Gazette Vet: Breaking the News

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This has been one of those months where I’ve had to break a lot of bad news to people.

Your dog has a terminal cancer.

Your cat is in severe kidney failure.

Your dog needs emergency surgery.

Your cat is permanently blind.

Your dog just died.

Any way you slice it, delivering bad news to people is always a difficult task, at least it is for me. In my job as a veterinarian, I’m usually breaking bad news to clients that I’ve known for years. We’ve developed mutual trust, respect, and often friendship, and I’ve gotten to know their dog or cat for years as well, developing a similar type of trust, respect, and friendship with them, too. But there inevitably comes a time when they bring their sick pet in, wearing their worry and emotions on their sleeve. After an exam and running some tests or imaging, I find the bad news. Ugh. A tumor. Ugh.  Liver failure. Ugh. Our relationship is about to permanently change.

As the doctor, I take this information, consider the options available, and try to give an honest and reasonable plan to the owners for how to proceed. As a person, I know I’m about to walk into that exam room and make someone really sad. My typical thought as I grab the chart and walk into the room is, “This is gonna suck.”

People take bad news in a lot of different ways. When you’re telling someone that their pet is going to die, I suppose that all reactions are appropriate. Most people react with a mix of sadness and acceptance. Some people are incredibly unemotional. Others are absolutely hysterical. You never know what you’re going to get.

After 15 years of breaking bad news to people about their pets, I’ve developed some strategies and thoughts on the process. Although it is still never easy, now I can approach it in a way that lets me sleep at night, knowing I did the best I could.

Be honest. Being honest can be hard. And time consuming. Sometimes we are tempted to sugar coat bad news, or to try to give people false hope.  We do this simply because we hate to tell people really hard bad news. Maybe we think they can’t handle it. Or that they will direct their emotions at us.  But this approach almost always causes more pain in the end.

It took me a few years of practice to be able to walk into a room, look the owners in the eye, and tell them the bad news, slow and clear. “I have bad news. Rusty has a bleeding cancer in his spleen. He is suffering and I don’t think he will survive surgery. I really think we need to put him down tonight.” Tears start coming out as the owners process this information, and I can’t help but feel somewhat responsible. But as hard as it is, it is our job as the “bearers of bad news” (I’m talking about anyone in a similar type of position…) to be honest. I always think to myself that when I walk out of that room, I had better not have any different thoughts in my head than what I just told those clients. If so, I’m not doing my job and I’m not being a good person. People end up always appreciating honesty.

Care. Often times, caring is easy—good people, sweet pet, sad story. Easy to get sad and teary-eyed when we think about those cases. But sometimes caring is hard. Sometimes I don’t particularly like the clients. Sometimes the bad news is all due to their own negligence. Sometimes they are particularly rude to the staff. Sometimes they don’t seem to care about anyone but themselves, so why should we care about them?

But if you don’t care, and you don’t find some empathy for that person, you’re going to be a crummy bad-news-breaker. If you don’t care, it will show.

Actually, caring is easy. If it’s not coming naturally in a situation, assume that the person you don’t like behaves the way they do because they had some hard stuff in their life that made them this way, and second, assume that person is actually going to be really sad when you break the news. In my experience, these two points generally hold true.

Be complete. Assume they can handle the details. Give them the short and long-term plans. They may not be asking for it, but they will soon be seeking as much information as they can. Sometimes when I tell people bad news, they start to shut down a bit. As much as I may want the conversation to end, it’s important to fill in the blanks and give them a plan for dealing with the problem. Part of the grieving process involves searching for understanding. I can’t tell you how many times someone has remembered and regurgitated verbatim something I said that I didn’t think was significant. When you’re breaking bad news, it’s important to balance giving people silence and space, with giving people pertinent information that they may not want to hear. They may not want any more info right then, but will likely appreciate it later.

As I write this, I finish a work day in which I had to walk into the exam room three separate times thinking “this is gonna suck.” But by being honest, caring, and being complete, I can rest easy tonight knowing those clients have what they need, even though they are sad.

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John Andersen DVM
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