How to break bad news for an OSCE

Breaking bad news seems like a daunting prospect however during an OSCE it is quite predictable.

1. Confirm patient identity

2. Then introduce yourself: My name is .... I am one of the doctors in the team that's looking after you.

3. Ask how they are feeling/ are they in pain.

4. Bring up the topic - I've been told to speak to you today about.... (e.g your leg, your blood results)

5. Find out where the patient is currently at/ what they know:
Could you tell me what's been going on so far?
How do you feel that it's been progressing?
Has anything been worrying you?
Do you have any idea of the possible treatments?

6. Slowly break the news:
The team have had a discussion about ...... The situation is not as we would have hoped
PAUSE
Unfortunately .... (the current treatment is anadequate... (or words to this effect but more specific))
PAUSE
I'm sorry to say this, but this would mean....
SUPER PAUSE

(let the patient speak as much as possible)

7. Facilitate with empathetic statements
I can understand that this is a really big shock for you
This must be very difficult news to process
Can you tell me what's going through your head at the moment

8. You won't be going through this on your own and the team will be with you for every part of it.
I
9. One of my colleagues will come to speak to you later about planning.

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