Insights From Our Editors

How Honest Should You Be With Patients?

By Mark Wright, OD, FCOVD,
and Carole Burns, OD, FCOVD

May 8, 2019

Your patients deserve honesty, and you try your best, but how good a job do you do? Here’s how to be kind yet honest.

A survey was done to determine why doctors are not honest with patients. Here are a couple of the results:
• 55 percent said that in the last year they had been more positive about a patient’s prognosis than the medical history warranted.

• 20 percent admitted they didn’t disclose a medical error to patients because they were afraid of being sued for malpractice.

Studies consistently show that patients prefer the truth. They would rather hear harsh news than remain ignorant about a dire medical condition.

One solution is to get more training about how to communicate with people when it comes to delivering bad news. Watch this video on the wrong way to deliver bad news followed by the right way to deliver bad news.

SPIKES is a helpful acronym to use when you are delivering bad news.

STEP 1 is Set up the interview.
• Arrange for privacy.
• Involve significant others.
• Sit down.
• Make a connection with the patient.
• Manage time constraints and interruptions.

STEP 2 is ASSESS THE PATIENT’S PERCEPTION.

• Use this rule: before you tell, ask. Before discussing the medical findings, use open-ended questions to determine a reasonably accurate picture of how the patient perceives the situation:

“What have you been told about your medical situation so far?”

“What is your understanding of the reasons we did the additional testing?”

STEP 3 IS OBTAIN THE PATIENT’S INVITATION

Discuss information disclosure at the time of ordering tests. This helps plan the next discussion with the patient.

“How would you like me to give you the information about the test results? Would you like me to give you all the information or sketch out the results and spend more time discussing the treatment plan?”

STEP 4 IS GIVING KNOWLEDGE AND INFORMATION TO THE PATIENT

HERE ARE A FEW SUGGESTIONS TO HELP YOU WITH THIS STEP:
• Start at the level of comprehension and vocabulary of the patient.
• Try to use nontechnical words.
• Avoid excessive bluntness.
• Give information in small chunks and check periodically as to the patient’s understanding.
• Don’t take away hope from the patient.

STEP 5 IS ADDRESSING THE PATIENT’S EMOTIONS WITH EMPATHIC RESPONSES

Until an emotion is cleared, it will be difficult to go on to discuss other issues. If the emotion does not diminish, continue to make empathic responses until the patient becomes calmer.

Here’s how to do this.
• Observe for any emotion on the part of the patient.
• Identify the emotion experienced by the patient and use open questions to query the patient as to what they are thinking or feeling.
• Identify the reason for the emotion.
• Let the patient know that you have connected the emotion with the reason for the emotion by making a connecting statement.

STEP 6 IS STRATEGY
Patients with a clear plan for the future are less likely to feel anxious and uncertain. But, before discussing a treatment plan, first ask patients if they are ready at that time for such a discussion.

By working today on delivering bad news we will be ready in the future when we are facing this situation.

 

References
i. http://healthland.time.com/2012/02/09/white-coats-white-lies-how-honest-is-your-doctor/
ii. http://theoncologist.alphamedpress.org/content/5/4/302.long

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