Bearer of bad news
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There is this saying, no news is good news which means:  no news or information about a situation or someone suggest nothing is wrong and everything is all right.  But things might be terribly wrong if out of the blue someone came a knocking on your door...

The other day I was appointed as an examiner for Year 4 students in the Objective Structure Clinical Exam in which students were assessed on their communication skills in breaking bad news. This is quite important especially in the medical profession. And who said it will be easy?

Breaking bad news is not simply conveying the news. The person who is giving out the message need to be empathetic, patient and alert to the feelings of the person at the receiving end. There might be anger involved, feelings of sadness, wanting to slash back at someone or something and sometimes they just went into shock. And a good communicator should be able to tackle the feelings of the receiver calmly and try as best as possible to comfort them. (ooppss... the lecturer side of me keluar pulak...big grin)

So, that day, the students were challenged on this skill. The scenario:  A patient had some complications during a surgical procedure but survived and will be sent to ICU. Students need to relay the information  and explain what's happening to the patient's husband who was waiting.

I'm glad to see that most of the students were empathetic enough. However, there were a few points of improvement that they need to look into.
  1. Some were nervous, even more nervous than the husband who's waiting for the news. Understandably, they were under the duress of examat wits' end.
  2. Some were so nervous that they forgot to ask the husband to sit down even though chairs were provided in the room. Isn't it better to ensure the husband comfortably sitting down before breaking any news especially when it's bad. Kalau berdiri, buatnya pengsan, tak ke naya... Of course la, nobody fainted that day...happy
  3. Inappropriate facial expression. Some were smiling inappropriately and tersengih-sengih and did not look like they were conveying the news seriously. Memang la patient tu tak mati but the near death news was quite a shock to the patient's husband worried. And of course, since it was an exam setting, the husband was just an actor and no real patient was involved. But then, real or not, seriousness is expected.
  4. Some forgot to confirm that the person they were talking to is really the husband of so and so.. Imagine relaying bad news to the wrong person waiting.
  5. Some were really confused when addressing the patient's husband. Some addressed him as abang, then changed to Tuan then changed to Encik. I think Encik is better and better still if use the name together, eg Encik Ahmad. I even heard some students said 'Isteri Puan' instead of 'Isteri Encik' raised eyebrows. Maybe I misheard. But I don't think so...
  6. In every bad news stories, people will want to know what exactly happen and they will be very grateful if things are explained to them in the simplest lay man language. Some students were very good in this but some did blunder and blurted out the medical jargons that may be a bit too techie for the patient's husband. Hmm.... resuscitation in Malay might be a bit tricky...thinking
  7. And finally, based on the scenario, the patient will be brought to the ICU. She was not in the ICU yet. But most students had this piece of information wrong. And they explained that the patient is already in ICU and the husband can go visit her in a short while d'oh.
If it sounds tough in the exam setting, it will be even tougher in reality. People don't want bad news and they hate those who bring bad news. In my line of work, I guess I'm lucky I don't have to deliver bad news to others. Imagine, if I need to convey to students that they score 0 in the exam... Jenuh weh...winking

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