The Art of Delivering Bad News: What I Wish I’d Known
I was recently unpleasantly surprised with the diagnosis of a bone tumor in a young golden retriever I was convinced had a cruciate ligament tear. The ensuing conversation blindsided the pet owners and I was reminded of the importance of delivering bad news properly. I’m not the most articulate person but as I travel along in my veterinary career I have learned invaluable lessons in the delicate art of breaking bad news. Below is a short list of insights that may help an unsuspecting new veterinarian.
Be honest and forthright.
I am not a fan of the question “What would you do if he was your pet?” While I offer my opinion when solicited, I always note that I have a bias. That bias is what makes me a veterinarian. My job is to cure and treat disease, alleviate pain, and want to find the diagnosis. If you think an animal is suffering, kindly say so. Veterinarians sometimes better recognize the signs of pain, discomfort, and failing quality of life.
Get to the point. Repeat.
When delivering bad news to an owner, like the diagnosis of a tumor, it is tempting to talk about normal results and how the animal arrived at this point before giving the diagnosis. It just doesn’t work. Most people are perceptive enough to sense something is dramatically wrong and their minds begin racing as soon as you don’t say everything is okay. I find the most effective way to deliver the blow is with a soft voice, caring personal tone, and preface the entire conversation with “I’m afraid I have some very bad news for you, it appears as though Fluffy has a tumor in his abdomen that looks as though it has spread to his chest. I know this is a lot to handle but I’d like to discuss it with you.”
Further discussion at that time is completely dependent on the owner. Some owners want to discuss all options then and there. Others need time to digest the information and will need to call or visit later. Determining what the owner needs is a skill a vet develops over time. Too many times I have tried to plow through a discussion of what we do next only to realize the owner hasn’t moved beyond the word “cancer”. Once you deliver the news, summarize the findings again. In a state of shock, owners may remember only a fraction of what you tell them.
Don’t Use Euphemisms
It may be tempting to sugar coat findings to try to spare emotions but you will do a disservice to your patient if you fail to adequately explain the dire situation to its owner. A gentle apologetic tone prevents you from sounding too calloused. For suddenly deceased pets, using terms like “moved on”, “passed on”, and “no longer with us” are not definitive for a reeling mind. Use the terms “death” and “died” at least once in conversation and supplement the conversation with the other terms. For the terminal diagnosis, terms like “life-ending”, “end-stage”, and “not recoverable” are warranted. In addition, “uncomfortable” does not mean the same thing as “suffering” to most owners so choose your descriptors wisely.
Offer Follow-Up
Once you’ve delivered the news, acknowledge there will be more questions. Suggest owners write them down, sleep on it, and call you the next day with questions. Make yourself available for a consulation appointment as some owners prefer speaking in person.
Be Compassionate
You’ve just rocked someone’s world. Remember what it is like to be confused and stunned. Don’t be afraid to reach out and hug a client in need.
Dr. Koehl,
I am most impressed with your frank discussion on delivering bad news to patients and caregivers. You offer great advice the both veterinarian and medical providers alike.
1Be honest and forthright.
I am not a fan of the question “What would you do if he was your pet?”
Neither am I, simply because he/she isn’t your pet. And what you may be able to do or not do may not match our ethics, emotions, and capabilities.
It also may play guilt into the situation, by convincing an owner to do something they do not believe in. period.
Honest & to the point, no maybe this maybe that.
Thanks for the post.
2Another tip: When it comes to potentially fatal diagnoses, don’t think out loud. Don’t say anything until you’re sure.
A 4-week-old kitten I had just adopted developed breathing problems. The vet did x-rays, thought they showed fluid in the abdomen and blithely pronounced that my cat had FIP. Death sentence delivered.
As I was getting things together to go home, tears welling up in my eyes as I was trying to wrap my head around what was happening, the vet came back and suggested we send the films to a radiologist who was experienced with tiny kittens. Turns out, what the vet interpreted as abnormal fluid was actually normal physiology for such a young kitten. The kitten did have some kind of lung infection, but it cleared up quickly with medication, and the kitten is now a happy, healthy adult.
3I am really grateful to an emergency vet who leveled with me about the condition of my cat. I think my regular vet didn’t level with me a day earlier because it was obvious I was clueless about how serious my cat’s kidney failure was and he knew me well enough to know it would be a shock. One of my earlier cats had kidney failure for 2 1/2 years and that’s what I expected. It never occurred to me that a cat could reach an end stage in 6 months. I took him in for fluids and when I was ready to go the vet tech said I should stay as the vet wanted to talk to me. When he entered the room, he looked at his feet a lot and then said I would probably want to bring my cat back in a couple of days to have more fluids. But on Sunday morning my cat looked terrible so I decided not to wait and took him to an emergency vet for fluids. She picked him up, cuddled him, kissed him, and said “It’s so hard to say good-bye to these old timers but I think that’s what you should do. Let me show you your cat.” And she showed me ulcers in his eyes, his throat, had me smell his breath which smelled like urine, and explained the course of the disease. Her compassion and her directness punctured my expectation he would live for a couple more years like my other cat. She made it clear my cat was suffering and for that I am grateful. She wanted to know if I wanted to talk this over with my husband and I said yes. After telling my husband I would not be bringing Travis home, she put him down. Even now I cry thinking about this event. But I admire her directness and professionalism in helping me to spare my cat any more suffering. Your guidelines are the way this vet handled me in helping me to understand the condition of my cat. Years later I am still grateful to her.
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