A good stepwise process, for future reference in residency, from a lecture today in Family Medicine. This applies to both deaths and bad news in terms of studies, lab results, etc. (It’s also often a good idea to have the social worker or chaplain with you if you can.)

1. Make a setting. Don’t do it in a hallway, go find a private, quiet place to sit and talk.
2. Introduce yourself. Often the family has seen a number of different people caring for their loved one–doctors, nurses, techs, etc–so reiterate who you are, especially to the significant other.
3. Ask what they know already. It gives you a sense of their knowledge level, what they might be expecting, what they’re worried about, so you don’t repeat anything or speak above or below their level of understanding and medical knowledge.
4. Make a “preperatory statement.” This readies and focuses the loved ones for what they’re about to hear. A good suggestion from the lecturer: Don’t say “I have some bad news.” Try, “I have something very important I need to tell you right now.”
5. Deliver the news. Be brief, direct, and succinct, 25 words or less.
6. Pause, wait for a response. Be there and be present.
7. Arrange a follow-up for later. A phone call, a card–it doesn’t have to take extraordinary effort.
8. Take care of yourself. It’s emotionally trying and exhausting to do this, so allow yourself to grieve however you may express that, too.

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