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Rogerian Letter: Chapter Two Staying Out of the Line of Fire: A medical Student Learns

About News Delivery

Cydni Haley

April 30, 2017

Louisiana State University

Author Note:

This letter is addressed to Hospital Administrators, and is written from Christies

perceptive a medical student to the administrators. The case study that is focused on in

this letter is chapter two, Staying Out of the Line of Fire: A Medical Student Learns

about Bad News Delivery. This letter has been prepared for Ms. Coco for English 2001 at

LSU.
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3849 Aspen Drive

Harvey, LA 70058

Phone: (504) 210-7471

Fax: (504) 912-4722
Chaley6@lsu.edu

April 30,2017

Hospital Administrators
(Oschner Hospital)
1514 Jefferson Hwy
New Orleans, LA 70121

Dear Hospital Administrators,

My recent experience as I shadowed the doctors around the hospital, I have witnessed
many ways doctors deliver bad news to patients. I know as a medical student, we are
taught and have demonstrated on how to handle patients when it comes to
communicating with them. We have witnessed that maintaining an appropriate distance
from our patient can prevent any inappropriate mistakes when delivering such news that
might affect a patients life.

Administrators stress that doctors have to remain professional when delivering bad news
because they rather them be straightforward instead of beating around the bush. In
medical school, physicians are socialized to dehumanize patients because their first
patient is a cadaver. Professors in medical school stress to students not to become too
attached to patients. As a whole administrators want their hospital to stand for ensuring
that patient care is the upmost important job, and allowing for minimum error to occur
when delivering bad news. Administrators also enforce that instructors maintain
emotional distance from their patients, and not to show emotions toward them because it
clouds their judgment up for a treatment plan.

Being a medical student and now shadowing doctors and working in the hospital five
days a week I see the importance of a balance between professionalism and emotions.
Ive learned first hand how professionalism was benefitted more than showing emotion
especially when time is a major factor that comes with patient communication. A patient
had heart problems because of his weight and the doctor basically said in a professional
manner if he doesnt get this under control, his heart may give out(Thompson 2005),
the patient preferred the doctor be blunt and tell the truth whenever they know anything
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then being tactful or nice about it. This showed how being more professional satisfied the
patient because he wanted to know everything sooner than later. But I feel that there are
some ways we can try to compromise emotion with communication bad news.

Is there any chance that while being professional and showing a little bit of emotion it can
provide better communication between patient and doctors? My fear is that if doctors
lack communication skills then patients will misinterpret what the doctors are trying to
deliver and feel a lack of emotion from the doctor. If we do not do the work of
communicating, we usually find ourselves at odds with an upset patient. By using the
six-step approach it will help communication between patient and the doctor when
delivering bad news (Brixey 2004). The six steps are providing information, persuade
patients to adopt recommendations, minimize patient distress, promote patient
satisfaction, maintain patient hope, and minimize health professional discomfort (Joekes
2007). This approach has created a better communication between physicians and
patients because patients feel more comfortable with how the doctors are approaching
them when delivering the news, and they have a sense of feeling they care about them
and what they will be going through.

I also wonder since doctors are hiding their emotion from patient does it end up affecting
the physician in a negative way? I feel as if the physicians have a lack of training, fears or
sense of powerlessness, it can end up resulting in inadequately, or incompletely giving
patients information (Joekes 2007). In particular it may affect the way in which the
physician deals the patients emotions. Patients tend to value the informant, being kind,
confident, sensitive, and caring manner (Sweeny et al., 2011). Because of this physicians
should understand the necessity for showing empathy and having an understanding of the
impact that the news will have on the patient and the family. Physicians start to show
distance when handling with patients, which ends up putting a negative mindset in their
head. If physicians check frequently to see how the patient is receiving the news,
reinforce and clarify, and have patients ask any questions regarding the topics that they
seem concerned about it ends up making the physician feel like they are not helpless
(Brixey 2004).

After talking hospital administrators, I have an understanding why physicians are taught
detach from their patients. I believe professors and hospital instructors can work as a
team to find a balance between professional and emotional approaches of physicians and
patients. I want to continue to ensure that as I continue learning from doctors that they
give me the appropriate and excellent patient care especially communication with
patients. By adding classes in medical school dealing with communication of bad news
would be a great way to implement that communication is a big aspect in patient and
physician relationship. Also doctors could take a little bit more in consideration by
providing comments to patients on how they are being taken care of and how they feel
about their news theyve received.
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Looking Forward,

Christie
Christie Haley
Medical Shadow at Oschner Hospital
Chaley6@lsu.edu
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References

Brixey, L. (2004, August 1). The difficult Task of Delivering Bad News. Dermatology
Nursing.
Joekes, K. (2007). Breaking bad news. In et. al. et al. (Eds.), Cambridge Handbook of

psychology, health and medicine. Cambridge, UK: Cambridge University Press.

Retrieved from http://libezp.lib.lsu.edu/login?

url=http://literati.credoreference.com/content/entry/cupphm/breaking_bad_news/0

?institutionId=463

Sweeny, K., Shepperd, J. A., & Han, P. K. (2011). The goals of communicating bad news

in health care: do physicians and patients agree? Health Expectations, 16(3), 230-

238. doi:10.1111/j.1369-7625.2011.00709.x

Thompson, T.L. (2005). Staying Out of the Line of Fire: A Medical Student Learns About

Bad News Delivery. In Ray, E.B. Editor, Health Communication in Practice: A

Case Study Approach. (pp.11-25). Mahwah, NJ: Lawrence Erlbaum Associates,

Inc.