‘I’m Sorry But’: Striving Towards A Culture Of Collective Care And Space For Reflective Practice In Breaking Unfortunate News To Patients In Pakistan

Background: Breaking bad and potentially negative news to patients is an integral aspect of the life of a practicing doctor and being a part of specialties like Surgery, Trauma and Obstetrics often tests this ability. Effective communication strategies and techniques are essential in such circumstances for they help build trust and influence the patient’s future choices. In LMICs such as Pakistan, no standard training is imparted to healthcare professionals and trainees on how to deal with such circumstances. Objective(s): This study intends to explore the degree and effect of such lack of communication skills on the daily practice of obstetricians, emergency doctors and surgeons. Methods: The study comprised of two phases involving three tertiary care hospitals in Islamabad, Pakistan. First, an e-form was circulated among doctors appointed at various levels of the hospital hierarchy including trainees and consultants, of the concerning specialties, obtaining their consent, demographic details and vignettes relating to their everyday practice. Second, the participants were individually approached for In-depth interviews (IDIs). Results: The participants of the study affirmed that they had faced the challenging situation of breaking bad news to their patients very often and were mostly at loss of words and experienced significant discomfort and emotional toll while delivering the news. As many as 60% of the respondents believed that adequate training and guidance could alleviate their concerns and help provide better patient centered care. Additionally, serving an underserved and uneducated population, from diverse backgrounds, their security fears remained a valid concern. Conclusion: Training programs must be incorporated in medical years of study which help understand human emotion during such trying times so that the doctors are better able to empathize and relate. Students must be acquainted with the SPIKES protocol, ABCD protocol and tested on simulations to provide them with valuable feedback which may help shape their future practice.