“I am certain that I made mistakes”

I remember wanting to be able to tell the patient about the condition but without scaring them. I took my time to get a structure clear in my mind so that I could break the bad news in a structured and empathetic way. I was definitely nervous because I was unsure of how the patient would react.

In this case, I was informing the patient that they had papilloedema. I remember that the patient had said that they had been losing their sight every time they were getting stressed. It was due to high blood pressure, and they thought they needed spectacles.

When I told the patient that I needed to send them to the hospital as an emergency, they didn’t believe me and they were more concerned about the meetings they had that afternoon. However, once I explained everything clearly and even told them that I was willing to cancel all my patients and physically take them to the hospital they became convinced. That is when the panic set in. Understandably, the next step involved me calming them down and reassuring them that everything would be ok.

I remember wanting to be able to tell the patient about the condition but without scaring them

How you develop

When I first qualified as an optometrist and started to have to break ‘bad news’ to patients, I am certain that I made mistakes. I quickly learned that using the words ‘suspect tumour’ caused a lot of anxiety for patients. Over the years, I have become better at using phrases such as lesion, or, in the case of a naevus for example, explaining that ‘if a mole on your skin gets bigger you would be concerned, it’s the same with the eye, so I need to monitor it.’

To newly-qualified optometrists, I would like to reassure them that it is normal to feel nervous about breaking bad news. As humans we all react differently to bad news, and sometimes the patient may break down and we have to control that situation. Personally, I don’t think there is enough training for students during university about how to console a patient who is upset or crying.

In terms of techniques that I draw on when discussing difficult things with patients, I have learnt to always have a clear structure in my mind as to what I will say. I would encourage practitioners having difficult conversations to make sure they mention the name of the actual condition, what they are going to do about it, and the prognosis of the condition.

Remember to be empathetic towards the patient, tell them what the condition is that you suspect, and be prepared for the worst-case scenario of the patient being upset. Consider writing down how the patient reacted in your clinical notes, as well as any conversations that you had.

As humans we all react differently to bad news, and sometimes the patient may break down and we have to control that situation

Remember, you need to present the facts as they are, avoiding ‘wishy washy’ comments such as ‘I think your pressure might be high and I need to refer you,’ but mentioning that you suspect it’s glaucoma and then explaining glaucoma.

Finally, remember to use relevant patient leaflets where possible, sharing them with patients to take home because, as humans, we will forget some of what was discussed.

About the author

Shamina Asif is a locum optometrist and founder of Optom Academy. Alongside working in independent practices, Asif is chair of Dudley Local Optical Committee and a lead assessor for the Wales Optometry Postgraduate Education Centre.