Useful Phrases
Finding the right words can be tricky. These scripts can help.
Always start by introducing yourself and your role. "Hi, my name is Dr. X and I'm a family medicine resident working with your inpatient care team."
Prepare: "I have some news to share with you." (A simple warning can decrease the shock that follows the disclosure of bad news.)
Ask: "Are you ready or would you like to wait for a family member or friend?" (They may wish to delay until a loved one can be there to support them.)
Inquire: "How much do you know about your condition?"
(Use open-ended questions) Use simple, non-technical terms. No medical jargon. "The scans you had last week show that the cancer has spread" rather than "The contrast CT from last week displayed evidence of metastasis."
If the family says "Please don't tell the patient," then say "Could we ask the patient together about how to proceed?"
You can discuss spirituality without talking about God. Ask, "Are you at peace with yourself, your family, your faith?"
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Prognosis: "How much do you want to know about the likely course of this illness?" Normalize: "Some patients want details, some want big pictures, and others prefer that I talk to their family."
Use a mixture of positive and negative language for prognosis: "The studies for this type of cancer show that a third of the patients have died by two and a half years. In other words, two-thirds survive past two and a half years."
Note paralanguage (umms, aahs, silences) that may signal discomfort and explore directly. "I notice you are hesitating...are you having other thoughts about this?"
Acknowledge: "It looks like that information was not what you were expecting" or "I can see this is upsetting for you."
Near the end of the encounter, ask "Have you received the information you need" or "Am I giving you the kind of information you wanted?"
At the end of the encounter, check patient understanding. You may summarize or ask "Tell me what you are taking away from this discussion" or "What are you going to tell your spouse about the news we just discussed?"
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