Bearing Bad News: Should We Err on the Side of Truth or Compassion?

Bearing Bad News (1)One of the first questions the Association of American Medical Colleges asks prospective students is “Do you care deeply about other people, their problems, and their pain?” The fact is, beyond the glamour, pay, and prestige, one of the most common reasons people become doctors is because they want to do good and help people.

Yet, doing a doctor’s job well sometimes means upsetting or even hurting a patient.

Delivering bad news provides one example. A recent study showed that physicians delivering negative information (an evaluation that a cancer patient could not be helped by further chemotherapy) were evaluated as less compassionate than physicians who were less blunt and more optimistic.

But, at the same time, honest and realistic information is important if we expect patients to make decisions about their care. In fact, giving patients enough information to map their paths is one way to support autonomy, one of the basic psychological needs that helps sustain motivation. And if you consider that many patients have poor health literacy, plainspoken and honest communication by doctors becomes even more essential.

For a doctor to do good in the long term, he or she may have to take the less pleasant road in the short term. Delivering a diagnosis, bluntly and clearly explaining treatment options, or explaining a poor prognosis all may cause patients to see doctors as less compassionate and caring, but those activities also better equip patients to be partners in their care.

It’s a tough trade-off for people who want to do good.