Communication is a key area of any healthcare worker’s role and the ability to communicate effectively is one of the General Optical Council’s core competencies. We not only have to communicate with our patients, but also our colleagues, other healthcare workers and the general public.
As much as we aim to deliver good news to the people we are in contact with, inevitably bad news will need to be delivered to somebody at some point. As an optometrist, there are several types of bad news we may have to deliver and this article looks at ways that can help us all be as effective and as compassionate as we can when breaking the news.
The first thing to remember is that bad news is not nice to receive (the clue being in the name!) and that there is a human being on the receiving end of your words. You might be stressed that the discovery of a retinal detachment may now mean you’ll delay your clinic whilst referring out for emergency treatment, but your patient will be very anxious about what is happening and may have the fear they could go blind. Putting this into perspective and demonstrating that you care will not help the news be better received, but also let your patient know you are looking out for their welfare in a professional and dignified way. Your reputation will also benefit.
If a patient is presenting with a problem, then they are partly prepared for some bad news. In a lot of cases however the findings of eye disease or ill health are incidental and your advice may come as a surprise. If you come across a severe incidental finding (asymptomatic retinal tear, severe glaucomatous discs or haemorrhaging) it can even be a surprise to you. Compose yourself with what you are going to have to say, keep calm and explain your findings in a clear voice. Be prepared for questions and know what your plan of action is, as this will enable your delivery to come across as professional and better received.
Some people can withhold information out of fear of how it will be received or even to save face to cover up for a previous error. We have a duty of candour, so if something isn’t right then tell the person it isn’t right and what you propose to do about it. Purposely withholding important information can lead to a misdiagnosis, lack of action and occasionally an underestimation of how significant the news is. Furthermore, if it soon is revealed that you were dishonest or withheld important information, you will look worse for doing so…and will end up with potential complaints or GOC investigation.
Another responsibility is to keep clear and contemporaneous records. Document that you have found something negative, document that you have informed the patient and document your actions. This allows you (or another healthcare professional) to be able to explain to your patient what was said during your examination (as they may not have comprehended more than “I’m going to refer you for…”) if they ask about it at a later date. It also protects you from any litigation should the patient ignore your advice/instructions, resulting in harm, and they then choose to act against you by saying nothing was said.
It is human nature to want to know what can be done to rectify a bad circumstance. Some solutions are easier than others as it could be a case of changing a patient’s prescription for a progressing cataract or general change in refractive error. Some are much harder to produce, when you inform someone that they should now inform the DVLA of their inability to reach the driving standards due to their advanced macular degeneration. Always show willing and support – as there is always something that can be done to help the patient in some way or another. Be aware of local support groups, low vision pathways and the latest low vision aids to suggest – you might not be able to improve their eyesight, but you can help them maximise the support that they can receive.
They often say it’s better to give bad news than receive bad news, but in my experience the former isn’t something that is easy to do. Most healthcare professionals are compassionate and caring, wanting the best for our patients. Having to break the news that someone needs to go to hospital for a suspect brain tumour or that they are no longer legal to drive is the hardest part of our optometrist jobs and can affect us in strange ways including increased stress and anxiety, or even sleepless nights worrying for their welfare. Put together a coping mechanism – be it a few tears at lunchtime or pounding it out at the gym in the evening and know that you are doing the job as best you can and that the patient will be better off for your actions in the long run.
Thankfully with more preventative healthcare measures in place, giving bad news is rare but still occurs. Being prepared to give it is a must, but also remember that your own welfare in the process is important too!
If you are a registered or pre-registered Optometrist and you are looking for your next career move please contact Prospect Health's Optical Team on 01423 813450 or visit the Optical Jobs pages of the website.