Bad News: Delivery, Dialogue, and Dilemmas

doi:10.1001/archinte.1991.00400030033006

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Vol. 151 No. 3, MARCH 1991

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Bad News: Delivery, Dialogue, and Dilemmas

Timothy E. Quill, MD; Penelope Townsend, RN, BSN

Arch Intern Med. 1991;151(3):463-468.

Abstract

The narrative from a real patient encounter is used to illustratethe powerful effect that delivering bad news can have on bothpatient and physician. The meaning of bad news to the patientmay be quite different than the medical or the personal meaningto the physician. Differences in perception must be exploredand understood before the common ground necessary for jointdecision making is established. Initial patient responses canbe divided into three categories: (1) basic psychophysiologic(fight-flight or conservation-withdrawal), (2) cognitive, and(3) affective. Responses vary considerably depending on themeaning of the diagnosis to the patient, the degree of immediatethreat, and the patient's previous experience with illness.Desired outcomes of the initial meeting include (1) minimizingaloneness and isolation for both patient and physician; (2)achieving a common perception of the problem; (3) giving informationtailored to the immediate needs of the patient; (4) addressingimmediate medical needs, including the risk of suicide; (5)responding to immediate discomforts; and (6) ensuring a basicplan for follow-up. Though all clinicians deliver bad news,few have had formal training or open exploration of the profoundpotential impact of the experience.

(Arch Intern Med. 1991;151:463-468)

Author Affiliations

From the Department of Medicine, The Genesee Hospital (Dr Quill), the Departments of Medicine and Psychiatry, University of Rochester School of Medicine and Dentistry (Dr Quill), and the Visiting Nurse Service (Ms Townsend), Rochester, NY.

Footnotes

Accepted for publication August 13, 1990.

Reprint requests to Department of Medicine, The Genesee Hospital,224 Alexander St, Rochester, NY 14607 (Dr Quill).

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