In this post, we discuss a challenging, yet crucial, aspect of our work in optometry: the process of breaking bad news.

Our daily practice involves helping patients achieve their best possible vision and maintaining their eye health. Many consultations are routine and positive. However, there are occasions when our examinations reveal unexpected findings. These situations require us to communicate news that can be difficult for a patient to receive. This is where the skill of breaking bad news becomes essential.

Effectively delivering unwelcome information is not always extensively covered in our formal training. Consider the complexities: informing a patient their vision does not meet driving standards, explaining a significant ocular condition, or discussing a diagnosis that carries serious implications for their future sight or general health. These conversations carry considerable weight.

This process extends beyond simply relaying clinical facts. It involves connecting with individuals during potentially vulnerable moments. It requires careful consideration of language and approach to share difficult information sensitively. We will explore strategies to navigate these challenging interactions, aiming to make them less burdensome for both the practitioner and the patient.

Leading with Compassion When Breaking Bad News

When you are faced with breaking bad news, remember the person sitting across from you. They are a human being, possibly feeling scared, anxious, or worried, especially if they came to you already experiencing symptoms. Your initial approach matters greatly. It is crucial to lead with genuine empathy and compassion.

Acknowledging their potential emotions and offering a sense of solidarity can make a significant difference in their experience. By validating their feelings and showing authentic concern, you create a supportive atmosphere.

This environment fosters trust and provides comfort during a difficult moment. This human connection offers reassurance, even when delivering breaking bad news. A kind and caring approach profoundly impacts a patient’s well-being. It helps them feel understood and valued during challenging times.

Consider the situation of discussing driving standards. Informing a patient they no longer meet the legal requirements can feel like you are taking away their independence. This is a prime example of breaking bad news that hits hard. Even if you can improve their vision with new glasses to meet the standard, the conversation shifts. It moves from a gentle suggestion to a firm “you must update this prescription” to remain legal for driving.

“Informing a patient they no longer meet the legal requirements can feel like you are taking away their independence.”

Jason Searle – The Eye Care Advocate

This transition feels like a much harder message to deliver. It highlights the emotional layer involved in breaking bad news, extending beyond just the clinical finding. Your empathy helps to bridge that gap.

Keeping a Steady Hand When Breaking Bad News

Finding something unexpected during an eye exam can trigger various emotions within us as practitioners. You might feel a rush of excitement from a fascinating clinical find, perhaps seeing a retinal tear or papilloedema for the first time. However, this can quickly turn to worry or fear for your patient’s well-being. Managing these personal reactions is a key part of breaking bad news.

Personally, I often feel panic trying to set in. I worry about the patient’s health and also about doing everything perfectly, especially in a busy clinic. Over time, I have learned to control these feelings. Staying calm and composed is essential. Take a deep breath before you start explaining your findings. Speak in a clear, steady voice. It helps to anticipate potential questions a patient might ask. Having a clear plan of action prepared also builds your confidence. This professionalism and composure makes the news more manageable for the patient. It helps them receive the information better.

There was one time, for instance, when I had to get a patient with a pupil-involved third nerve palsy seen immediately. I found it coincidentally while they were there for a post-cataract assessment. They also had a complaint regarding their last visit. Dealing with their complaint while realising the seriousness of the incidental finding of the palsy was challenging. I felt panic rising, but I had to control my emotions and reactions. I needed to handle it professionally.

This experience really highlighted how tough it can be to stay composed when breaking bad news about a potentially serious condition, especially when it’s an unexpected finding. Thankfully the patient was seen (unfortunately a diagnosis of a brain tumour) and returned to me for the post-cataract assessment when in a position to be seen appropriately.

Admitting When Things Go Wrong

Sometimes, despite our best efforts, things don’t go exactly as planned in practice. Maybe a new prescription you issued just isn’t working for the patient. You checked everything, the optics are spot on, but they simply cannot adapt to the new lenses.

It feels difficult admitting your initial professional judgment might not have been the perfect fit for this particular patient. You genuinely felt it was the right call during the examination. This situation, where the solution isn’t working yet, is a different form of breaking bad news. You are essentially delivering breaking bad news about the failure of success of the initial plan.

Explaining your reasoning helps the patient understand your thought process. More importantly, you must show them exactly how you will correct the issue. Provide clear, actionable steps for resolution.

Owning the mistake, even if it is just a judgment call on adaptation, is incredibly powerful. It might feel a bit embarrassing at first. However, it significantly builds trust with your patient. They see that you are a genuine person, truly trying your best to help them.

This authenticity strengthens the practitioner-patient bond. It is part of our professional duty of candour, being open and honest when things haven’t gone perfectly. This instance of breaking bad news about a plan needing adjustment is different from a diagnosis, but it still requires honesty and a clear path forward.

Patients appreciate knowing their optometrist is human. They trust you more when you are transparent, which can make future instances of breaking bad news easier to navigate. It is a crucial skill in breaking bad news, showing integrity even in smaller challenges.

Talking About Transitions

Our work in optometry often involves transitions, both for us and our patients. Sometimes, we need to communicate that we are moving on from a practice. This can also feel like a form of breaking bad news, especially for patients who have built a relationship with you. As a locum, I often tell patients at the start that I am here temporarily. This manages expectations early. I let them know they can contact the practice if they have questions later, and I will help if I can.

Leaving a job you enjoy presents a different challenge. During a period of personal difficulties in 2022, I had to leave a practice I liked very much. I felt I could no longer perform at the level they needed. This was difficult because they had been incredibly supportive. Telling them felt awful. It was a form of breaking bad news to a supportive team. I felt embarrassed leaving them short-staffed during a busy time. It added pressure to colleagues who were already working hard.

Being open about my reasons for leaving helped. I remained professional throughout the process. Not burning bridges was important. I still have a good professional relationship with them now, even though I am not an employee.

Communicating these professional transitions clearly and honestly is another facet of breaking bad news we face. It requires care and consideration for the people involved, whether patients or colleagues. Handling these changes well is part of being a professional, even when it feels like breaking bad news personally.

Giving Time When Breaking Bad News

When you deliver significant news, especially breaking bad news about a serious condition, patients need time. They need time to process what you tell them. They need time to react. Sometimes, people only hear one small piece of the information you share. They might focus on that one detail and miss the main points.

I have seen this happen when breaking bad news about macular degeneration. I mentioned an early cataract was present, but the reason for their vision loss was the macular degeneration. The patient only heard “cataract“. They completely missed the more critical diagnosis.

Therefore, it is important to structure your explanation. Break down the information into smaller, easy-to-understand parts. Deliver the most important and relevant points first. Use simple language. Avoid jargon. After sharing a key piece of information, pause. Give the patient a moment. Allow them to absorb it. Check their understanding before you move on. Ask them to tell you what they heard or if they have questions.

When we are starting out, we often feel eager to explain everything we found. We may feel proud of identifying the cause of vision loss. However, we must remember to deliver this breaking bad news sensitively. Professionalism means more than just making a correct diagnosis. It means communicating it in a way the patient can handle.

Giving patients time to process is crucial when breaking bad news. It ensures they grasp the important details and feel supported. This makes the experience of breaking bad news more manageable for them.

Understanding Patient Reactions When Breaking Bad News

Patients react in many different ways when you are breaking bad news. Some patients appear stoic. Others become emotional. Sometimes, you encounter denial. This frequently occurs when discussing driving standards.

Many patients may have heard before that their vision is not adequate for driving. However, they simply deny it, forget it, or simply ignore previous advice. When you deliver this bad news, you must clearly reiterate the risks and consequences. You also need to explain the steps you might have to take if they do not follow your guidance.

It can feel frustrating when patients do not seem to accept bad news. New students often expect patients to simply follow instructions. However, people do not respond that way. Being aware of this helps you consider different strategies for managing these conversations when breaking bad news.

Recognise that hearing bad news can trigger a grief process. People grieve at different speeds and in various ways. Watch their body language closely. Are they showing signs of denial or acceptance? This gives you vital clues about their thought process.

Remain open and honest throughout the discussion. Allow them plenty of time to ask questions about the bad news. Stay objective while you explain what needs to happen next. Avoid pre-judging how they will react to the bad news. Use your empathy and kindness. These human skills are incredibly important when breaking bad news.

Always Offer Support

When you are breaking bad news, patients often want to know what happens next. They ask what can be done to help their situation. Even when you deliver significant breaking bad news, there is almost always something you can offer. It might not be a cure or a way to fully restore their sight. However, you can provide support and solutions.

Be confident in the referral pathways and criteria, should a referral be needed. Know about local support groups available for specific conditions. Understand the low vision pathways in your area. Be familiar with the latest low vision aids. You might not be able improve their eyesight clinically, but you can help them maximise the support they receive to live with their condition.

Think about the patient as a whole person. For example, you might break bad news that a patient no longer meets the visual standards for driving. This is difficult news. But perhaps they initially came in because they struggled to watch television. The new glasses you prescribed may improve their vision significantly to see the TV. Even with when breaking bad news about driving, you still helped them with their initial problem.

If you find signs of a cataract, which might upset the patient, explain the treatment options. Discuss interim measures you can take. Reassure them if their worries are much greater than your clinical findings suggest. There is always a way to offer help, even if it is not directly related to the bad news you delivered. Offering this support builds their trust in you. It reassures them that you are a healthcare professional who cares about their overall well-being, not just their diagnosis. This approach is vital when breaking bad news.

“There is always a way to offer help, even if it is not directly related to the bad news being delivered.”

Jason Searle – The Eye Care Advocate

Looking After Yourself After Breaking Bad News

Breaking bad news takes a toll on us too. These conversations can be emotionally draining. It is really important to look after your own mental well-being afterwards. You need a way to process these difficult moments. Find a coping mechanism that works for you and fits into your day. It could be allowing yourself a quiet moment to process your feelings. Maybe a vigorous workout after your clinic helps you release tension. Talking to a trusted friend or colleague can also provide support, but always be mindful of patient confidentiality.

My own experience of receiving unexpected bad news about a client cancelling all my future dates with them. This taught me a lot about timing as the news was delivered when I was waiting for a patient to dilate during a busy clinic, just weeks before my son was due. I had to stay professional and finish the appointment while processing significant personal news. It was incredibly tough. This showed me that while there are right ways to deliver breaking bad news, the timing also matters hugely. Sometimes, waiting until you have all the facts is crucial before breaking bad news, even if you suspect something serious.

Remember you are doing your best in challenging circumstances. Even though the news is hard for the patient, giving them the truth allows them to make informed decisions about their health. That is the right outcome.

“Remember that you are doing your best in challenging circumstances”

Jason Searle – The Eye Care Advocate

Prioritising your self-care ensures you can continue to handle these situations effectively. Your well-being matters just as much in ensuring patients receive the care they need, especially when you are breaking bad news.

Concluding Thoughts on Breaking Bad News

So, we have talked through some of the different times we face breaking bad news in optometry. It is never easy. Whether you are telling a patient about sight loss, admitting a mistake, or even leaving a practice, these moments require care and skill. We have discussed leading with compassion, keeping your composure, being honest, giving patients time to process, understanding their reactions, and always offering support.

Handling breaking bad news well strengthens the bond you have with your patients. It builds trust and shows your professionalism. It is a vital part of being a good optometrist. Remember to look after yourself too. These conversations are demanding. Finding ways to process them helps you stay resilient.

Ultimately, delivering breaking bad news is about guiding patients through a difficult moment with empathy and clarity. You provide them with the information they need to move forward. You are doing important work.

Have you faced a challenging situation involving breaking bad news? Do you have tips on how you handle these conversations? Share your experiences in the comments below.

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