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Breaking bad news

Tips on Breaking Bad News

By Anthony Blackman MSc BSc(Hons) FBDO CL (Hons)SLD SMC(Tech) PGCert CetAcc(Open) MRSB MBCLA FRSPH FInstCPD

As healthcare professionals, it is inevitable that there will be times where we need to tell patients something they will not want to hear.  If you do not communicate the news in a professional and tactful manner, then the patient can be made even more upset and anxious. You want them to see you as a kind professional, not a rude and unsympathetic practitioner.

The steps for delivering bad news

This is never easy, so here I have summarised some of the key steps in breaking bad news to patients

Build a relationship

By building up your rapport with the patient, you gain their trust and you have a better foundation for the difficult conversation.

Make time

Appointment times will vary between practices, but if you do not allow sufficient time for breaking the bad news then you will rush it and this will be very poorly received by the patient, leading to them having a very negative impression of you, or not understanding what you have told them. The patient will need time to process the bad news.

Body language 

You will probably feel a little uncomfortable with what you have to tell the patient, but try to keep your body language open. Fully face the patient, make eye contact, lean in slightly, and try to keep your arms & legs uncrossed.

Setting up

Make sure you have tissues at the ready, that you are somewhere private and quiet, also make sure you are both sitting down, facing each other, with no barriers (e.g. a desk between you). If the patient has attended the appointment with someone else, then ask if they would like the person to join them; but also, if the person is already in the room, then check that the patient is happy for you to discuss things in front of the other person, so if they wish to be told alone.

Be clear and avoid jargon

Remember that you are talking to a layperson and not an optometric colleague. They will not understand some of the words we use, so try to keep it simple and try to avoid too many medical terms. Diagrams or photos can help with the explanation.

Start at the beginning

You do not want to jump straight into the problem. Start by discussing the sequence of events that have led to this point e.g. the patient symptoms, test results, etc. You can then establish what the patient already knows. Some patients will be more knowledgeable than others or simply be more aware of what is going on. If they have no idea then phrases such as “symptoms like the ones you have been experiencing can sometimes be as a result of just needing new glasses, but sometimes they can be the result of more serious underlying conditions” This acts as a ‘warning shot’ to lead the conversation.

Deliver in bite-size chunks

Giving the patient too much information at once will only confuse them. You want to break it down for them so that they can process what you are saying. For example:

“I’m afraid the problem with your eyesight is not down to needing new spectacles”


“Unfortunately, the problem is with the layers at the back of your eye”


“I’m sorry to tell you that you have a condition call macular degeneration”


“This affects the centre of your vision, which is why you have been noticing changings in what you can see”

Show empathy

This means delivering the bad news using your own feelings. You will not always fully understand how they are feeling, but you can make an effort to show that you understand. The question to ask yourself is “how would I feel in that situation?” Using statements such as “I can see this is a huge shock for you” or ”I can see this is not the news you were expecting, I’m sorry” show you have recognised their emotions.

Let them ask questions

Many patients will want to know more, such as “will I go blind?” they might of course be in shock and require a moment of silence, so leave a long pause. Do make them aware that they can come back to you at another time to ask questions. Also, make sure you are honest with your answers, rather than telling them something just to reassure or comfort them. If you do not know the answer, then say so “I’m sorry, but at this stage, I do not have enough information to answer that” as you do not want to give false hope.

Offer help or advice

Depending on the problem, there is likely to be help available that you can signpost them to. This might be leaflets in the practice, website, or details of charities, local support groups, etc. The Sightline Directory can be a very useful resource You might also be able to offer them a referral to specialist clinics, or for a low vision assessment.

Although this is never easy, you can make the situation more successful though setting up the conversation properly, taking your time, and watching how you communicate.

This series on communication skills has been written by Anthony Blackman, who is Director of Training and Development at Insight Optical Training. They offer a range of courses, qualifications, and short courses for optical support staff

Insight Optical Training is also a registered CET provider with the GOC, providing CET to optical professionals, as well as on behalf of optical suppliers.

Insight Optical

Read Anthonys previous articles here

Body Language Basics 

Written communication

The 6 P’s of Oral Communication 

The 7 C’s of Effective Communication 

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