A focus on the burdens, boosters, and bonuses of the bearers of bad news in India
Lawrence Martis1 and Anne Westhues2
1Social Aetiology of Mental Illness, Centre for Addiction and Mental Health, Canada
2Anne Westhues, Faculty of Social Work, Wilfrid Laurier University, Canada
Submitted: 17/01/2013; Accepted: 16/06/2013; Published: 01/07/2013
Int J Med Educ. 2013; 4:126-138; doi: 10.5116/ijme.51bd.9294
© 2013 Lawrence Martis & Anne Westhues. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use of work provided the original work is properly cited. http://creativecommons.org/licenses/by/3.0
Abstract
Objectives: This study was done to explore the experiences of physicians in India about being the messengers of bad news and management of psychosocial burdens associated with such consultations.
Methods: Narrative data was collected from 27 physicians working in four teaching hospitals, using a semi-structured interview schedule. Constant comparison analytic procedures were used to examine physicians' perceptions and behaviors related to their role as the bearers of bad news.
Results: Physicians perceived that being a messenger of bad news was very challenging throughout the course of their careers, although their self-confidence increased over time. Two types of patient care contexts were identified based on the intensity and duration of distress experienced by the physicians. Treatment failure with children and young adults, patients' inability to access care at the initial stages of the disease, and withdrawal of life-saving treatments due to financial constrains caused intense distress among physicians. Physicians used a number of strategies to cope with the burden of bearing bad news. Clinical bad news puts physicians at risk for burnout, and in some cases is an opportunity for growth.
Conclusions: Clinical skill trainings should increase clinicians' ability to assess and attend to the psychosocial impacts of delivering bad news as much as teaching them the procedures of conveying such information. More studies about the impacts of bad news disclosure on physicians working in societies or settings with inequitable access to health care will improve such training programs.