✔ Prepare yourself for delivering bad news—allow enough time, and have calls held.
✔ Find out how much the patient understands and how much he or she wants to know about the prognosis.
✔ Be straightforward and compassionate.
✔ Give the patient time to react.
✔ Establish a plan for next steps; let the patient and family know you are not going to abandon them.
✔ Give the patient an opportunity to continue the conversation in follow-up appointments or calls.
breaking bad news 43
Working With Diverse Older Patients
Appreciating the richness of cultural and ethnic backgrounds among older patients and providing interpretation for those with limited English can help to promote good health care.
“Cultural differences, not divides.”
Azeeza Houssani had been Dr. Smith’s patient for several years.
She had always carefully followed his instructions. So, Dr. Smith was surprised when Mrs. Houssani was not willing to take her morning medication with food, as directed. He reminded her that these drugs were very hard on the stomach and could cause her pain if taken without food. But Mrs. Houssani just shook her head.
Rather than getting frustrated, Dr. Smith gently pursued her reasons. Mrs. Houssani explained that it was Ramadan and she could not eat or drink from sunrise to sunset. Dr. Smith thought a bit and suggested that she fi nd out if it’s okay to take medicine with food during Ramadan—there might be an exception for people in her situation who need to take medicine.
Understanding how different cultures view health care helps you to tailor questions and treatment plans to the patient’s needs. Although you cannot become an expert in the norms and traditions of every culture, being sensitive to general differences can strengthen your relationship with your patients.