebrations, parents’ days at their children’s schools and also illnesses and demises within their own families. But who cares; when my loved one is sick, the doctor has to be there, emotionally stable and strong to take care of the patient, no excuses granted.

Breaking bad news is another very difficult aspect of being part of the medical profession. Before telling a mother or a father that their baby is not going to make it, or before explaining to a family member that their beloved one will be physically or mentally handicapped for the rest of his/her life, how the doctor struggles within to choose the appropriate words and to show empathy, while trying to stay calm and confident—no other professionals will understand. Then there is the aftermath of the event—once having broken the bad news, the poor doctor has to be a silent observer of the reactions, aggression, denial and grief of the family members. Often, we doctors question “why me”, or “why on my duty day”, but it has to be one of us always. Sometimes, doctors taking care of very sick, terminal patients, pray that the patients do not die on their duty hours, because deaths, breaking bad news and being part of the whole process is a source of emotional stress to doctors as well. We do not have any support system for doctors who have difficultly handing these situations. People never even think that doctors need support as they are assumed to be “tough people”, either born or trained to be so. This is not really true. We watch birth and death so closely, and feel all the emotions attached to these events and on many occasions, we get very emotionally involved, which is not unnatural. After all, we doctors are also the part of the same human species. Fortunately or unfortunately, we are treated or grouped differently.

Medical schools teach the scientific aspects of medicine very well but the important elements concerning how to communicate with patients and their families, breaking bad news and taking care of ourselves, are often not taught very well. Instead, we’ve learnt in our own ways, learnt by doing. All of us might not be perfect at it, and we should keep on trying to improve ourselves, it is never too late.

Dr Shrestha is Chair of the Department of Paediatrics and Professor of Paediatrics at the Patan Academy of Health Sciences

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