At dinner the other night, I sat next to Dr. Rebecca Brooks, who is gynecologic oncologist and assistant professor at the University of California San Francisco.Dr. Brooks operates on many patients with advanced cancer.
So one of the questions I had for her was how she tells people they are going to die.
Dr. Brooks said she developed her own style of doing this in part by watching a range of different styles during her residency years.
One of the doctors she worked with, she says, was so dark and direct about it that he often sounded as though he was going out of his way to paint the worst-case scenario in the blackest possible terms–even if the outlook wasn’t that bleak.
Being overly sunny in the face of a bleak prognosis, of course, is also problematic. And it’s dishonest to people who often have little time left and need to use that time as best they can.
Watching the first doctor, Dr. Brooks says, helped her get comfortable delivering very bad news–albeit in a less-apocalyptic package.
Each patient is different, Dr. Brooks says, so there’s no one-size-fits-all way of delivering the news. For some patients, Dr. Brooks says, she employs a communication tactic called the “sandwich” (It’s often used in Little League, in addition to many other situations).
In the “sandwich,” you package the bad news with some good news.
“The good news is we were able to remove all of the cancer. Unfortunately, the prognosis for people with your condition is usually still fatal. But we have now bought you some time, and they are always developing new treatments.”
Miracles do occur, Dr. Brooks says, so you would never want to be completely black and white. But you also wouldn’t want to mislead anyone about their chances.
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