Disclosure of Adverse Events

How I Practice Video Series
Bryan T. Oshiro, MD, FACOG

HIP: Disclosure of Adverse Events from ACOG on Vimeo.

HIP: Disclosure of Adverse Events from ACOG on Vimeo.

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I wanted to talk to you today about breaking bad news to patients, primarily because this is something that happens not too infrequently. But we rarely get a chance to learn about it, to practice it, to really get into it with our patients and do a good job at it. I don't know if I do a really good job at it, but this is how I practice. First of all, when giving bad news to patients, I think it's very important to sit in front of them, have their family members or support people with them if possible. Have tissue ready. And have a warm environment in which you can sit down and really concentrate and not be distracted. You have to be warm, and caring. And really understand that when you are breaking bad news, patients may react in various ways. First of all, they may get angry; they may get angry at you. But don't take it personally, because they are human and this is just a normal response. Remember the five stages of grief, one of them is denial, and one of them is anger. And then they may get depressed over time. These are things you need to consider when you are talking to you patients and breaking bad news. Now, unfortunately because I am a perinatologist, and because people refer abnormal patients to me that have babies that aren't normal or have other problems, they are hoping I can do something about it. And sometimes we can help their babies, help their pregnancies move along, but other times we can't. And it's at these times that they really need you to be compassionate. In your practice if you are the primary OBGYN and you find out for example that Ms. Smith is coming because she hasn't felt her baby move in 2 days. And you come and you put the ultra sound on the patient, and you discover that the baby has no heart beat. How are you going to handle that? The best thing to do is not talk to her at that point in time. Just have her get dressed and sitting up in the consultation room. Sit down with her, look her in the eyes, be compassionate, be human, and be warm. One of the things I've seen in my experience is that people distance themselves. They don't want to be associated with a still birth; they don't want to associate it with a bad outcome. But that's absolutely the wrong take. I think it's much more important to really give a sense to your patient that you are compassionate, that you are a caring physician. And you know what, I've had so many patients come back to me, to our hospital, to my practice, saying 'I know I had a bad outcome, but if ever anybody was going to give me bad news, I'm glad it was you.' So remember the compassion, and remember that when patients get angry at you in the stress of the moment, because they had a bad outcome, don't take it personally. If they were your wife, your mother, your sister, how would you like to break that news to them? And this is how I practice.


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