“As the examination proceeded, I knew something was wrong”

My first case of delivering bad news came early in my career, during my pre-registration placement. I remember that I was just six weeks into my training when I called this patient into my consulting room.

The patient had returned to practice from hospital following cataract surgery to their right eye. Their left eye was known to be amblyopic. When the patient came into the room, it was clear they were anxious. I asked them how their vision felt following cataract surgery and they sighed, looked at me and said, “It was good at first, but it’s gone bad since last week.”

As the examination proceeded, I knew something was wrong. The patient’s vision wasn’t improving with a refraction, and as I moved to Volk examination, it became clear what had happened. A very large haemorrhage had developed. Their dry age-related macular degeneration (AMD) had progressed to wet AMD.

“Their fears were becoming a reality, and they then began to almost plead and beg me not to take their licence away”

Not only did I have to break the bad news about their wet AMD and the need for treatment at the hospital, but I also had to inform them that they no longer met the standard for driving, and should therefore stop.

As I explained the condition, I could see the patient getting visibly more upset. Their fears were becoming a reality, and they then began to almost plead and beg me not to take their licence away. This made the situation very difficult. At that moment, I found myself breaking out of my professional mask and gave the patient a chance to catch their breath. I got them a glass of water and explained what treatment would be able to do. When I explained that they would be seen in the next two weeks, this reassured them further.

Professional impact

This first case of breaking bad news to a patient made a marked change in the way I communicated with patients going forward. I realised that being professional did not have to mean that I had to put on an act.

Speaking to a patient should be done in the same way as talking to someone in your day to day. Of course, being sensible is important, but I have found that being myself has meant that patients are put at ease – it has broken down barriers and allowed for better communication. For me, breaking bad news has become about delivering information to a patient in a way that I would like it to be delivered to myself or to one of my loved ones.

"Delivering bad news is perhaps one of the most difficult parts of practicing as an optometrist"

As time has passed, and I have gained more experience, I have found encouraging patients to bring family members in for the discussion helpful. This is because, often, patients fail to fully absorb all the information during the conversation, and having a family member there listening ensures that the message I wish to pass on is reinforced at home.

Additionally, I have found that when the discussion has been acutely distressing, following up with the patient a few days later helps them to feel supported –it can also help to emphasise the original message.

An example of this is when I recently had speak to a patient about dry AMD during a medical retina clinic at Newmedica. Although to us, as eye care practitioners, this may seem like a common diagnosis, for patients, it can be a devastating piece of news. However, a phone call a couple days later allowed the patient the time to process the information and we were able to have a more detailed conversation when they were more prepared and ready to hear about the advice and support that was available.

Now, I am a number of years on from my pre-registration placement. While delivering bad news will never be a pleasant part of the job,I have found that it has become easier – both in terms of explaining a condition, and in providing the patient with the comfort and support they deserve and require.

About the author

Optometrist Karan Vyas works at Newmedica. He is also an AOP Councillor, representing Employees of multiple practices. Read more about Karan’s career journey in our How I got here series.