Talk about an intense class. Our doctoring lab today was called "delivering bad news" and we were in simulated scenarios where we had to do exactly that.
We split into groups of about 9 students with one professor per doctor's office (it was in the clinical skills labs so the location was also as realistic as possible). For each of the 5 patients that came in, one student had to give them the news as the rest of the group watched.
We had some readings beforehand about how to deal with this kind of situation- how to interact, what to say, what to do, etc. But when you're actually in the situation, it is quite different from reading about it on paper. The standardized patients were also pretty darn good actors who were for the most part all taking the news badly.
The scenarios were as such:
-A 40 yo lady who's been trying to conceive for the past 10 years got pregnant and you have to tell her that her recent cramps and bleeding is because she miscarried.
-A 50 yo man has just had recent surgery for his pancreatic cancer. He's feeling better but you have to tell him they couldn't get everything out bc it's so widespread that it's inoperable and he has a few months left to live.
-A man whose wife has been in Iraq for a year has recently come home and while she was away, the man had unprotected sex w/another woman - so we find out he has contracted gonorrhea. Both the man and his wife come into the office and you have to tell him about his STD test results.
-Your patient has passed away and you have to tell his son/daughter that it happened in the short time (an hour?) that they were gone to run errands getting things ready so they could bring their father home.
-A 57 yo woman's mammogram showed possible cancer and you have to tell her that she needs a biopsy so they can catch it before it spreads if it is malignant.
So... I did the last scenario, and I learned a lot both from that and from watching everyone else talk to the patients. A big one for myself is that I need to not project on the patient how I think they should be feeling just because I went through a similar experience and felt a different way about it. I need to tune in to the patient's personal reactions to the situation and what the impact may be on *them*. Basically, you cannot "expect" things, but only respond to them. From others, I also learned that it's okay to touch a patient to be comforting if they seem sad, and to lead up to the bad news with what has happened so far instead of bluntly saying what the news is.
There is so much more I feel like we can learn by practicing how we communicate, and I am so glad we had the opportunity TO practice before being plunged into a real situation. I talked to my brother about setting up an acting workshop to explore some of the emotions that our patients may be feeling... think I'm going to try to make that happen soon. :)
