ELH 111

Lecture 8: Breaking bad news & Group

assignment discussion
 Robert Buckman's Six
Step Protocol for
Breaking Bad News
How to break bad news Robert Buckman, in an
to a patient’s next of kin excellent short manual,
has outlined a six step
protocol for breaking bad
news
Getting started.

• The physical setting ought to be private, with both

physician and patient comfortably seated.
• You should ask the patient who else ought to be
present, and let the patient decide--studies show that
different patients have widely varying views on what
they would want.
• It is helpful to start with a question like, "How are you
feeling right now?" to indicate to the patient that this
conversation will be a two-way affair.
Finding out how much the
patient knows.
• By asking a question such as, "What have you already
been told about your illness?“ you can begin to
understand what the patient has already been told ("I
have lung cancer, and I need surgery"), or how much
the patient understood about what's been said ("the
doctor said something about a spot on my chest x-ray"),
the patients level of technical sophistication ("I've got a
T2N0 adenocarcinoma"), and the patient’s emotional
state ("I've been so worried I might have cancer that I
haven't slept for a week").
Finding out how much the
patient wants to know
• It is useful to ask patients what level of detail you
should cover. For instance, you can say, "Some
patients want me to cover every medical detail, but
other patients want only the big picture--what
would you prefer now?" This establishes that there
is no right answer, and that different patients have
different styles. Also this question establishes that
a patient may ask for something different during
the next conversation..
 Sharing the information
• Decide on the agenda before you sit down with the patient, so that you have the
relevant information at hand.
• The topics to consider in planning an agenda are:
• diagnosis, treatment, prognosis, and support or coping.
• However, an appropriate agenda will usually focus on one or two topics.
• For a patient on a medicine service whose biopsy just showed lung cancer, the
agenda might be:
• a) disclose diagnosis of lung cancer;
• b) discuss the process of workup and formulation of treatment options ("We
will have the cancer doctors see you this afternoon to see whether other tests
would be helpful to outline your treatment options").
• Give the information in small chunks,
• and be sure to stop between each chunk to ask the patient if he or she understands
("I'm going to stop for a minute to see if you have questions").
• Long lectures are overwhelming and confusing.
• Remember to translate medical terms into English, and don't try to teach
pathophysiology.
 • If you don't understand the patient's
Responding to reaction, you will leave a lot of unfinished
the patient's business,
• and you will miss an opportunity to be a
feelings. caring physician.
• Learning to identify and acknowledge a
patient's reaction is something that
definitely improves with experience, if
you're attentive, but you can also simply
ask ("Could you tell me a bit about what
you are feeling?").
Planning and follow-
through.
• At this point you need to synthesize the patient's concerns and the medical
issues into a concrete plan that can be carried out in the patient's system of
health care.
• Outline a step-by-step plan, explain it to the patient, and contract about the
next step.
• Be explicit about your next contact with the patient ("I'll see you in clinic
in 2 weeks") or the fact that you won't see the patient ("I'm going to be
rotating off service, so you will see Dr. Back in clinic").
• Give the patient a phone number or a way to contact the relevant medical
caregiver if something arises before the next planned contact.
 • In general, it is better simply to wait for the person to
What if the stop crying.

patient starts • If it seems appropriate, you can acknowledge it ("Let's

just take a break now until you're ready to start again")
but do not assume you know the reason for the tears
to cry while I (you may want to explore the reasons now or later).

am talking? • Most patients are somewhat embarrassed if they begin

to cry and will not continue for long. It is nice to offer
tissues if they are readily available (something to plan
ahead); but try not to act as if tears are an emergency
that must be stopped, and don't run out of the room—
you want to show that you're willing to deal with
anything that comes up.
I had a long talk • Sometimes patients ask the same question of
with the patient different caregivers,
yesterday, and today
the nurse took me • sometimes they just didn’t remember it all,
aside to say and
that the patient
doesn't understand
• sometimes they need to go over something
what's going on! more than once because of their emotional
What's the distress, the technical nature of the medical
problem? interventions involved, or their concerns were
not recognized and addressed
Group
Assignment_26 May
2023
• Each group (5 members) will make a Pamphlet
and a PowerPoint Presentation that will be
presented in class.

• The Topics are as follows:

Causes en consequences/implications with
special focus on social, cultural & economic
aspects thereof as well as interventions
needed to curb these pandemics.
1. Childhood obesity
2. Addiction/ substance use
3. Mental health issues specific to health
care science students
4. Heart/ Lung diseases
 General Guidelines:
Presenting a project orally
;
 How do we plan?
The process is not always linear:
What you should consider when preparing
a presentation:
1) The audience (who are they, what do they know, and what do
they need to know?).
2) Your purpose (what do you want to say, and in what order?).
3) The time-frame (going over the time allotted to a presentation is
a mortal sin).
4) Visual layout (colour scheme and contrast, font types and font-
pairing, image quality, and length of text).
5) Voice (fluency, enunciation, pace, and intonation).
6) Comportment (posture, clothing, body-language, and eye-
contact
 Audience

It is important to realise who your audience is.

In other words, you have to identify their interests, needs, attitudes, and prejudices, and then
focus your appeal on them.
If your audience comprises only experts, they will not need much background information. In
fact, these people will probably be bored and offended by basic explanations.

Shall we Of course,
save the duh…
world?
 Audience

On the other hand, non-experts will be mystified unless you give them
background information. If audience members are professional doctors
or dentists, they will be more interested in the technical aspects of your
talk that pertain to their specialties.
In contrast, an audience of non-experts will probably be bored by a
detailed talk on a subject they do not understand (Adler &
Elmhorst,2005:319).
Violating the standards of what your listeners find acceptable
can antagonise your audience and destroy your credibility.
 Formal

What are
styles and Informal
tones?

Plain English
Formal vs Informal
 Time-frame

The structure and pacing of your presentation will be fitted to

the allocated time-limit (not the other way around);
Aim for completion without rushing; never rush.
Be deliberate about how much time you will spend on each
slide.
You will have 5, NO LONGER, per presentation.
Structuring
an oral
presentation
 Overall structuring of the presentation
Oral presentations will typically follow a
similar structure as the written report or
other document.
 Introduction
How the presentation is structured is
vital to a listener’s understanding.
According to Sylyn-Roberts (2005:208)
everyone in the audience should be able
to understand the broad concepts of
what you are talking about.
In her opinion “it is a far greater
achievement to express a complex idea
clearly than to bombard the audience
with detail” (2005:208).
 Main message/thesis
The thesis or main message gives
your listeners a clear idea of what you
are trying to tell them.
It is very important that you have
clarity on your thesis as every other
part of your presentation should
support it, and you have a limited
amount of time to drive this message
home.
 The following breakdown is suggested:
• In terms of business presentations Thill and Bovée
(2005:445-446) suggest the following breakdown
of the available time:

• 10%: Greeting and introduction

• 60-70%: Discussing your main points
• 10%: Closing
• 10-20%:Responding to comments and questions
Designing visual aids
Maybe not?
 Creating electronic slides

1. Decide on the number of slides 4. Visuals

2. Writing and designing the text 5. Fonts and type styles

3. Colour 6. Animation and special effects

Hints and tips for successful delivery

Rehearse
 During your presentation

1. Put yourself in a relaxed mode 4. Use visuals effectively

2. Present your first sentence from

5. Engage your audience
memory

3. Introduce your slides 6. Use appropriate non-verbal behaviour

 Layout and visual design
Font:
 Between size 32 and 48 for headings
 Between 20 and 28 for body text
Limit yourself to two font-types:
 One for headings and
 One for the body-text
Avoid fancy fonts;
 Stick to the classics
AVOID ALL-CAPS IN THE BODY
 Layout and visual design
Text and background colour: you need to decide on a colour
scheme and stick with it for the entire presentation.

The colours of your headings, body-text, backdrop, and captions

should be consistent between all your slides.

There should be sufficient contrast between the text and the

background.

Keep it simple; keep it minimal.

 Layout and visual design

Use a photo only if it illustrates your point.

Use a graph only if it gives a broad overview.

Use a diagram only if it clarifies the relationship between certain elements.

Do not use a photo for your backdrop. Do not use a busy backdrop.

You do not need animations. If you use them, keep them extremely
minimal.
REALLY bad examples!
What is wrong with this slide? (Hint: everything)
What is wrong with this slide? (Low contrast between
text and background; colours are too intense)
 What is wrong with this slide?
(Too many elements in one place)
What is wrong with this slide?
(Distracting background)
 Voice
A strong voice conveys confidence.
Speaking too softly, mumbling, or trailing off at the ends of sentences
can suggest uncertainty or timidity and will undercut the strength of a
presentation.
If you're not sure a word or phrase is worth saying, don't say it. If it is
worth saying, say it like you mean it.
[www.syntaxis.com]
Comportment (posture, clothing, body language, and eye
contact)

 Posture: Stand tall. Your posture is important in projecting more confidence. Stand with your weight on both feet and your
shoulders back. Avoid gripping the lectern. Vary your facial expressions to make your message more dynamic.
 Body orientation: Do not turn away from the audience with your body.
 Maintain eye contact.
 Move naturally. You can use the lectern to hold your notes so that you are free to move about casually and naturally. Avoid
fidgeting with your notes, your clothing, or items in your pocket.
 Do not overdo hand gestures. Use your hands to emphasize your remarks with appropriate gestures, but keep them still at
other times. Do not distract your audience with nervous hand movements. Keep your hands out of your pockets.
 Clothing and personal grooming: Dress appropriately according to the culture of the organisation by which you are
employed.
 Voice: Rehearse your presentation beforehand so that your speech is as fluent as possible to exude confidence.