Friday, December 10, 2010

Tell me the news up front

I have previously discussed the difficulty of presenting bad news to a patient. How you give good news is also important.

A friend received a preliminary diagnosis of cancer, based on a pathology sample that was reviewed by a general purpose commercial laboratory. Her doctor suspected differently and asked one of our BIDMC pathologists, who is a specialist in this particular area, to review the samples. He concluded that there was no cancer.

The doctor thoughtfully called the patient as soon as he heard the news. Here is a transcript of the voicemail message he left (reprinted with her permission, with names changed):

Betty, hello, this is Dr. Smith. I'm calling you back again. It is Saturday. I have some important information to share with you prior to your MRI on Monday. Please give us a call at 617-632-****. You will reach the page operator. I am not the doctor on call but you can ask that I am paged. And if they give you a hard time, tell the other physician that I want to talk with you, and she'll pass the message along to me.

By now, about 35 seconds had passed, endlessly in her mind. You can imagine her distress.

It's good news. I hope to speak to you soon.

She starts to scream with joy.

All's well that ends well, but imagine if he had started with: It's good news. I hope to speak to you soon.

5 comments:

Anonymous said...

Paul,

Let's highlight the good deeds of this doctor, calling on a Saturday...leaving his number asking to be paged when not on call. True probably could have been a bit better but certainly above and beyond what many would do.

Paul Levy said...

For sure, and he is a great clinician and wonderful person.

e-Patient Dave said...

Yes, perfect. When a call like this comes, one's heart is in the throat. It's perfect to start it with "good news" in the first breath or two.

Elaine Schattner, M.D. said...

Paul,
Thanks for this terrific, subtle example of how thinking before we speak, even for just a moment to contemplate the listener's position, affects how someone perceives a discussion. Of course this "case" isn't so bad, as pointed out by another comment above. The doctor was going far out of his or her way to let the patient know the good news, and 35 seconds is zilch in the big scheme. Still, it's a revealing transcript from which a lot of us might learn to be better communicators.

Dhaya Lakshminarayanan said...

I like this post. It has business relevancy outside healthcare too. Many of us begin our "direct" conversations with preambles:

"Hey, Scott, you've been doing great work. You're a lovely human being. I respect you. Now, let's talk about the last financial model you emailed me"

instead of

"Scott, have a question about where you got this depreciation number. I don't disagree. Wanted to clarify"

OR

"Scott, you impressed the entire board with your analysis. Footnoting all the OPEX items is what won them over"

Positive feedback can stand alone. We can also be direct without sugarcoating. Provided we have strong relationships in place!