Breaking The Bad News

We’ve been seeing a lot of our nation’s governors lately.  In Ohio, Governor Mike DeWine has been on TV so much with afternoon announcements about COVID-19 developments that some people are timing their first cocktail with the news conferences and enjoying “Wine with DeWine.”  We’re getting a living reminder of lessons learned during our junior high school civics classes and the fact that we live in a country where the states have significant powers and duties.  When a once-in-a-lifetime crisis like the COVID-19 pandemic hits, governors are put front and center in dealing with all of the issues.

img_2632Unfortunately for the nation’s governors, a lot of what they’re doing right now is breaking bad news.  They’re announcing shutdowns and “shelter in place” edicts and other orders and showing small-print graphs and charts that make people upset and anxious.  Nobody except introverts and hermits wants to be cooped up in their houses indefinitely.  But the time durations of these shutdown orders varies widely, from state to state.  In Ohio, I think the initial “stay at home” order covered the period until April 6.  In Virginia, by contrast, the governor just announced a shutdown until June 10 — more than two months longer than the initial Ohio order.

The current situation squarely raises the issue of the best way to break bad news.  Put yourself in the shoes of the governor of your choice.  If you were issuing a shutdown order, would you give your citizens the worst-case scenario — which seems to be the technique used by the Virginia governor — so that they can start to get adjusted to the prospect of being at home for two months?  It’s a kind of “rip the band-aid off” approach, isn’t it?  And, if you take that approach, you can hope that future developments might allow you to shorten that time period and give the residents of the Old Dominion a pleasant spring surprise.

Or, do you proceed in a more incremental way, issuing orders that have a shorter duration, acknowledging that this is a fast changing situation where you need to be responsive to new information?  Of course, all the while you would understand that you might well have to extend your shutdown, perhaps multiple times, and disappoint people who were hoping the current deadline would stick?  In that scenario, you’re doling out the bad news in bite-sized chunks, hoping it might go down easier.

I don’t think there’s any right or wrong answer to this, necessarily.  Some people are band-aid rippers, and others prefer to remove them a fraction at a time.  I’m normally a band-aid ripper, but I think if I were governor during this period I’d take the incremental approach.  We’re still gathering information about the coronavirus and its trajectory, and an incremental approach allows that information to be analyzed and addressed as it comes in, giving the governor the chance to keep the citizens of his or her state updated and abreast of the latest news.  The incremental approach seems a bit more humble and nuanced than the two-month thunderbolt edict issued from the executive.  And who knows?  There may be something to this “Wine with DeWine” thing, too.

Breaking The Bad News

On the TV show House, House’s oncologist pal Wilson was reputed to be so humane and caring when giving patients bad news about their condition that, when he was done, patients actually thanked him.  Studies indicate, however, that there aren’t a lot of Wilsons out there in the medical profession.  Instead, many doctors botch one of the most important parts of their job — giving patients truthful information about their medical condition when the diagnosis is grim.

photo-hospital-doorwayTelling patients that they have untreatable cancer, or some other fatal disease, clearly is one of the toughest parts of a doctor’s job — and research indicates that doctors just aren’t very good at it.  Some doctors will break the bad news indirectly or use medical jargon that leaves the patient confused, others will do it with brutal directness, and still others will sugarcoat the news with treatment options.  As a result, many cancer patients aren’t well informed about their actual condition, and their prospects. A 2016 study found that only five percent of cancer patients understood their prognoses well enough to make informed decisions about their care.

Why are doctors so inept at giving patients bad news about their condition?  Of course, it’s incredibly hard to be the bearer of bad tidings, especially when the bad news is about a fatal illness, but there’s more to it than that.  Communications skills apparently aren’t emphasized at medical schools, and many doctors see a diagnosis of an incurable disease as a kind of personal failure on their part.

It’s interesting that, in a profession so associated with the phrase “bedside manner,” so many doctors regularly mishandle what is arguably the most important part of their job and so few medical schools make sure that their graduates are equipped to handle that task in a genuine, caring, and understandable way.  I hope I never receive a devastating diagnosis, but if I do I hope it comes from a doctor who knows how to break the bad news.