Medical Education
7:51 am
Thu November 7, 2013

Medical Students in New Haven Learn How to Deliver Bad News

Periods of silence between doctor and patient can be a sign of respect and care.
Credit National Cancer Institute

Students at the Yale School of Medicine spent time last week delivering bad news to patients. Their task was grim: one student told a woman she had breast cancer while another broke the news to a professional athlete that he blew out his knee and would never play football again.

Except there was one catch. The patients were actors, responding in real time to medical students as part of a "bad news" seminar aimed at teaching the skills of patient-centered interviewing

"When you break bad news to someone, you're really changing their world view."
Auguste Fortin

Patient-centered interviewing got its start in the 1970s, but it's catching on today because of concerns about patients getting rushed along by busy doctors with heavy workloads. The technique outlines how to deliver things like bad news, ask diagnostic follow up questions, and create a lot of space for patients to share information about their support network and how they are feeling.

"When you break bad news to someone, you're really changing their world view. Sometimes in a dramatic way," said Dr. Auguste Fortin of the Yale School of Medicine. "And witnessing that. Just being able to sit with it ... it's hard. Medical students are young people."

Often, these interviews involve a lot of silence, which Fortin said he teaches students to embrace.

"In the rest of our lives," Fortin said, "periods of silence mean this date is going really badly, right? But in the doctor-patient encounter, periods of silence can really just be respectful and tender and create space for the patient to ask really important questions. Or ask about something that's really scary for them."

Dr. Charles Hatem agrees. He teaches medicine at Harvard.

"I think one of the most effective forms of communication is silence," Hatem said. "Beginning clinicians often have trouble dealing with that. Not because they are defective, but because they have not yet come to acquire that skill set that says, sitting and listening may be the most powerful things to be done."

Hatem said medical students can be too focused on the technical aspects of medicine.

"But that's not the beginning and end of a story," Hatem said. "[Patients] want individuals who can understand who they are as individuals and very much factor that into their care."

August Fortin says these "bad news" seminars were things he would have loved to have had when he was in medical school. As a beginning clinician, he had to learn it all on his own.

"People of my vintage didn't learn anything about it," Fortin said. " What's exciting is that these skills are teachable. So even if a student may have less-developed social graces, and is less-skillful interpersonally -- they still can improve their skills. So that gives us a lot of hope for medicine in general.

And medical training continues to move in a more empathetic direction. In 2015, the MCAT examination, which students take before entering medical school, will reflect these changes with more emphasis on sociology and psychology -- on understanding science and people. 

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