HOW TO BREAK BAD NEWS TO PATIENT’S FAMILY?

Jamal TashkandiFANZCA

4 years old boy

Wt. 14Kg

elective adeno - tonsillectomy

Eczema and AsthmaMultiple allergies (milk, sesame, strawberry, eggs, peanut and possible other food items) and Omnicef

Preoperatively

discussed with his parents the issues of allergy in details, Informed them re-drugs contains food extract

super anxious mother

DiscussionInformed consent = Risks & benefits  to discuss Known risks i.e. rare but the detriment severe common but the detriment slight

Examples:

Common adverse effects of GA:

nausea, vomiting, sore throat.

Less common but not rare adverse effects

spinal headache and dental trauma

Rare adverse effects which are unpredictable

anaphylaxis, awareness, neurological damage or death

in healthy people

Adverse effects related to pre-existing disease

death in a patient with recent myocardial infarction

undergoing emergency surgery

inhalation of Sevoflurane with 100% O2

Fentanyl 20 mcgPropofol 20 mg Dexamethasone 4 mgMetoclopramide 4 mg Easy intubation

severe bronchospasmrapid desaturationrapid bradycardia

call for help was initiatedCPR + adrenaline + fluids

sPO2 15%-100% , lasts for 7minbradycardia last for 3min

extubated in the OR

PACUbreathing spontaneously O2 Saturation 92-98% on RA

Fully conscious and talking

Parents were called and informed Referred to the pediatrician to follow up

Referred to Allergy Clinic

How to break bad news to patient’s family?

Communication in difficult situations

do the job well = rehearse

Minimise long term distress in relatives and doctor

Minimise the risk of litigation

Maximise the eventual acceptance of bad news

If a potential medico-legal implications:

ensure information is supplied to insurers

internal hospital protocol is followed

It is important:

To expressing sympathy and regret for the situation of the patient

No explicit admission of liability of blame should be made

Private room, free from interruption

Establish what to call him/her

All must be sitting, at same level

Ensure body language is appropriate

Check the knowledge of the person(s)

Fire a warning shot to give the person(s) time to prepare his/herself:

“I’m afraid I have bad news…”

Allow pauses for the news to sink in

Deliver confirmed information

Do not use jargon

Allow pauses at all steps for:

- reflection

- for the news to sink in

- express emotions and concerns

Express sympathy without accepting any blame for the incident

Verbalise acceptance of person’s emotional responses

“I can see that this is very distressing for you..”

Check the person’s understanding

“Would you like me to repeat that ?.......tell you more ?....

Elicit concerns and information needs

“Do you feel I have covered all your concerns ?...

Offer further contact

Record the substance of the interview in the chart

What should I do next time?