What is "the job" of a physician in delivering medical bad news, poor prognosis?

In my opinion, a physician must be able to deliver any medical news in a professional, simple and sensitive manner because they, in our society, are entrusted with much and are responsible for a lot. They should not give undue hope but provide reasonable expectations – if they do not know, they should say so instead of pulling numbers out of their ass. And more should be comfortable with saying ‘I advise you to see another physician for a second opinion’.

I think it’s to tell the patient what the diagnosis is, to break it down for them and explain it to them so they understand what’s going on in their body, to give them the prognosis, and give them their treatment options – either referring them to the different specialists, or going into detail if they would be the person treating them. It should not be their job to do the counseling part, as they don’t have the training, instead they should refer the patient to someone who can help them grieve.

I think that regardless of skill, if a physician is socally inept, callous, and otherwise possessed of a rotten bedside manner, they are failures in the totality of what they provide in the way of care and service.

A lack of tact, grace, diplomacy and compassion are not traits that I look for in a medical professional.

That goes for my pets as well…just changed vets because I cannot stand the owner of the clinic I have been using for several years…he cannot keep good staff because he is such an abrasive guy.

I expect and insist that my physician consult with me as a peer in the management of my health and that means to be honest and sensitive to my needs and those of my close family members should I be seriously ill.

@Dr_Lawrence you expect that because you are a medical professional. Others here who are knowledgeable and tough-minded may also expect that. But what of the person who cannot understand or cannot face the truth?

I have been in a position where I went from having no disease except for a cold for to a whole list of problems. The physician was straight forward, gave me the information and time to digest it. I cried for myself for the fist time since I was a kid. The next day I worked with the physician to develop a plan to get past these problems.

My wife thought he was cruel, I appreciated the information and his attitude for making me a part of the improvement process.

@Ron_C Even though I know it’s because time is of the essence on TV shows, it always bugs me when a character will get cancer and the doctor will say “you-have-cancer-so-you-need-to-start-chemo-right-now” all in one breath without giving them a whole 15 seconds to process.

Well, I had the possibility for cancer, fortunately, further tests said that there was no problem but the process for telling me that and other things took longer than 15 seconds, more like an hour (I think). I wasn’t concerned about the clock at that time.

SPIKES protocol for delivering bad news.
http://theoncologist.alphamedpress.org/cgi/reprint/5/4/302
You may need to hit “begin manual download”.

I think docs have to give bad news in an honest, comprehensible way; convey to the patient that regardless what happens she won’t be abandoned; try to convey a sense of hope (the pt can decide on hope for what); and try to imbue this new phase in the patient’s life with meaning.