Rogerian Letter

Madison Vernaci

Louisiana State University

Author Note

The following Rogerian letter was written for English 2001, taught by Jean Coco, and addresses

issues raised in the case study Staying Out of the Line of Fire: A Medical Student Learns About

Bad News Delivery, published in Health Communication in Practice: A Case Study Approach.
360 West Livingston Place
Metairie, LA 70005

April 30, 2017

East Jefferson General Hospital

4200 Houma Blvd.
Metairie, LA 70006

Dear Hospital Administrators of East Jefferson General Hospital,

I am a medical student, and the issue on communication between doctors and their
patients has sparked my interest in pursuing a career in the medical field. My brother was a
victim of inappropriate bad news delivery. He was given bad news in unethical and uncaring
ways, which put my brother and our entire family in a stressed and overwhelmed state. This
experience has given me the motivation to go to medical school and become a doctor who will
treat my patients as individuals and will not devastate families in the way that mine had been
affected. I know that not every doctor delivers bad news in the pompous way that it was
delivered to my brother, but I feel that this is still an issue that needs to be addressed. Some of
my medical professors and peers encourage the class to keep emotional distance from their
patients and treat them as they would treat a cadaver. Delivering bad news has become blunt,
straightforward, and comes off as no big deal, which does not give the patient validation or hope,
and caused confusion among the patient and their family. Because of my recent dedication and
research on this topic, I know that there are many reasons for doctors to act in this manner, but
communication should be a top priority of the doctor. I am writing you because I want the entire
hospital administration to take this situation into consideration, and work with me to improve the
delivery of bad news for current and future doctors.
I understand that there are many reasons that hinder a doctors emotion and cause them to
come off as rude, even though that is not their intention. Delivering bad news is an extremely
complex and subjective process for both the doctor and the patient because every medical case,
doctor, and patient is different (Joekes, 2007). Doctors feel that this process is just as stressful for
them as it is for their patients because of the many obstacles and emotions they have to overcome
as well. Even though there are classes in medical school, guidelines, approaches, and literature
that help doctors cope with fears and obstacles of delivering bad news, doctors still do not
always deliver bad news in effective ways (Delivering Bad News, 1999). The chaotic hospital
environment, their own personal fears and the patients reactions hindered the implementation of
these guidelines (Dosanjh, Barnes, and Bhandari, 2001, 201). Because of the many barriers that
doctors face and the complexity of this issue, hospital administrators may think it is inevitable
and unrealistic to try to suddenly improve this.
I have realized that there are many different levels of bad news because all situations and
people are different. I agree that delivering bad news to patients is a skill that does not come
naturally to every doctor, and that experience is needed. I know that it is nearly impossible for a
doctor to adapt to their patients emotions and situations perfectly when they also have to deal
with their own emotions. I believe that the worldwide medical field and myself are in agreement
on wanting to make patients comfortable, appreciative, healthy, and hopeful. There needs to be a
distinction from doctors who are trying to deliver news in the most effective ways, but fail
because of the barriers, and from doctors who are straight up dehumanizing and rude towards
their patient. Even though not all cases of ineffective bad news delivery come from improper
medical training and unemotional doctors, it still effects the patient in a negative way. This not
only effects the patient, but it damages the hospital and doctor because lawsuits are more prone
to happen. I am trying to warn the hospital about the serious outcomes that can come from an
innocent, nervous doctor who delivers bad news to patients in a rude manner because of the
many obstacles of delivering bad news. I am not a doctor yet, so I have not experienced these
barriers to the extent of your staff, but I can only imagine the feeling of helplessness and stress
put on the doctor. One of the reasons for my understanding is because doctors are trained to cure.
Delivering bad news goes against all of the reasons someone goes to medical school. Some
doctors may feel that communicating with patients is not as important as curing their illnesses,
but I am hopeful that we can work together to improve this situation.
I appreciate how the medical field shows their awareness to this issue by placing
guidelines and step by step approaches to try to condition the doctor to deliver bad news in
effective ways. However, I believe that these approaches are not good enough to solve this
because one cannot be taught to react to certain situations in a step by step manner. Those
approaches are helpful, but do not focus on the individual patients unique situation and
emotions. The literature and guidelines for bad news delivery vary, so when doctors try to deliver
the bad news using the best approach, they become confused because there actually is no specific
or best approach way to deliver bad news (Dosanjh et al., 2001, 200). It all depends on how well
the doctor can adapt to how their patient is reacting to the bad news. A doctor, whom I agree
with, shares his thoughts on the use of guidelines and courses on this subject to be unnecessary
because he feels that case discussions with peers and observing mentors during clinical training
will be more beneficial. He believes that these approaches will help relieve the doctors anxiety,
and that it will allow doctors to create guidelines that fir their own emotions, so that they become
more comfortable with their own fears (Delivering Bad News, 1999). I also believe that
support from staff members will encourage nervous patients to overcome their fears. Role
playing as practice is another suggestion I have to allow doctors to become comfortable with
delivering bad news.
No matter the reason for the doctors ineffective bad news delivery, there needs to be a
solution because the manner that bad news is given has effect on the patients satisfaction,
understanding, and level of hopelessness (Joekes, 2007). I know that it is difficult to change a
doctors personality when delivering bad news and force them to adapt to the barriers, so this
factor will improve slowly based on that doctors level of experience. However, a component of
bad news delivery that can be quickly solved is when the doctor gives bad news in unethical
ways. Hospitals should have a clinic of some sort to remind their doctors of the procedural or
ethical components of delivering bad news. They should be reminded that bad news should be
given by no one other than patients physician in a private setting, never during a rush of rounds,
and never on the weekends unless it is crucial (Delivering Bad News, 1999). The cause of my
brothers bad news delivery was from mistakes like that, which could have easily been
preventable.
I know that this is a very difficult topic to improve, but I believe that it is possible
because there has been many cases of doctors who deliver bad news in the most effective, caring
ways. I am opened to discussion on finding more reasonable solutions with you because there are
many possibilities that could help improve communication in the medical field. Communication
should come naturally to doctors and be their first priority so that they can form a relationship
based on trust before operating on their patients.
Sincerely,

Dr. Christie Smith

 References

Delivering Bad News [Editorial]. (1999). Einstein Quarterly: Journal of Biology & Medicine,

16(4), 169.

Dosanjh, S., Barnes, J., & Bhandari, M. (2001). Barriers to breaking bad news among medical

and surgical residents. Medical Education, 35(3), 197-205. Retrieved April 18, 2017.

Gillotti, C. and Thompson T. L. (2005) Staying Out of the Line of Fire: A Medical Student

Learns About Bad News Delivery. Ray, E. B. Editor, Health Communication in Practice:

A Case Study Approach, 2, 11-25. Mahwah, New Jersey.

Joekes, K. (2007). Breaking bad news. In et al. (Eds.), Cambridge Handbook of psychology,

health and medicine. Cambridge, UK: Cambridge University Press. Retrieved March 24,

2017.