How to break the news
Conveying messages your patients don't want to hear
By Dennis Perman, DC

Every doctor finds himself or herself in this position: You detect something nasty on the films and you need to tell the patient what's going on without causing alarm. Or, you realize that the patient needs an extensive program of care, not the "quick fix" they may have wanted or expected.

Either way, you are faced with a significant challenge. How do you break the news? In other words, how do you convey the truth to a patient, even when it's unpleasant?

To do this requires preparing yourself, understanding your patient (in terms of communication style), and applying the best approach.

Prepare yourself

Even before you interface with the patient, get your game plan together. Get yourself into an empowered state, develop a crystal clear perspective on the message you wish to communicate, and determine your exact outcome: What is it that you want to accomplish? How do you want the patient to respond to your input? What do you want to happen as a result of that input?

Understand the patient

Once you are focused on your outcome, you must plan to gain rapport with the patient.

Rapport is a feeling of comfort, ease, or connection with someone, and while it seems like an emotional phenom-enon, it's actually neuromechanical. The nerve system is tuned to recognize similarity to itself, so you can easily gain rapport with someone by matching and mirroring — in other words, by giving the individual back some of himself or herself in your communication, such as a similar facial expression or posture, pace of speech, or movement.

Now, armed with a feeling of certainty about your message and a sense of being able to connect, you can enter into the confrontation feeling fully equipped. Remember that the meaning of your communication is the response you get: It's not what you said, what you meant to say, or what you thought you said. It's what the other person actually heard that really counts.

So, you must size up the individual and solve some basic riddles about his communication style to put the message in a form that will work best for him or her. (See sidebar, "Confrontation and communication styles.")

Quickly decide if the patient falls into one of two broad categories — hard or soft. To hard patients, give a direct message. To soft patients, deliver a gentler message. You will know if you guessed right from the patient's response.

If you have a hard patient, say, "Mr. Patient, you have a serious problem here. You're in the right place because we take care of people with serious problems all the time. You're going to get everything explained to your satisfaction, but let me cut to the chase, so you know exactly what's going on."

If you have a soft patient, say, "Mrs. Patient, we take care of all kinds of people in our office, some with simpler problems, some with more challenging problems. Yours seems to be more challenging and that means we have a lot of work to do, but we'll be explaining all of that to you along the way. For now, what's most important is that we have helped many people in your situation, and we expect to help you too, as long as you follow through and cooperate with us as we guide you back toward health."

It would be lovely if there were magic words that worked every time, but there are as many right ways to deliver bad news as there are people who come to our offices.

Solving the puzzle of their communication style is a worthy objective, however it may seem intimidating. For advanced students, you can include more metaprograms or deeper personality structures, such as the Enneagram and Myers-Briggs.

But one thing is for sure — by becoming a more skillful and effective communicator, you'll find scenarios such as these more within your scope of expertise and master the process of giving patients the information they need to make good decisions and get well. Giving patients a clear, accurate, and understandable explanation of their situation builds patient compliance and improves your results because patients who see the real picture can cooperate and help you help them.

Temper your communication with genuine, loving concern, and the words will often take care of themselves. Listen and be present with your patients, and you'll discover the best way to communicate your message, no matter what the content. Then, deliver your support in a loving fashion. With your leadership, your patients will usually prove up to the task of their own recovery.

Dennis Perman, DC, is co-founder of The Masters Circle, a personal and professional development company dedicated to helping chiropractors find success through practice mastery and personal growth. He can be reached at 800-451-4514 or visit www.themasterscircle.com.