No one likes to hear that something's gone wrong, but a doctor's delivery can make all the difference

Barbara Elliott got her first major lesson in giving bad news to patients in the worst way possible. Thirty years ago, she gave birth to twin boys, Jim and Jack, in an Iowa hospital. A nurse walked into her room.

Barbara Elliott got her first major lesson in giving bad news to patients in the worst way possible. Thirty years ago, she gave birth to twin boys, Jim and Jack, in an Iowa hospital. A nurse walked into her room.

She told Elliott that one of the babies was sick and needed to be taken to intensive care, and as a precaution her other baby would follow. The nurse never talked about the babies by name, only listing them as "Baby A" and "Baby B." That was the only information the nurse provided before she walked out.

"All I remember is that she had red hair, and I never wanted to see her again," Elliott said. "I just sat there and sobbed until I could call my husband."

Teaching students how to give bad news is critical to Elliott, who incorporates the subject into her ethics class as a professor of family medicine and director of clinical research at the University of Minnesota medical school at Duluth.

Getting bad news can take only a few seconds, but the repercussions can last a lifetime. And it will happen to just about everyone at least once in a lifetime.


"It is a skill that truly needs to be developed but one that very few of us would choose to develop," she said. "How [a patient] lives the rest of their lives is going to be greatly impacted.... How we adopt and incorporate that new reality is set up by how that information is delivered."

It's a skill that doctors can spend their careers learning, said Dr. Thomas Kaiser, because it's crucial that patients understand the information. Sometimes, he said, if given in the wrong way they might not fully comprehend it.

"I can have two people in the room when I'm giving the bad news," Kaiser said. "They'll come back and have two totally different interpretations of it."

Part of that is because of the intense shock that comes with getting a devastating diagnosis. Jessie Gruman, author of "AfterShock," a book about what people can do when they get bad health news, says she found in her research that many people were so overwhelmed that they couldn't absorb complex information a doctor provides.

"There is no way to prepare for it," said Gruman, who was the recipient of bad news from doctors four times in her life. "You don't get to pick the doctor who tells you."

Gruman's book outlines a 10-stage approach as to how people can come out of the shock and make clear-headed decisions about what to do next.

One of the most important steps to cope, she said, is to take control of your situation and find out as much as possible about the ailment.

The same can be said in the emergency room, where Dr. Chris Delp of St. Luke's said even in cases where children are severely injured and doctors are fighting to save them, he invites parents back to watch.


"Parents, when we go back and ask later, almost universally said they like being back there. In retrospect, they're able to grieve better and respond better," Delp said, citing research that suggests it helps parents during those crucial times.

It can be an added stress for a physician, he said, "but they feel better knowing that somebody was really trying."

If it isn't an emergency situation, Gruman recommends taking time after the shock has worn off, finding answers to questions you might have, and not rushing into treatment.

"People have a sense of urgency because they feel the ambiguity will go away," she said.

Instead, she recommends getting a second opinion. Gruman said in her research that all of the doctors she spoke to indicated that they would not proceed with a treatment for a devastating diagnosis without one.

"There's rarely only one approach to treating a disease, and it's rarely only one person who is qualified," she said.

While some doctors may not like that you're getting advice from someone else, Dr. Bob Niedringhaus, a specialist in hematology and oncology with SMDC, said it shouldn't be that way. He said he will help patients seek out another physician.

Niedringhaus has often lectured to other doctors on how to give patients bad news, and said the keys are making sure that a relationship is developed that will encourage the patient to feel comfortable asking as many questions as possible and being their primary resource for information -- no matter how long that takes.


"This is a big moment in a person's life," he said. "Whoever's waiting for you in the office is going to have to wait."

Niedringhaus said it also is important for physicians to know as much as possible about a subject before delivering the news, to give the news directly but in an appropriate, sensitive manner.

That was the opposite of what happened to Laura Plys of Duluth.

Eight years ago when she gave birth to her son, Jonah, Plys said her pediatrician came in "forlorn and discouraged" and told her there were a few problems with him.

"It didn't add up to me," Plys said. "I finally asked, 'what are you saying' and [the doctor] blurted out 'your son is a mongoloid.' I said, 'are you referring to Down's Syndrome?' And she said yes."

While Plys said the doctor later apologized, she still gets angry when doctors treat her son's condition pessimistically.

"It's like you think you're buying a piece of art, but they make it seem like you're getting something from the thrift store," she said.

Niedringhaus and other doctors said it's important that patients, even in terminal cases, feel there is hope to a situation.


"You have to make sure they don't run out of hope, that we'll still see them -- that they don't feel like we've abandoned them," he said. "Medical care should be looked at as something to sustain your normal life. I don't want this to be your normal life."

In Dr. Barabara Elliott's case, though, it ended tragically with the death of her twins, caused by a virus, five days after they were brought into the intensive care unit. But she said the care and information provided by other hospital staff members made the difficult time easier. The only negative experience she remembers about her children's care was from her doctor.

"They [the hospital staff] were wonderful in allowing us to be a part of what was unfolding," she said. "It helped that we were able to take some part of participation and control."

BRANDON STAHL covers health. He can be reached at (218) 720-4154 or by e-mail at bstahl@duluth

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