Good Ways to Deliver Bad News

Dr. Robert Buckman is a cancer specialist who teaches doctors — as well as executives at IBM, Andersen Consulting, and Upjohn — how to break bad news: "You can't let emotions interfere with your message."

The first job of a leader is to be a clear communicator. And one of the toughest challenges for a communicator is to deliver bad news. So leaders who want people to take them at their word in good times had better choose their words wisely during bad times.

Dr. Robert Buckman, 50, has delivered more than his share of bad news. A specialist in breast cancer, he is a medical oncologist at the Toronto-Sunnybrook Regional Cancer Centre and an associate professor in the Department of Medicine at the University of Toronto. The toughest part of his job, he says, is also the most unavoidable part: telling patients that they have a severe, or even fatal, illness. "When I was an intern," Buckman says, "I would see doctors get so embarrassed when they had to give bad news to patients. I thought, 'There must be a protocol that will keep people from having to invent this conversation time and again.' "

The protocol that Buckman developed has caught on. He teaches it to doctors, to medical students — and to businesspeople, including executives at IBM, Andersen Consulting, and Upjohn. "Begin a difficult conversation by listening," he says. "And end it by summarizing: Review the ground you've covered, identify a plan, agree on a 'contract' for the next contact."

Serious stuff. But Buckman is also a very funny man. At Cambridge University, he was a member of Footlights, a renowned theater revue. He has appeared as a regular in TV series in England and in Canada, and he has worked with John Cleese, of "Monty Python" fame, on a video series for patients. His 10th book, to be released this month, is titled Not Dead Yet: The Unauthorized Autobiography of Dr. Robert Buckman (Doubleday Canada). "That word, 'unauthorized,' seems to increase sales," he deadpans.

Buckman recently sat down with Fast Company to deliver some of his ideas about delivering bad news.

Start by listening, instead of talking.

Don't just "get right down to business." Start with a few open-ended questions: "How are you feeling?" "How's it going?" And when the other person is talking, be quiet. The trust that you can build just by letting people say what they feel is incredible.

Eventually it will be time for you to talk. Get your eyes on the same level as the other person's eyes. Look relaxed. And when you respond, use a word or phrase from the other person's last sentence. That kind of repetition signals, "I heard what you said."

Explore perceptions before you try to define reality.

Let's say I'm your boss and I have to give you a rotten performance review. I might say, "Let's start with your telling me what you think of your first year here."

You might say, "I've done pretty well."

I'd say, "Tell me what you mean by 'pretty well.' Are there any problem areas?"

You might say, "Apart from the time I threatened the CEO with a knife, no."

Now comes the hard part. I'd say, "My job is to tell you what it says in your review. And your supervisor reports that it wasn't such a good year." I have to deliver that news. How I do it should reflect my understanding of what you perceive: How well do you comprehend the situation? Are there mismatches between perception and reality?

Legitimize emotions.

Bad news comes with very strong emotions — and you must always acknowledge those emotions.

I once had a patient who had treatment for ovarian cancer. Sadly, as often happens, her cancer came back a few years later. I had to give her the news, and she reacted in a way that was as dramatic as any I've ever seen. She literally threw herself around the room. I didn't feel calm, but I tried to look calm. I kept offering an empathic response: "This must be absolutely awful." That made her feel that she was in a safe place.

But don't get emotional yourself.

A good, empathic response acknowledges not only someone's feelings but also the reasons for those feelings. It legitimizes emotions in two ways: as a response to the situation, and as an item on the conversational agenda. But you can't let those emotions interfere with your message. If you've got to fire somebody, you can't not fire him because he's crying. But you do have to acknowledge his distress: "I'm making you cry. This must be awful for you."

Sidebar: Ways to Receive Bad News

Dr. Robert Buckman hasn't just delivered bad news. He's received it as well. About 20 years ago, Buckman developed an autoimmune disease called dermatomyositis (it's similar to rheumatoid arthritis). The experience taught him lessons about life and death — and about the right way to interact with his patients.

Two of the doctors who treated Buckman communicated with him in very different ways. "My gastroenterologist was quite wonderful," Buckman says. "He told me, 'Rob, you've got this thing in your joints, you've got this problem with your nerves, you've got inflammation of the muscles. All of this must be absolutely awful for you. I'm so sorry.' I almost sobbed with relief. He was not really known for his empathy, but he gave me permission to feel rotten."

Four months later, Buckman met with his primary physician. "I was going downhill rapidly," he says. "My doctor thought I was going to die. But he couldn't abide the pain of telling me. So he called in my then-wife and told her. She came down to my room. She was bright red around the eyes. I said, 'Does he think I'm going to die?' She said, 'He thinks you might.' I had so many questions, but my wife couldn't begin to answer them. This doctor was a good friend, so I understand what he was going through."

Eventually Buckman did respond to treatment, and he hasn't needed to take medication for his condition since 1982. What did he learn from being on the receiving end of bad news? "I realized that I could stay intact psychologically even under the threat of death," he says. "Because of that, I became a braver person."

You can reach Robert Buckman by email (drbuckman@sympatico.ca).

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