Letters to the Editor

Privately Breaking Bad News


Am Fam Physician. 2002 Jul 15;66(2).

to the editor: I salute the article "Breaking Bad News"1 and the techniques described therein. I agree that the impact of bad news delivered to a patient can be softened by establishing a therapeutic relationship and communicating effectively and compassionately.

However, the ABCDE mnemonic (Advance preparation; Build a therapeutic environment/relationship; Communicate well; Deal with patient and family reactions; Encourage and validate emotions) described in the article does not address the protection of the patient's privacy. Every day, situations occur in which staff members other than the patient’s physician give the patient news of abnormal test results, sometimes over the phone, or in which technicians are unable to conceal their discoveries. These occurrences can leave patients feeling lost, bewildered, and with a sense of impending doom.

New regulations in the Health Insurance Portability and Accountability Act (HIPAA) specifically address the issue of patients’ consent regarding who has access to their medical records and how this information is disclosed. Noncompliance can result in civil and possible criminal penalties.2,3

The concepts of "advance preparation" and "build(ing) a therapeutic environment/relationship" should include establishing patient consents before initiating diagnostic testing, treatment, and management, and should outline measures of protecting patients’ privacy. This topic is not only timely but should be a required course for physicians.


1. Vandekieft GK. Breaking bad news. Am Fam Physician 2001;64:1975-8.

2. Josefson D. US sets national standards for patient privacy. BMJ 2001;322:8.

3. Kibbe DC. What you need to know about HIPAA now. Fam Pract Manag 2001;8:43-7.

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This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.



Copyright © 2002 by the American Academy of Family Physicians.
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