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TITLE:
BREAKING BAD NEWS IN
EMERGENCY: HOW DO WE
APPROACH IT ?
AUTHORS:
MUHAMMAD SAAIQ* , KHALEEQ – UZ –ZAMAN**
ACCIDENT AND EMERGENCY DEPARTMENT,
PIMS, ISLAMABAD.
*Dr Muhammaad Saaiq, Medical officer , Department of Surgery, PIMS,
Islamabad.
**Prof. Khaleeq-uz-Zaman, Professor of Neurosurgery, PIMS, Islamabad.
CORRESPONDENCE:
Dr Muhammad Saaiq
Medical Officer,
Department of Surgery ,
Pakistan Institute of Medical Sciences (PIMS)
Islamabad.
e-mail : muhammadsaaiq5 @ gmail.com
ABSTRACT
Breaking bad news has far reaching implications on the overall management
of the patient and his illness. It should not be taken casual and
SAAIQ emergency approach that has five components. i.e. Setting the
news’ recipient , Alerting about the bad news, Informing clearly and
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In this evidence based era it is imperative to redesign the entire health care delivery
from the patient’s perspective . Breaking bad news to patients or their relatives is one of
the most challenging aspects of medical practice. Effective communication skills hold
the key to solve such knotty issues of clinical practice as a well communicated
message though tragic, not only enhances the patient’s understanding of and adjustment
to his illness but also improves the overall satisfaction of both the patient as well as
1,2
the care giver.
diagnosis such as cancer. However bad news can come in many forms as for
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a disease that ultimately mutilates the body such as rheumatoid arthritis and
care has been replaced by one that emphasizes patient autonomy , empowerment
and full disclosure.. Many recent studies have found that majority of patients
want to know the truth about their illness.7 One review of studies on patient
to make informed health care decisions that are consistent with their goals
and values. A small percentage of patients still may not want full disclosure
needs of the patients. The unique situation in our set up arises when
the relatives request that the actual facts be withheld from the patient.
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Such situations must be handled with great care and a tactful
approach would better serve neither to harm the patient nor his miserable
relatives.
issues such as the fear of being blamed by the patient , of not knowing all
of the answers sought by the patient , of inflicting pain on the patient , and
even the physician’s own fear of illness and death. Many physicians have no
adequate training in how to break bad news and many perceive a lack of
time in which to present the news. Moreover patients may have multiple
Owing to the lack of adequate training , doctors and nurses fail to give
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anxiety and depression is more among patients who have unresolved
news.
12
Parker PA et al found that physician’s competence , honesty and attention ,
and the use of clear language are the factors which matter to the patients in
evaluate delivery of bad news and found that privacy, physician’s attitude,
competence , clarity of the message and time for questions were the top
rated areas.
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HOW TO TACKLE THE ISSUE OF BAD NEWS
DELIVERY ?
Bad news delivery in a proper way is a relatively new area of
however few of those guidelines are evidence based.1 The clinical efficacy
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being empathic, giving a broad but realistic time-frame concerning
The authors have enjoyed working at the busy Accident and emergency
for quite some time. PIMS is a premier medical institution of the country
and its catchment area not only includes the twin cities of Islamabad
Here neither the settings are conducive to intimate conversations nor the
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can’t be furnished in small chunks and usually the swiftly changing
There is often hectic pace of clinical activity and yet the doctor
the patient himself is critical and bad news must often be conveyed
words can easily shift the balance of the situation in any direction.
Review the case in detail so that all the necessary information is at hand..
Arrange privacy .Our emergency department now has a room for
counseling the relatives of serious patients.
Prepare to act naturally
Introduce yourself
Assess what he knows and how much further he wants to know. This can be
elicited by a probing question such as What do you know about the critical condition
of your patient .Also inquire as to whether he wants to know all the details or may
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simply be given a broad picture of the situation.. This helps to tailor the subsequent
transfer of information . .
• Inform in clear and understandable words about the serious state / demise etc.
This SAAIQ emergency approach has been of great help not only for us
but was also found very helpful by our colleagues . This new approach is
CONCLUSION:
management of the patient and his illness .It should not be taken
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REFRENCES:
3) Hulsman RL, Ros WJG, Winnubst JAM , Bensing JM. Teaching clinically
7) Baile WF, Buckman R, Lenzi R . SPIKES ----A six step protocol for delivering bad
news : application to the patient with cancer . Oncologist 2000 ; 5 (4) : 302-11.
9) Kutner JS, Steiner JF, Corbett KK, Jahnigen DW, Barton PL. Information
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10) Buckman R. Breaking bad news : Why is it so difficult ? Br Med J 1984 : 288
(6430) : 1597-9.
11) Maguire GP. Breaking bad news : explaining cancer diagnosis and
13) Jurkovich GJ, Pierce B, Pananen L, Rivara FP. Giving bad news : the family
14) Girgis A, Sanson-Fisher RW. Breaking bad news : consensus guidelines for
15) Rabow MW, McPhee SJ. Beyond breaking bad news : how to help patients who
www.fpnotebook.com/HEM 209.htm.22 k
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