I hate it when I have to give this kind of news

Sometimes an expression that would be appropriate and kind in normal circumstances can add pain or anxiety in a clinical setting.

A friend recently went to the Emergency Room because of some bad symptoms. After a few tests, the attending returned to give the diagnosis. He started out by saying, "I hate it when I have to give this kind of news" and then proceeded to summarize the test results and finally to tell my friend that she likely had a very serious, probably terminal form of cancer.

I think what happened here was that the doctor thought that his introductory clause displayed empathy. But what this patient and her spouse heard was that the doctor was more concerned about what he was feeling than what the patient was feeling. Especially after they found out that, no matter how badly he felt, it was the patient who was likely to suffer and die.

Further, in the extended minutes of explanation before he actually delivered the diagnosis, his introductory comment caused a heightened level of stress. He felt the explanation was important to provide a context for the conclusion, but it mainly served to create suspense.

They would have preferred a more direct, "I am sorry to have to give you some bad news. We believe you have ** cancer. Let me explain why we think so." In their minds, the slight change in wording would still have presented empathy but would have made clear that the doctor's concern was about them and not about how badly he felt. The direct delivery of the diagnosis at the start of the explanation would have relieved suspense.

Some reading this might feel that my friend and her spouse were overly sensitive and were misinterpreting common courtesy. I can only respond that these folks' reaction was immediate and negative. I conclude from this that common courtesy does not always feel like such in a difficult clinical setting.

I claim no expertise in how bad news should best be delivered by doctors. But I have told this story to other people with serious diseases, and they have resonated with the feelings of this couple, often remembering their own moments of diagnoses in a similar fashion.

I would love to get reactions and wisdom from both clinicians and patients on this matter. Please comment.