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.
‘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.
‘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.
‘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.
Free CME Credit Available
Certain material on this site is available for Continuing Medical Education Credit. To obtain credit you must use the “Earn Free CME Credit Online” link on the left.
Risk Management Education (RME) Credit Available
Certain material on this site is available for Risk Management Education Credit for physicians enrolled in the The University of Texas Professional Liability Insurance Plan only. To obtain credit you must use the “Earn Free Risk Management Credit Online” link on the left. RME is only available to those who have UT Professional Liability Insurance.
Applying for both CME and RME?
If you are applying for both CME and RME for the same module, you MUST view the video through the CME link The Fundamental Principles section and Managing Difficult Communication section will now allow you to register and print both RME and CME certificates upon completion of the module. All other modules you must view the videos and then print both the CME forms (found on the right side of the video page) and the RME forms (found below the video window) and send to the appropriate offices. NOTE: RME is only available to those who have UT Professional Liability Insurance.