Breaking good news: an essential skill for avoiding too much medicine?

From First10EM (Research Roundup):

Danczak A. Breaking good news: an essential skill for avoiding too much medicine? BMJ. 2018 Sep 11;362:k3843. doi: 10.1136/bmj.k3843. PMID: 30206143

This is a great essay, and it is worth reading in its entirety. In medicine, many of us develop the habit of framing good news as bad, and even if we don’t, our patients often hear it that way. “Negative” test results mean that we found no pathology, which is good news. However, this good news leaves uncertainty, and is often interpreted as a significant remaining possibility of illness; that the doctor just hasn’t found the problem yet. Medical education fosters this attitude. Diagnosis is taught as if there is always a disease to be found, but experienced doctors know this is rarely the case. This author argues that we need better training in “breaking good news”. The language we use matters a lot. Truly positive phrases, such as “you chest sounds healthy”, and interpreted better than negative or uncertain ones, such as “I don’t hear anything wrong”. It is also important to be explicit about the value of the tests we order before we order them. Is this test meant to rule in or rule out? (I have made this mistake many times, by not explaining the value of a Ddimer test, and having a patient panic when it comes back positive. This is even worse in an era where patients can access their test results online before they are explained by the physician.)

Bottom line: I think that the impacts of our language on our patients is an area that needs a lot more attention. This paper doesn’t give us definitive answers, but does provide a lot of food for thought.

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