You are a junior doctor on a ward with a very sick patient who has been waiting for the results of several tests and scans to come back. The results arrive but you aren’t able to tell the patient her results until the Registrar arrives, and he has been held up and will be late. Upon hearing this, the patient becomes angry and insists that you tell her what her results are. 

 

How do you respond? Discuss some of the problems with this scenario with your interviewer.

Breaking bad news and role play scenarios are a lot trickier to practice at home as most people do not have an actor at their disposal. We recommend trying to to get one of your friends or family members to try to act as the patient/role player for you. You can show them the scenario, the explanation and the commentary beforehand so they have an idea of what is expected from them and from you.

When dealing with upset or angry patients/ families, it is important to exercise a lot of empathy. You have to understand how frustrated, scared and upset they are and realise that this often means they don’t have the patience to be nice to you, but you must also accept that because of this, their outbursts aren’t a personal attack on you and so you shouldn’t react as though it is. 

 

In a situation such as this, the most important thing is to stay calm. Don’t panic if they start crying and if they’re angry, don’t stoop to being rude in return. Allow them to cry, allow them to yell at you for a moment. They’ve often been bottling up those emotions for a while and this particular situation has just been like opening a can of shaken up Coke: let them get the initial rush out and often this will calm them down and make them a lot easier to communicate with. 

 

Explain the situation and apologise. If the scenario was different and you had made a mistake, it is important to be open and honest about your fault in whatever happened.

 

At this point, acknowledge their feelings and their reaction, and reassure them that it was not unreasonable. In the situation above, you could say something along the lines of “I know this is a very difficult time for you that having to wait is incredibly frustrating, it’s very understandable that you’re upset.” Whatever you do, don’t tell them to calm down because this can often antagonise them and rile them up even more. The other thing to do is avoid making false promises, as innocent as they may seem. You cannot promise that everything will be okay/ there’s nothing to worry about because you don’t know if that’s the case and this could upset the patient even more if it turns out that everything is not okay. In the situation above, you should also avoid saying something like “I’m sure the doctor will be here soon” because again, you have no way of knowing this for certain and the patient could become irritated if the doctor takes longer than they expect. 

 

You can console the patient in a way that doesn’t put your integrity as a doctor under fire. Offer her tissues, ask her if there’s anything else you can do for her, or if there’s anything you can do/get to make her more comfortable while she waits for the Registrar to arrive.