The first interview illustrates the more common kind of breaking bad news situation. The news is not life threatening nor life-ending, although it is definitely unwelcome and disturbing to both physician and patient. The tone of this conversation shows two people who clearly have an ongoing physician-patient relationship. While the situation is not life-threatening, it represents a loss of freedom and independence. It may result in a profound emotional response from the patient, and perhaps a sense of guilt or helplessness in the physician.
There are a number of situations (e.g. suspicion of child abuse, and communicable diseases, etc.) in which a physician is legally required to report the patient’s condition to a third party. When a patient has a medical condition that makes them unfit to drive, a physician must be prepared to discuss this with the patient and may have a duty to report. Provincial and territorial reporting obligations vary, physicians must know how to have these conversations and where to find the appropriate resources. We recommend reviewing the following resources:
In cases of mandatory reporting, only the relevant information can be disclosed. The patient should be informed of the disclosure, and with the patient’s permission, a discussion with family is encouraged. You must clearly document the details of the discussion. Those interested in finding out more about evaluating fitness to drive can read Determining Medical Fitness to Operate Motor Vehicles and consult DriveABLE.
The second interview is the classic kind described in the literature: a terminal illness in a patient unfamiliar to the physician. Also, the physician is a relatively inexperienced resident and is clearly uncomfortable. Compared to the first interview, he uses many more of the behaviours and techniques suggested in the literature. While his approach lacks finesse, his honesty and compassion are evident. What other behaviours suggested in the literature does he use? How successful are they? Which behaviours would help the physician communicate more effectively?