Eyeworld

18 Ophthalmology Business • December 2017 In these situations, Dr. Lee said he will engage with the patient in di- rect conversation. When the patient offers information that he thinks is important and limited to what he can remember, he'll say, "If you'll excuse me for a second, I'm going to enter this into the computer, then I'll ask you some more questions." At the 2017 Women in Ophthal- mology (WIO) Summer Symposium in August, Dr. Lee gave a presenta- tion on delivering bad news, "Break- ing Bad: Empathetically Delivering Bad News to Patients," where he said that it's important to "be the doctor who communicates information; don't delegate it to a team mem- ber, resident, fellow, or colleague. … Don't be the person who says, 'I think you're going to be OK, but go see Dr. Smith.'" It's also important to prepare the patient preoperatively for complica- tions and surgical risks. "It's a whole different ball game if you've talked to the patient about what could happen," Dr. Lee said. "I've had my fair share of compli- cations, and having spent the extra couple of minutes ahead of time, the patient remembers, 'You did say that could happen.' That changes the conversation of why did this happen, what can we do? Minutes here can save hours and days and weeks if it ends up in court." Dr. Maehara offered similar thoughts. "This is where an ounce of prevention goes a long way. Setting realistic expectations when we first meet a patient or encounter a new consequential problem can signifi- cantly ease the transition to bad news," he said. "If we are taking a 'final shot' at something, we should make this clear to a patient. It is always better to underpromise and overdeliver." Dr. Lee said when a negative outcome is the result of a physician's mistake, it's important to be upfront about it. "Patients sue to get informa- tion because they feel they've been stonewalled. We're in this as a team; let's be honest and tell them what happened," Dr. Lee said at the WIO meeting. "The results of doing so are good for patients and good for physicians and the health systems, based on experience at the University of Michigan." 3 When a patient acts emotionally In addition to considering how you deliver bad news to patients, physi- cians need to consider their response to patients' reactions. "Having an appropriate, compas- sionate reaction is something I try to do with folks," Dr. Lee said. "For example, if they're crying, offer them a tissue. Depending on the relation- ship, help reassure them. If they're angry, let them express themselves and work with them on how to ad- dress their concerns." Dr. Maehara said in addition to being supportive and explaining that these emotions are normal, it can be helpful to provide examples of how things could be worse and emphasize positive attributes that remain, even if it's the other eye. In these situations, Dr. Lee said it's often helpful to have a patient's loved ones engaged in the conversa- tion. A close friend or family member can provide support to the patient receiving negative news as well as a second set of ears to help process the information. In tense times, Dr. Lee said it's important to ask patients to repeat back what they've heard so the phy- sician can be sure they fully under- stand the situation. "When breaking bad news, it's often overwhelming for the patient, so it is best to ensure family members are present and to summarize where the patient was before, the unfortu- nate events that have occurred, and what positive things remain," Dr. Maehara said. Scheduling a follow-up appoint- ment after delivering bad news might not help soften the blow, but it pro- vides reassurance to the patient. "A 7- to 10-day follow-up appointment to check on how the patient is doing is not a bad idea and reinforces that the patient is not alone despite a permanent condi- tion," Dr. Maehara said. OB References 1. The National Academies of Sciences, Engineering, and Medicine. Institute of Medicine. Improving diagnosis in health care: Quality chasm series. September 2015. www. nationalacademies.org/hmd/~/media/Files/ Report%20Files/2015/Improving-Diagnosis/ DiagnosticError_ReportBrief.pdf. 2. Monden KR, et al. Delivering bad news to patients. Proc (Bayl Univ Med Cent). 2016;29:101–2. 3. Boothman RC, et al. A better approach to medical malpractice claims? The University of Michigan experience. J Health Life Sci Law. 2009;2:125–59. Contact information Maehara: michael.gedmin@advicemedia.com Lee: pleemd@med.umich.edu Delivering bad news to patients • Do it yourself; don't delegate to a team member. • Recall from previous interactions how the patient might prefer to receive such news, how much detail you should get into, etc. • Suggest having a family member or friend present for extra support. • Focus on positive attributes of the situation. • Schedule a follow-up appointment a week or so after delivering bad news to check on how the patient is doing. continued from page 17

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