Physician Nurse Conflict: Breaking Bad News

1. Physician � Nurse Conflict:Breaking Bad News LifePoint Webinar November 13, 2009

2. Ask yourself or your team: Is it ever permissible to withhold medical information from a competent patient? Yes No Only in exceptional circumstances Answer Answer

3. Case study� Mr. Sherman, 71, history of severe depression Metastatic colon cancer Attending physician informs family Plans to delay disclosure to patient for �a couple of days� following resumption of patient�s anti-depressant medication

4. Over the next 48 hours� Attending visits patient twice but doesn�t answer questions about his condition Mr. Sherman increasingly anxious; repeatedly asks nurse, family members about test results/diagnosis Family defers to physician, asks nurse when doctor will inform patient

5. The nurse�s dilemma� Patient has right to know condition Not the nurse�s responsibility to tell Feels her behavior is deceptive Reduced to a �moral spectator?�

6. The physician�s dilemma� �It takes two to speak the truth � one to speak and another to hear.� Thoreau