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Telephone Conversations

Bad news or highly sensitive information such as the occurrence of a medical error is best delivered in person, but there are times when a phone call is either sensible or necessary. Test results are an example of information that is often communicated by phone. In order to minimize the surprise to the patient, it may be best if the patient and physician agree ahead of time if that will be the case, so that the patient can choose to have someone available for support if the news is not good.

In these scenarios, we see three different types of conversations in which information about an abnormality is communicated.

Three Scenarios

‘We need to repeat your mammogram...’

Because this is a situation that is usually not terribly alarming, the physician is able to reassure the patient that it is often routine to repeat a mammogram. While this does not preclude the need for further testing, there is not a need to warn the patient that something could be seriously amiss.

View vignette: Repeat Mammogram (1:43)

‘Your mammogram is abnormal. We need additional studies...’

If the medical news is more worrying, or of greater concern, you can change the tenor of the phone conversation accordingly.

This scenario illustrates a situation that is more serious than the previous one because of the medical findings and the need for a fine needle aspirate. In an empathic manner the physician acknowledges the awkwardness of the phone conversation and explains to the patient that he is getting the tests ordered as soon as possible. This expression of empathy acknowledges an understanding of the anxiety that uncertainty can produce.

View vignette: Abnormal Mammogram (2:27)

‘Unexpected serious x-ray’

Sometimes there is an unexpected result of an x-ray or a blood test and you have to start the process of breaking bad news over the phone.This is a very difficult situation and is basically a SPIKES interview. Note that the physician again acknowledges the awkwardness of the phone conversation and then uses the narrative approach to help the patient make the transition from feeling well to realizing that there is something seriously wrong.

View vignette: Unexpected Serious X-Ray (2:43)

Telephone Conversations: Pearls & Pitfalls: Expert Comment (3:42)


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