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I am a medical oncologist, and a frequent part of my job is giving people bad news. Due to the pandemic I have been doing almost all of my clinic visits by phone or video the past three weeks, and I have some reflections on giving bad news remotely 1/9
Firstly, many of the principles are the same: assure you won’t be interrupted. Be ready to spend the time. Know the facts. SPIKES is a good template to start with. 2/9
I have always taught trainees that it is a mistake to try to find words to mitigate bad news: the news is bad, and there are no words that are going to make it not bad. So tell the truth, in the simplest words you can. 3/9
This can result in verbal messages that are blunt, and it’s necessary to combine them with respectful delivery, appropriate time for response, and compassionate acknowledgement of the reaction of the person and their family. 4/9
This latter part is what can get lost in the remote conversation: the ability to lean over and hold someone’s hand, to acknowledge the tears of the third family member, who is just outside the frame of the videoconference. 5/9
Tough as it can be by videoconference, I have found it harder still over the phone. It’s almost impossible to gauge the response of the person on the other end. There is silence after giving the news: are they crying, stunned, or waiting for you to say something else? 6/9
But it’s not all bad. Literature suggests many would rather get bad news at their home than in the clinic. As well, virtual visits free doctors from the tyranny of clinic schedules. We can call patients on successive days; we cannot book them on successive days in clinic. 7/9
So if I have any tips after a few weeks, they are these:

1. There are some advantages to doing this remotely: you’re not doing a bad thing.
2. Remote bad news visits should be videoconference, rather than phone.
3. Offer very short term follow up, even in a day or two

Most important, whether virtual or in person a bad news visit shouldn’t be a discontinuity. From the first consult people need to understand the gravity of their situation. When bad news comes it has to be within the range of what you have previously counselled them to expect.9/9
Stay healthy everyone! Stay home if you can. 10/9
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