This is Part 2 of our Support Protocols for 14 Common Situations series. The cases described in this series are drawn from everyday scenarios found in general veterinary practice or emergency and specialty practices. Below you’ll find an example of a type of case you’re likely to encounter in practice. This blog’s subject is a case about delivering bad news
Situation: Delivering Bad News
A client named Joanna rushes into your hospital holding her cat, Boots, in her arms. She is crying and distraught, and it’s obvious that Boots is in respiratory distress. You immediately take the cat to an examination room and perform emergency care and 15 minutes of CPR. Despite all your efforts, Boots dies. You must now meet with Joanna to deliver the bad news.
Assessment: What’s Going On Here?
Joanna was clearly very upset by her cat’s unexpected emergency and she will most likely react in an emotional way when you deliver the news of the cat’s death. Clients’ reactions to bad news about their pet are often unpredictable, however. Therefore, when you deliver the news, be prepared to deal with a wide range of grief responses. Shock, disbelief, anger, blame, sadness, and even hysteria are common. Anxiety and shock may cause one client to appear calm, stoic, or too much in control. The client may say nothing but engage in intensive hand-wringing and aimless pacing. Anxiety may cause another client to smile or laugh inappropriately even when his or her pet has died.
Still other clients may react with rage, guilt, or confusion. They may sob scream, and even hit or kick objects that are in the room. A few clients may accuse you of incompetence or even of making up a disease so you can charge them for expensive treatments. One or two may hang up on you if you’re delivering bad news via the telephone. Or, when face-to-face, simply turn and walk out the door, leaving the pet behind.
Plan: Support Protocol for What to Say and Do When Delivering Bad News
Lay the Foundation (Step 1)
- As in any other situation where you must communicate with grieving clients, you will need to make a plan that will allow you to communicate the information effectively.
- Think carefully ahead of time about where you would like to be with the client when delivering the bad news. Create a relaxed yet structured environment where you and your client can sit down, touch, and make direct eye contact.
- Stock a private area with tissues and arrange furniture in a way that allows you and the client to sit down and talk without a desk between you. This is called a Client Comfort Room.
- Make sure the client has access to a telephone in case he or she does not have a cell phone on hand.
- Never deliver bad news in a public area or in front of other people. Delivering bad news is challenging enough without also having to deal with an audience.
Implement Support Techniques (Step 2)
- When delivering bad news, use a soft voice and speak more slowly than usual. Crisis intervention experts recommend creating a context of sensitivity and compassion. Provide the client with the basic facts. Then, listen and attend to his or her emotional responses without becoming defensive, guilty, or angry yourself. This is a tall order, but possible to accomplish if you understand the wide range of normal responses to grief. In most cases, when clients respond inappropriately to loss, they are not aware of how their words and behaviors may affect you. They are simply reacting. Later, when they realize what they have said or done, most clients who reacted in these ways feel embarrassed and apologetic. When you understand the grief process, you can normalize their behaviors and forgive grieving clients for taking their feelings about the situation out on you.
- When it’s time to implement support techniques, try to predict how a client may feel about or respond to the news of the pet’s death and then proceed to offer information in brief, step-by-step conversations. Expect to deal with a wide range of grief responses, from angry accusations to complete silence. Be sure to use words such as “died” and “dead” so there can be no confusion in the client’s mind about what has happened. It is not helpful to use euphemisms when discussing bad news.
- Deliver the bad news in four stages:
- Prepare yourself emotionally for the client’s potential responses, keeping in mind that the client may be in shock. Reactions may include sadness, anger, crying, and denial.
- Tell the client that there is bad news that will be difficult to hear. For example: “Joanna, I have some difficult new s that will be hard for your to hear.” This prepares the client emotionally for what is to come.
- Proceed to offer the client information in brief, step-by-step increments, using clear and concise language. Offer information in slow, deliberate sentences, giving the client the opportunity to process what is being said before continuing to provide information. For example: “We did everything possible for Boots and performed CPR on him for 15 minutes. Despite our best efforts, we were unable to save him and he died. I’m so sorry for your loss.”
- Give the client permission to express themselves by normalizing their feelings and using appropriate self-disclosure. Touch, attend, and paraphrase to deescalate tension and calm the client. Acknowledge your client’s emotions, and do not take any comments that he or she makes at this time personally. For example: “I know this is a horrible shock for you and I can’t imagine all you must be feeling right now. I want you to know that we want to support you in any way that we can.” After a brief pause, you could continue with, “Is there anything we can do for you right now? Would you like to call anyone, or would you rather have a little time alone for a few minutes?” If the client would just like some time alone, before you leave the room you could say, “We have some support materials for you when you feel ready.”
- It takes time for most clients to fully realize the magnitude of what they have been told. Most will remember little about the first conversation they have with you and will have many questions later. If you are the veterinary professional who delivers the news, it is important for you to proceed by asking the client what she or he needs next. For example, you can offer to provide more detailed medical information in an hour or so, either by calling or meeting with the client again, acknowledging that it is difficult to absorb information when first hearing that one’s pet has died. You should lso offer the client the option of viewing the pet’s body.
Stay Connected through Follow-Up Care (Step 3)
- Send a condolence card to the client and acknowledge how difficult it can be to lose a loved one (especially unexpectedly).
- Follow up with a phone call or another appointment if the client would so desire. This may be a perfect time to talk about how the client is dealing with things and find out whether they would like a referral for some extra support.
- Debrief with your staff, when possible, or make a note to discuss the situation at the next staff meeting or another appropriate time.
Delivering Bad News Role-Play Ideas
- For hospital managers and client care specialists: Practice delivering bad news using the above situation. Use the four-step process and seek feedback from your colleagues.
- For veterinary technicians: Practice supporting a client while he or she is waiting for the doctor to deliver bad news about a pet’s condition. Pay close attention to your verbal and nonverbal behavior.
- For veterinarians: Using the above scenario, practice delivering bad news to a client. Use the four-step process, paying close attention to your verbal and nonverbal communication.
Keep up the good work,
World by the Tail, Inc.