A man goes to his doctor for a complete checkup. He hasn't been feeling well and wants to find out if he's ill. After the checkup the doctor comes out with the results of the examination.

"I'm afraid I have some bad news. You're dying and you don't have much time," the doctor says.

"Oh no, that's terrible. How long have I got?" the man asks.

"Ten..." says the doctor.

"Ten? Ten what? Months? Weeks? What?!" he asks desperately.



An ICU nurse says that when there is bad news to deliver, doctors often lack the bedside manner to deliver it well. “Doctors are sometimes not so great at it and they leave us standing there to deal with the family. I give them a hug because I’m that type of person. We don’t have any formal program to tell the family. Of course, after the fact, they can see grief counselors. There was this one guy who didn’t make it after open-heart surgery. We were just waiting for him to die and even after we unplugged everything he still held on. We couldn’t figure out what was holding him on. All the while the family was at his bedside – all but a twin son who didn’t get there until much later. Once he arrived, he held his father’s hand and at that moment he passed. There was something special about that and while we can’t explain it, there is more to life than we understand. The family was grateful that we stayed with them as long as necessary.”


It’s never easy delivering bad new whether it’s as mundane as explaining why a minor procedure didn’t work as expected, or as sad as telling the family the patient died.

In a litigious society, the way bad news is announced can be the difference between the successful delivery of a message versus the messenger being shot. As unfortunate and callous as it may sound, avoiding litigation is a reality in a world that assumes if something went wrong it was the doctor’s fault.


A Gastroenterologist’s Experiences

“I once had six deaths in 24 hours in ICU. There is no right way to tell the family. I use the euphemism: ‘I’m sorry, but your mother moved on.’ Quite often I would hear the loved ones say things like: ‘Did you see my mom’s soul go to heaven?’ I would reply: ‘God hasn’t given me the privilege to see or understand that kind of thing.’ The physician is in a no-win situation. How can you console a mother who lost a daughter? Never say, ‘I know how you feel.’ It’s better to say, ‘I know you feel bad.’”


“I had to tell an eighty-year-old woman and her daughter that her husband (the daughter’s father) had died. Not a moment after I told the wife, she passed out right there on the floor and died. I initiated a code and we tried to revive her, but to no avail. I looked up to the daughter and said, ‘Please don’t die on me.’ It sounded so cruel, but she understood and kindly said, ‘Don’t worry, I’m all right.’”


Many times people say they are going to sue the doctor when they have a loss. They often don’t understand or believe the doctor’s explanation, and once they institute a suit, the explanation will come in a long, tiring, brutal, and hostile environment of depositions and testimony. If complications are explained in a compassionate, understandable manner, the courtroom can be avoided, and the aggrieved will better cope with their loss.

The most difficult bad news involves telling the family the patient died. “I’m terribly sorry, Mary, but I just killed you mother,” is not the way you would ever deliver bad news, but you can be sure that’s the message the personal injury attorney is going to deliver to the jury of laymen who will decide your fate. While compassion has to be the utmost concern at the time of delivering news of loss, you also must be concerned with protecting yourself.

Since blame is the essence of personal injury law, you must make sure you assign blame to the patient, unless you truly performed an act of malpractice and wish to make such a pronouncement. Assuming you did nothing wrong, it is best to begin by establishing a rapport with any of the family members you may not already know. This is especially true for the emergency room physician, who often meets the family for the first time to deliver the news that a loved one died.

You need to introduce yourself and determine to whom you are speaking: 


“I’m Doctor Smith.”

In most instances the person will tell you who they are, if not, you ask:


“How are you related to Joan?”

You put out your hand, take their hand in both of yours. This immediately shows concern and compassion. You repeat this for each person you need to know.


“Please, let’s sit down and let me explain.”

Once everyone is seated:


“We did everything we could, but Joan’s injuries were just too extensive and she didn’t make it.”

 Often the loved one will try to get the bad news by shouting, “Did she die?”  It is best to respond to the demand since this personality doesn’t want to wait for protocol.

Notice the blame is placed upon the injuries, and you avoided the harsh sound of dead or died by using the euphemism “didn’t make it.” You now must allow time for the response, which will often be hysteria. If the person grabs you, you hug them and tell them how terribly sorry you are and that you wish there was something more you could say or do to make things better.

The more difficult situation arises when you have to tell the family their loved one died in a case where it was never expected. Probably the worst such scenario is when the patient dies during routine cosmetic surgery. Again, blame should be placed upon the patient. 

Every doctor knows there is risk associated with surgery and general anesthesia. These risks are supposed to be spelled out in the informed consent and that consent is your best protection. Though the patient consents to the procedure and is supposed to understand the risk, that doesn’t mean they, or their family, will not still attempt to sue the doctor.

Patients usually don’t sue doctors they love and trust. While the patient may have loved you and would never sue, that doesn’t mean their family feels the same way. It is at this time that you have to establish the rapport, trust, and bond with the loved ones to prevent a lawsuit. Beyond protecting yourself, you should understand that the most important motive to establishing this relationship with the family is to help them deal with a most unfortunate event in their lives.

Defensive posturing is not compassionate and makes the doctor look suspect. It is best to explain the nature of surgical risk in the most lay fashion possible:


“I have terrible news for you. Your wife had a bad reaction to the anesthesia and we couldn’t revive her.”

Most loved ones will respond to the euphemism:


“You mean she died?”


“I’m sorry.”

It is imperative to stay with the family as long as is necessary. Rushing away without cause appears callous. If you are the emergency room physician and it’s a busy day, you may have to excuse yourself, but you should make sure there is some protocol in your hospital to have a grief counselor, or nurse trained in dealing with these matters, take over once you have explained the situation. At that point you must explain that there is another emergency for which you are needed and introduce the counselor before you make your exit.

Never rush the family of the bereaved. Try to answer all the questions they may have. Always ask if there are any questions before you leave and say, “If there is anything else I can do for you please don’t hesitate to give me a call.” That offer to “give me a call” goes a long way toward making the patient, or the family, feel comfortable.

Now that you can tell a family member their loved one just died, everything else is easy. Maybe not. No one likes bad news and when you have to deliver it, it’s never pleasant for either party. Again, you must be prepared for any and all situations and have a script ready. No matter how trivial you think a loss may be, to a particular patient it could be devastating.

Failing Procedures


An Endodontist

“Telling patients a procedure failed is very uncomfortable for me. I always plan for failure when making a treatment plan. I tell the patient what we will have to do in the event that things don’t go as planned. I explain the alternatives, risks, and costs. I want my patients to be comfortable with any outcome.”


When a procedure fails, patients are at minimum disappointed, and others may exhibit hostility. Much of the reaction depends upon expectations, importance of the procedure, and financial loss. The loss of sight would be more disconcerting than the loss of a tooth. A loss involving a simple procedure with a high expectation for success is more upsetting than the failure of a procedure that had limited chance of success. And the failure of any procedure that required large out-of-pocket expense is less acceptable than the failing procedure fully covered by insurance.

All of these considerations must be addressed before treatment to avoid the bad feeling engendered when procedures fail. By preparing before the failure, delivering the bad news is much easier and preserves your relationship with the patient.

Besides the written informed consent, the doctor should deliver the oral consent and address all the possibilities of complications and chance of failure. If presented in a friendly, non-threatening manner, treatment acceptance will be high and disappointment minimized when treatment fails.

Most reasonable patients will understand a failing procedure and accept the need to move on. Some might question you about a refund. There are two schools of thought on this issue. You can offer some type of refund, best tied into an alternative treatment or you can revert to your informed consent where you prepared the patient so well they shouldn’t even consider asking for a refund. In spite of the best preparation, telling the patient who never understood your presentation that there is no refund, and they will now have to pay for the new device, is not well received. Which doctor are you going to love? I think we all know the answer.

To make a fair settlement, you can offer to apply the funds from the failed procedure towards an alternative or you can tell them they will get some sort of discount. Patients will be much happier if they feel they didn’t lose everything. While you will take a loss for a minimal amount, you will have a very happy patient. Since failures should be an uncommon occurrence, you can afford to be nice.

Some practitioners feel that offering a discount or refund is tantamount to admitting guilt. While that is a concern, most patients do not think that way. Even if they tried to use the refund against you in a lawsuit, good records and documentation that you are making a hardship adjustment will look favorable for you in the courtroom, though you’ll not likely get there.

Many doctors spend thousands of dollars marketing their practices and they are reluctant to make an adjustment when things go wrong. The goodwill generated by a patient who doesn’t have to pay twice for the same thing is worth many times more than marketing costs. The badmouthing that takes place when the disgruntled patient pays twice costs even more.

Besides death and failing procedures, there are lesser bits of bad news that need attention as well if you want to run the premier professional practice. It is bad enough that health-care providers are often behind schedule and keep patients waiting; sometimes hospital emergencies require them to miss appointments. The chapter on the waiting room addresses such problems.



• bruno azevedo (2024/05/01 07:55)
As an oral maxillofacial radiologist, I have encountered monthly or weekly conversations where I have to deliver bad news about diagnosis to patients. I find it difficult to express to someone that they have cancer ( which leads to the fear of death). As healthcare professionals, dentists often find themselves in the delicate position of delivering bad news to patients. When a screening suggests the possibility of cancer, communicating this information is crucial. It impacts not only the patient’s understanding of their health situation but also their emotional and psychological response. Over the years I have the follow the below rules: 1. Prepare Yourself: Before discussing serious health concerns with a patient, the dentist must prepare emotionally and intellectually. Ensure you understand all the medical details and are ready to answer the patient\'s questions. This preparation shows the patient that you are thoughtful and informed, which can help build trust during a challenging conversation. 2. Choose the Right Setting: Discussing potentially alarming news like a cancer diagnosis should always be done in a private, quiet space where the conversation can occur without interruptions. Comfort and privacy are key factors that show respect for the patient’s emotional state. 3. Be Direct but Compassionate: When conveying the news, it’s important to be clear and straightforward to avoid confusion. However, balancing this clarity with compassion is essential. I use language that is professional yet sensitive, explaining that the screening indicates a possibility of cancer and that a biopsy is necessary to understand more. 4. Listen Actively: After delivering such news, give the patient time to process and respond. Listen actively to their concerns and emotions. This not only helps you understand their perspective but also helps you provide them with the support they need. 5. Provide Clear Next Steps: It is crucial to leave the patient with a clear understanding of the next steps. Explain the referral process for the biopsy(make sure to stress your total confidence in the provider you are referring the patient to), what it involves, and any subsequent actions that need to be taken. Offer resources and support for emotional counseling if needed. 6. Follow Up: Arrange for a follow-up appointment or call to answer any further questions that might arise after the initial discussion. This follow-up is vital to ongoing care and shows the patient that they are not alone in this journey. By handling these conversations with care, we can significantly ease the burden of bad news for our patients. It’s not just about delivering information; it’s about providing support and understanding during some of the most trying times in a patient’s life.
• Julie Brann (2024/04/30 20:29)
I am so thankful that I never have to deliver news that the patient didn\\\'t make it through the procedure. I cannot imagine giving that kind of news. On the other hand, I also can get emotionally attached to teeth and patients and feel bad when treatment doesn\\\'t go as planned. I have learned to front-load the procedure with complications that could happen and advise the patient that the lesion may not heal and need additional treatment/surgery so they are not caught off guard if something doesn\\\'t go as expected. This script will be something I continue to tweak and perfect over time.
• Karen Kimzey (2024/04/30 12:19)
Good post about delivering bad news. I\'ve never liked delivering bad news and I also don\'t like confrontation. But it is a part of our profession. As a GP, I used to make an attempt to thoroughly explain the condition of the patient\'s teeth or tooth so that would understand the long-term prognosis of the procedure. I would see if they nodded and understood. Those were the easy patients - I knew they understood the risk they were taking with the treatment. Others that give me a shocked, wide-eyed look - I would give them a moment to digest the information and try to find a way to say it\'s \"in their best interest to ....\". I\'d follow up with, \"I know that was a lot of information, if you have any questions, here is my contact information if you have a question, please let me know. I may not get back to you right away but I will respond as soon as I can.\" I still don\'t know how to deliver bad news when it comes to endodontics. I perforated a young adolescent\'s lower molar the other week and I knew that it dramatically affected the long-term prognosis. I couldn\'t sleep that night because I have children and I felt that as a mom, I had this guilt over my head for ruining the patient\'s tooth. If (when ) it fails, she will have to look into added dental procedures for the rest of her life. If you can teach me how to deliver bad news, that would be great!
• John Millar (2024/04/28 19:24)
And therein lies a major reason for me pursuing dental over medical: it is not (or, at least, should not be) a matter of life and death. The first endodontist I ever shadowed told me, \\\"At the end of the day, it\\\'s just a tooth.\\\" And while losing a tooth can still be devastating, a majority of cases can be treated acceptably via alternative methods. With that being said, if you are callous enough to present the complications in such a drastic comparison as \\\"get over it, it\\\'s not life and death\\\", issues will arise. I have found it extremely helpful to be very thorough in the informed consent. If it is not the first time they are hearing about the complication, then it\\\'s not as far out of left field as it could have been. That extra few minutes in the beginning could save significant headaches in the future. While we have a tendency to run behind schedule, I think it is very sound advice to never make the patient feel rushed. If the patient feels that you have given them your undivided attention for as long as they required it, there is certainly less animosity potential.

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