Every new vet remembers their first difficult case. That case that pushed you outside of your comfort zone. That case that involved a very thorough work up with many hours of client communication. That case with the final diagnosis that stung. We all dread going into the exam room to break bad news to a client. It is one of the hardest aspects of our job. There is no way to avoid it in our profession, and it is important to master this conversation in order to ensure we help people and their pets through these crises.
This new veterinarian woe is a valid concern for every new graduate vet. As young doctors, we do not have much practice with this because often the clinician, resident, or vet we are shadowing are the ones having the conversation. We are hanging out on the sidelines watching, and yes, it does help you to watch them. You can pick up on the vet's demeanor, body language, tone, and certain word choices by watching. However, practice and actually being the one to share the bad news is what gives you the confidence to do it by yourself. Practice makes perfect, as they say.
So, how do you tell a client you just met that their 14 year old cat has cancer? How do you tell a client who's dog was just hit by a car that it came in D.O.A.?
There is a simple art to it and because it is so important, we dedicated an entire module in our course to breaking bad news. We created the acronym 'DEPART' to help you remember the steps to breaking bad news. It will come in handy as you have your first tough conversations, and we promise that it will eventually become second nature as you practice. Let us help you 'DEPART' from awkward situations with clients!
How to break bad news like a pro
It is important to go into the exam room and keep it real with the owner. Discuss what your exam and/or tests found. Be concise here. Your point will get lost in your words if you start rambling.
Remember that million dollar word you hear us use all the time? Empathy is important here because you just told them news that is going to change their life. Sharing empathy after your discussion will help to unite you as a veterinarian-client-patient team. It shows you are on their side and humanizes you.
Give them time to process everything. After you have done the above D-E, give them a moment. "I know this is a lot to process right now. I am going to step out of the exam room to give you a moment to process this, and I will be right back to answer your questions. Feel free to call a family member if you want." Or you can literally just pause after D-E and sit in silence for a moment to give them time to process everything. A little silence is ok in these situations.
After your pause, assess if the client understands what you just told them by asking if they have any questions or if they want you to clarify anything.
Review any pertinent points with the client based on your above assessment.
Go over next steps. This could be further diagnostics, referral to a specialist, and/or treatment options. You want to ensure the next steps are clear to the client and that they know exactly what to do next, whether this be with medications and follow up or facilitating referral to a specialist.
We dedicated an entire module in our course on 'DEPART' and our art to breaking bad news. We cannot give away all of our secrets here, so be sure to check out our New Vet Essentials Course for ALL the details. In the mean time, let's go over an example conversation to help 'DEPART' hit home for you.
Let's work through an example:
Mrs. Henderson has a scheduled appointment to bring her 14 year old MN DSH named Boots to see you after she noticed he was lethargic, weak, and not eating for 7 days. You are meeting her for the first time, and you just performed your history and physical exam. On exam, you are able to palpate a large orange sized mass in the cat's mid abdomen.
Let's use 'DEPART' to discuss this news with Mrs. Henderson.
Discuss: "Mrs. Henderson, I am worried I have found our problem with Boots. On physical exam, I can feel a large mass in his belly. Unfortunately, these masses tend to be due to cancer."
Empathize: "I know you love Boots very much and that you were not expecting to hear this news today. It is a lot to process and know that I am here to help you both through this."
Pause: Pause now to give her a moment to digest this news. She may start talking here. "Yes, Dr. Brighton, I am very shocked. I have had Boots since he was 6 weeks old, and I cannot believe I didn't notice any other signs to tell me how sick he was. I don't know what to do."
Assess: "Mrs. Henderson, I completely understand, and it is normal to feel this way after hearing something so shocking. Do you have any questions for me or anything you want me to clarify?" "No Dr., I understand it may be cancer. So, what do we do next?"
Review: "Whenever I find a mass in a cat, the most common cause tends to be a cancer called lymphoma. I do not know exactly what organ the mass is on, but I do feel that it is why he has stopped eating and isn't feeing well. I'd like to discuss our next steps so we can work together to help Boots. We have some options here with regards to tests I can perform along with treatments to help him feel better."
Treat: "Yes Dr., I'd like to hear both options to decide what I want to do." "Ok, one path we can go down is to perform some diagnostic tests to get more information for us on what exactly is going on. This includes blood work to assess his overall health, along with x-rays to see if we can get more clues as to where the mass is coming from, and x-rays will help us look for signs the mass could have spread to other areas such as the lungs. Based on what we find, an abdominal ultrasound may be needed next because an ultrasound lets you look at the organs in more detail and see how involved the mass is. An ultrasound can help us if you are interested in seeing a specialist so that we can know what other treatments can be done such as surgery to remove the mass, chemotherapy to treat the cancer, etc. The other path is to focus more on a treatment plan for Boots that aims at keeping him comfortable for as long as possible. I am happy to get you an estimate for each plan to help you determine what you want to do, and my technician will be in shortly with it."
As you can see, this approach helps you to break down the conversation into manageable chunks of information for the owner. The information you are giving is still very difficult, but this format allows the owner time to digest everything while you work through next steps. Utilize our last blog on discussing finances to learn the best way to handle the estimate discussion.
Be sure to sign up for our New Vet Essentials course so that you can experience the entire module dedicated to this important topic. Our course is a game changer for vet students and new vets, and it will help you be more prepared for the tougher aspects of our job that you are not taught in vet school. Here is our direct course link here.