There is (a) vast divide between the physician sharing a hard reality and the person receiving it. As much as the doctor works to imagine what it must be like, he or she is not the one whose life is changing. The physician moves on to the next patient, while the patient now lives in a new world.I read this after posting last night; the bulk of the post is about the poster's own autistic son, and how different it is to give versus receive bad news. Neither my spouse or I personally enjoy great health, so I'm hoping I can rely on that to not completely suck at giving patients unpleasant news.
It's kind of funny, I think, that we have an actual class session next semester dedicated to breaking bad news. One other student will meet with a standardized patient (an actor) and pretend to give bad news to him or her, and a group of us will watch a video and critique how the student could have demonstrated more empathy, etc.
I predict it's going to be awkward as hell for that student. But based on my own experiences and those of many people close to me, doctors are often terrible communicators. Your test results are X, Y, Z. Come back in 6 months. On to the next patient. But the patient is still sitting there in the room and the doctor just walked out because he's triple-booked and well it's damn hard to keep to a schedule. No other professional is scheduled the way that doctors are. You don't meet with your attorney for a 6 minute talk, after which he finishes your will. You don't meet with a counselor for 15 minutes and suddenly your anxiety is better. People often need time for healing, and few physicians have it to give.
Ultimately, the problem is not that doctors are terrible communicators (although some are) but the amount of time allotted to break bad news... well, that's time spent not seeing other patients, or performing procedures. You're losing money for your employer if you spend too much time with a grieving patient. You'd hate to get fired, right?
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