Breaking Bad News

I admit that when I started to write my previous blog entry, "A Year of Helping Medical Students," my intention had been to focus on the topic of breaking bad news. But I balked and ran off in a different direction, basically extending last week’s opening paragraph and turning it into an entire entry. The truth: I’m not sure how to write about this topic. But I’m going to try. So join me as I fumble about…


You see, at each Family Centered Experience (FCE) meeting with Andrew and Megan, they would come prepared to speak about a predetermined topic. At our first meeting, we talked about my diagnosis story; then we spoke about our experiences communicating with doctors, both the good examples and the not-so-good. For our third and final meeting a few weeks ago, the topic on the table: breaking bad news. Megan and Andrew wanted to know more about how the doctor presented the news to me that I had Type 1 diabetes. Although we had previously discussed how the doctor chose to deliver my diagnosis—as well as how we’ve received other bad news in the past—the extent to which we covered it at this final meeting was much more comprehensive.

Our conversation piqued my curiosity. Other than programs like the FCE, how do doctors learn the skills it takes to deliver what could be devastating news to a patient? For the first time, I put myself on the other side of the diagnosis. How difficult must it be for the doctor? Most patients are no doubt counting on this medical professional to have the answers, to know exactly what to say. Many people assume their doctor—an M.D.! a doctor!—knows all when it comes to matters of a patient’s health. I’ve been guilty of this assumption many times in the past, often incorrectly assuming (or wishing, hoping, wanting) that the doctor would be able to fix me, that I’d only need to sit back and let the healing begin.

Is it the doctor’s responsibility to handle the situation appropriately, with as much skill, empathy, and professionalism as he or she possesses? Sure. But can a doctor be expected to handle diagnosis and care perfectly? Of course not. We’re as much involved in our own treatment and disease management as the doctors. No, we can’t prescribe our own medications and perform surgeries, and we’re not trained to diagnose ourselves. But the truth is, day-in and day-out, we have to be more involved in our condition than the doctor.

Several articles, including this one I read by Walter Baile et al., roughly defined bad news as “any news that drastically and negatively alters the patient’s view of her or his future.” Breaking bad news is an often-discussed area in the medical field. Deservedly so. Browsing a medical-journal database, I found quite a bit of literature on protocols and models for presenting patients with bad news. One example is the SPIKES protocol; another is the mnemonic ABCDE. I’ll spare you the dozens of articles I’ve printed out and looked through over the past few days.

For those of us with diabetes, that initial diabetes diagnosis may well be the tip of the having-bad-news-broken-to-us iceberg over our lifetime. The complications of diabetes, each one with potential to sneak up on us insidiously, will no doubt come as bad news.

So I’m wondering, as patients, how we can prepare ourselves to better receive that bad news when it’s broken to us. Maybe looking at it from the perspective of the doctor can help. I know our reactions in those moments will be emotional, and all preparation has the potential to fall by the wayside, but shouldn’t we be somewhat responsible for being present at that bad-news delivery, to help the doctor help us?

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  • Joan

    Eric – 50 years ago at the age of 23 I was told immediately, no frills, that I had diabetes. I had been married a year and a half with a three month old baby son.

    My world did not fall apart.

    I have often wondered why I was able to carry on a productive and happy life without suffering depression, or fear of any kind. The only answer I have is that no one knew much about diabetes so in my case there was nothing to fear then or now! Today, I still do not fear dealing with Type I diabetes because I have self educated myself over the years. I trusted most of the many doctors I have had over the years, followed their treatment plan and never hesitated a moment to ask questions or to disagree with them or ask for an alternative method to help me control my disease!

    If it’s going to be, it’s up to me!

  • catdancing

    i sure hope once u have been a type 1 diabetic for over 40 years u r still in as good a shape asu r now.
    i have been a type 1 fpr 41 years now and after 34 yrs with this disease became legally blind, A couple years later i started to develope kidney problems which r now stablelized. My control was not the best as a child but is much better now of couse it’s much easier now than it was back in 1967.
    i wish u the best.

  • catastrophegirl

    my diagnosis was october 14th, 2007. i remember getting back from a vacation the end of september, i remember october 1st my roommate said she lost her job and didn’t want to get a new one and the next thing i remember:
    i was looking at the ceiling of the ER and a doctor poked me and said ‘are you conscious? how long have you been diabetic?’ and i said ‘i what? um, what time is it? about now?’

    i also have MS and sjogren’s syndrome so dizziness and a dry mouth were not unusual for me, i had no idea that i had been in DKA for two weeks. and with blood glucose of about 848 i was in no shape to evaluate my own health.

    by the time i was coherent it had begun to sink in. it wasn’t entirely unexpected due to a family history of both type I and type II.

    but it was a little weird to have various doctors parading through the ER and intensive care whispering about the 31 yr old adult onset patient. and i shocked a few of them when i started talking to them because they had assumed i was in a coma and couldn’t hear them. more than one ER doctor said ‘why are you conscious? how are you not DEAD?’
    i thought that was both rude and funny.