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GPs are better at breaking bad news

Originally Published 01 July 2002

A survey of the way doctors tell patients bad news is to be published in the July Journal of the Royal Society of Medicine. The research, which was carried out by Dr Mandy Barnett,currently Macmillan Senior Lecturer in Palliative Medicine at the University of Warwick, looked at patients' experiences during diagnosis and treatment of cancer. GPs got better ratings than surgical staff when it came to breaking bad news sensitively. Dr Barnett calls for better assessment of communications skills and training for hospital specialists.

Dr Barnett's team graded patients' experiences of hearing bad news from "positive" to "very negative" and asked for nominations for the most and least helpful doctors they had seen. They also assessed patients for depression and psychological distress.

Among the findings:

Patients particularly appreciated doctors who gave them the opportunity to ask questions and discuss their concerns rather than being "brusque and impatient"

The more extremely good or bad the experience of hearing bad news, the more likely the patient was to remember vivid details even years later

There was no connection between the way bad news was delivered and the patient's long-term chances of becoming depressed

Although the majority of nominated "most helpful" doctors were GPs, bad news is far more likely to be delivered by hospital specialists and research showns that patients expect and want this. Nearly 90% of the time it is a hospital doctor, usually a surgeon, who has to tell a patient he/she has cancer, but in Dr Barnett's research, surgeons were significantly more likely to be rated "less helpful".

Why are some groups of doctors better at communicating than others?

GPs may already have a rapport with their patients which a hospital doctor is unlikely to be able to match, but Dr Barnett points out that surgeons could be missing out on important communications training because of the 'apprenticeship' model used to teach junior doctors in hospitals. By contrast, the RCGP was the first Royal College to introduce formal communication skills assessment as part of their exams. Dr Barnett suggests there are clearly "implications for training" for those groups of doctors who are most likely to have to deliver bad news.

For further information contact:
Dr Barnett

University of Warwick

Tel: 024 76 522536

For full survey results, including extracts from patient interviews, contact:

Rosamund Snow, External Relations, The Royal Society of Medicine
Tel: 020 72902904