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A difficult conversation


Investigation results are a false crutch for breaking bad news to patients

Several years out of medical school, I was working my first general medical registrar job as the night cover in a rural hospital. An elderly gentleman, unconscious and intubated, was brought in by ambulance to our emergency department. A computed tomography (CT) scan of his brain showed massive bilateral haemorrhages. I phoned my consultant, discussed the case, and agreed that a “not for resuscitation” order was appropriate.

An urgent family meeting was arranged.

At 2 am I entered the relatives’ room, expecting one or two people. There were 15. They were crowded in the room, some standing, some in pyjamas, all white-faced and anxious.

None of them knew that this man, so special to them, was now lying unconscious in the next room, breathing through a tube, irreversibly damaged. I introduced myself, and thanked them for coming. I looked at the expectant faces. They already knew of the unconscious collapse. What “warning shot” could I give, to help steel them for the bad news? I thought about the only new information I had: the cerebral CT results. These were so clearly bad; surely they’d…