In an op-ed article in The New York Times (February 27, 2014) about the challenges of designing training courses to help physicians communicate more effectively with patients about important topics such as end-of-life care, Timothy D. Gilligan, MD, and Mikkael A. Sekeres, MD, of the Cleveland Clinic wrote, “as we devote more time to teaching students and doctors effective communication techniques, we risk muting their authentic human voices, and instead of learning to connect they apply rote tools and scripts.” They also warned that communication courses using what they called “a script for empathy” run the risk of contrived responses. “Having physicians sound like customer service representatives is not the goal,” they wrote.
Walter F. Baile, MD, one of the originators of a six-step strategy that uses simulation and role-playing to train physicians how to break bad news to patients with cancer, told The ASCO Post that he was aware of that concern. “I think you have to be genuine,” Dr. Baile said. “If you can reverse physicians into the role of the patient and have them experience what it is like to get bad news, and then reverse them back into their own role, then you’ve created an insight into what makes sense with the patient that is different from just giving them a script and saying, ‘Say these words,’” he said.
“Most people can put themselves in the shoes of someone else. They just need to be encouraged and helped to do it.” Dr. Baile is Professor of Behavioral Science and Psychiatry and Director of the Interpersonal Communication and Relationship Enhancement (I*CARE) program at The University of Texas MD Anderson Cancer Center in Houston. ■
When the prognosis is poor, breaking the bad news badly can exacerbate the distress experienced by cancer patients and their families. A lack of sensitivity to patient and family emotions and not being attuned to how individual patients would prefer to be informed about their prognoses can result...