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Breaking bad news

November 22, 2009

A friend of mine bravely decided to apply for Graduate Entry Medicine. Through the years I’ve learned that it doesn’t matter what kind of picture you paint of medicine, applicants will never listen to you, just as I didn’t listen to the doctors on work experience at the ripe age of 16. In this instance, my comments were supportive and to be fair to the friend, I think she’ll make an excellent doctor.

It has been years since I applied and since then, many things have changed, including taking the Biomedical Admissions Test (BMAT) and higher grade requirements. Another thing introduced at A University is the use of ‘real-life’ scenarios played out with an actor. I offered to help said friend as I’ve done several of these in classes and during exams. One of the scenarios that has cropped up in recent years is this: ‘You have just run over your next-door neighbour’s dog. Do you tell them? And if so, what do you say?’

A good exercise in being honest and delivering news sensitively. One thing we’re taught is to use what we call ‘warning shots’ as a way of setting the tone of what’s to come. Now Mr Jones, you remember that your wife was seriously ill when she was rushed to theatre? I’ve only delivered bad news once in a clinical setting where I had to tell a patient of a positive STI diagnosis. Unfortunately, language was a barrier and I had to simulate how she had given the sample to jog her memory.

Getting back to the dog situation, we all agreed over a game of bowling that it’s right to be honest that the dog had been dispatched. It was just a case of delivery. Two best answers are as follows:

1) Hi John. Do you remember that old, dirty, smelly dog that you never really liked? Well, I have some news

2) John, something very serious has happened. I was out in the car and I ran over your son … ok, now don’t worry, it wasn’t your son, it was just your dog!

Welcome to the club.

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