that their loved ones are not alone when they are close
to death. Dr. Numann said family members have asked
her to sit with patients if they are not emotionally
strong enough to do so.
Dr. Numann said she would always try to go to
the family’s calling hours after the death of a patient
in order to cope. Doing that shows families that “you
did truly do your best, and you did truly care about
the person,” she said. Dr. Numann added that many
people don’t realize how much surgeons miss some of
the patients they have treated. “[Some patients] become
like part of your extended family,” she said, because, as
part of a trusted relationship, they would get to know
what was going on in each others’ lives.
Being involved with patients’ families also helped Frederick L. Greene, MD, FACS, medical director of cancer data services, Levine Cancer Institute and former
chairman, department of surgery, Carolinas Medical
Center, Charlotte, NC. Dr. Greene is also the host of
The Recovery Room, a podcast featured on the ACS website that deals with medical topics.
Imparting difficult information was a big part of
Dr. Greene’s job as a cancer surgeon, and he found the
best approach was to communicate any bad news as
early as possible.
“I think it’s important that you don’t wait until an
event is over. For me, if I was going to operate on a high-risk patient, a lot [of learning to report bad news] has
to do with communication with the family up front,”
Dr. Greene said.
He cautioned to never impart difficult information
in a public arena, like a hospital hallway. Instead, he
suggested taking the family into a private area, such
as a conference room, and making sure they sit down.
Once the information has been presented, Dr. Greene
said it is important to let the family be alone. The sur-
geon can also offer to contact another physician for a
second or third opinion. Dr. Greene added that this can
be difficult for some surgeons who want to believe that
they can take care of their patients better than anyone
else, but “you have to be the one opening the door for
that conversation,” he said.
If a death occurs, the surgeon should ask how he
or she can help the family with the grieving process.
Dr. Greene said he has gone into the homes of families
to explain autopsy results if such a conversation is necessary to determine how the patient died, or to discuss
genetic risks for survivors.
Heena P. Santry, MD, FACS, assistant professor, University of Massachusetts Medical School, Worcester,
MA, rarely has the opportunity to form lasting relationships with patients or their families. As a trauma
and critical care surgeon, Dr. Santry said she is usually
delivering bad news within hours of meeting the patient
and oftentimes within minutes of meeting the family.
In her four years of practice, Dr. Santry said she has
developed a gut instinct concerning how to deal with
the situations she encounters when she walks into the
family waiting room.
Sometimes, Dr. Santry explained, she will give families a brief overview of what happened to the patient
before giving them the news. Other times, people are
so hysterical or nervous that she knows she needs to tell
them right away, adjusting her word choices, body language, and intonation to the emotion of the situation.
There is not much time to train surgeons in their
interpersonal communication skills, Dr. Santry said,
and she has relied on mentors in developing her own
style. It can be difficult to teach, so the best way for
trainees to learn is to watch surgeons deliver difficult
news over and over again, Dr. Santry said.
“The key is to develop a style that allows you to
perceive the needs of the family you’re talking to
while conveying the appropriate amount of empathy,” she noted.
Dr. Santry Dr. Greene Dr. Hughes