“There is no ‘right’ way to deliver potentially life changing news”

As we progressed with the refraction, I was suspicious that a simple update of her prescription wouldn’t be enough. My heart sank as I checked her OCT images and saw large patches of atrophy at her macula in both eyes. I would have to be the one to break the news that new glasses would only help so far, and that even a new prescription would not allow her to meet the DVLA driving standards for vision.

My heart sank as I checked her OCT images and saw large patches of atrophy at her macula in both eyes. I would have to be the one to break the news that new glasses would only help so far

Delivering the news

There is no ‘right’ way to deliver potentially life changing news, but there are certainly ‘wrong’ ways. It is important to remember that much like every other aspect of our daily routine as an optometrist, applying a formulaic approach will not always provide consistent results. Keeping the patient at the centre of the conversation is key.

There are a number of helpful points that I have learnt to routinely consider when I need to break ‘bad news’ to a patient. Firstly, it’s important to locate an appropriate, private space to speak with the patient, and their family members, if they would prefer. I will consider a patient’s cultural and religious beliefs and values, which might influence their preferred course of management. When speaking to a patient I try to provide the facts in an appropriate manner. Although it can be difficult, ensuring the patient is fully aware of the seriousness of the news you are telling them often means matter of fact language is necessary instead of talking around a point. I will also ensure that the patient understands what I am telling them by regularly checking if they have any questions around their diagnosis.

Taking these points into account with this patient, I returned to the examination room and delivered the news that she would no longer be able to drive. Her reaction was initially disbelief. She was understandably upset and scared about what the future held. We discussed her various options, and I offered her my support and reassurance. I explained the next steps and offered her information to take home and read in her own time. I do this often with patients as research shows they will only recall between 40–80% of the information presented to them during their examination, and up to 50% of the information they can recall may be partially incorrect. Therefore, providing information to digest once the initial shock has settled can be very helpful in helping the patient, and their families, to understand the condition better.

Although it is never easy to deliver bad news, I have learned to trust my instincts and rely on my experience to guide me through these difficult interactions

To newly-qualified optometrists feeling nervous about breaking bad news to patients, my advice is to approach difficult conversations with empathy and compassion. Remember you are there to help the patient – your delivery, advice and support will make all the difference in how the patient comes to terms with the bad news. Provide resources that the patient can refer back to later and share with family members. Finally, remember to leave the door open for them to follow-up with questions once they have processed the news.

These methods will help the patient along in the journey of accepting and coming to terms with their diagnosis.

When it comes to delivering bad news, I have learned to trust my instincts and rely on my experience to guide me through these difficult interactions. I have also learned the importance of taking time after a tense conversation to reflect and reset before starting with the next patient and seeking support from colleagues when needed.

While breaking ‘bad news’ to a patient is never easy, unfortunately it is part of our role as health care professionals. Approaching these conversations with compassion, empathy and professionalism is the best way to help our patients navigate their diagnoses to provide the best possible outcome, even in difficult circumstances.

About the author

Eilidh Thomson was elected as vice chair of Optometry Scotland in 2022, having been a member of the organisation’s executive committee since 2019. She began her career at Black & Lizars in 2008, first serving as an optical assistant before qualifying as an optometrist in 2014. Thomson gained a first-class honours degree in optometry from Glasgow Caledonian University. She became an independent prescribing optometrist in 2017.