LESSON 4.4: Breaking Bad News — The Complete Approach
Expect at least one case involving a serious diagnosis, an unexpected test result, or a conversation the patient was not prepared for.
Preparation (3-Minute Reading Time)
Review: What is the diagnosis? What results? What is the patient’s background?
Anticipate questions: Prognosis? Treatment options? What happens next?
Plan your opening: How will you transition to the serious news?
Consider: Are they expecting this news or will it be a shock?
The Six-Step Framework
Step 1: Find Out What They Know
✅ GOOD PHRASING Doctor: Before we go through the results, can you tell me what you’ve been told so far about what we were looking for?
Step 2: Give a Warning Shot
“I’m afraid the results have come back, and they’re not what we were hoping for.”
“I have some difficult news to share with you today.”
Step 3: Deliver Directly but Compassionately
✅ GOOD EXAMPLE: “The biopsy results show that the lump is cancerous. I know that’s very difficult to hear.”
❌ BAD EXAMPLE: “Your histopathology indicates a malignant neoplasm.” — Incomprehensible and cold.
Step 4: Stop and Respond to Emotion
After delivering the news, stop talking. Give the patient space to react. Do not fill the silence.
If they cry: “Take your time. I’m here.”
If silent: Wait. Let them speak first when ready.
If angry: “I understand this is shocking. It’s completely normal to feel angry.”
If they deny: “I can see this is hard to take in. Would you like me to go through it again?”
⭐ KEY POINT: Silence after bad news is not a failure — it is a skill. The examiner is watching whether you can tolerate the patient’s distress without rushing to “fix” it.
Step 5: Give Information in Small Chunks
Give one piece of information
Check: “Is it okay if I explain a bit more?”
Respond to questions before moving on
Repeat until covered. It is okay to say: “There’s a lot to take in. Let’s arrange to meet again soon.”
Step 6: Plan, Support, and Close
Outline next steps clearly: referrals, further tests, who they’ll see next
Ask if they want someone with them next time
Offer support resources: Macmillan, specialist nurses, counselling
Safety net: “If you have questions after today, please call or book in.”
Check how they will get home safely