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Am Fam Physician. 2002;66(7):1155

to the editor: I am responding to the article, “Breaking Bad News,”1 by Dr. Vandekieft. I appreciate the efforts of American Family Physician to improve the comfort level of family physicians when it comes to communicating difficult issues to their patients. However, I have long opposed using the term “bad news,” even though it was used in the Educating Physicians on End-of-Life Care (EPEC) course I took when I became a trainer for EPEC.

Reporting to patients, “I have bad news” is a “set-up.” It affects the patients’ attitudes and feelings and is an immediate and premature negative imposition on their psyches. Physicians need to realize that the information we impart to patients has an individual effect on each person. By prefacing the information with phrases such as, “I have bad news,” we are putting a bias of our own values on the information.

I recently told a woman, “I believe you have Alzheimer’s disease.” I paused, and she responded, “Well, at least I didn’t get it sooner.” Another patient’s response to a diagnosis of cancer was, “I have a friend who had it, and he’s cured.” Saying “I have bad news” immediately decreases hope, and hope is a very powerful human emotion and force.

When we learn that our patient has a disease that could cause disability or death, we must carefully measure our words and consider elements of communication, such as our body posture, tone of voice, and the location we’re in, when we share this information with the patient and family. We also need to have as much insight as possible about our own feelings. We should continue to improve our caring relational skills. It is not in the patients’ or the physicians’ best interest to label certain diagnoses as “bad news.”

Email letter submissions to afplet@aafp.org. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors. Letters submitted for publication in AFP must not be submitted to any other publication. Letters may be edited to meet style and space requirements.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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