Activity 13: Observe a Physician Breaking Bad News



Observe a physician breaking bad news to a patient and his or her family members. This bad news does not have to necessarily be a fatal diagnosis, it could be as small as an unpaid bill or a diagnosis of the flu.


1)   Students will gain insight into how to break bad news effectively by observing the physician’s gesticulations, body movement, and diction.

2)   Students will learn how to respond and react to the initial reactions of patients and their families receiving bad news.

3)   Students will understand how to comfort patients and family members while maintaining a professional exterior.


Any medical setting in which physicians can receive important information regarding patient health. Our suggestions for this location are:






-primary care facilities

Recommended Preparatory Reading:

McLauchlan, C.A.J."Handling Distressed Relatives And Breaking Bad News" BMJ: British Medical Journal. Vol. 301, No. 6761 (Nov. 17, 1990), pp. 1145-1149.

Barclay, M., Colleti, L., Gruppen, L.,  Stern, D. "Teaching Students to Break Bad News" Am J Surg. Vol. 182(1):20-3 (2001 Jul).


The estimated time frame needed for this activity would be 45 minutes to one hour. This gives ample time for the physician to approach the patient, deliver the news, comfort the patient and respective family members, as well as assess treatment options.

Appropriate for:

Undergraduate or graduate students wanting to pursue a career in the medical field.

Activity Description:

You will be observing the interaction of a doctor with the patient and the family when the health care provider is breaking bad news. Place your focus on how the medical provider includes (if at all) the family in the medical course of action.

1.     When you have time, take notes on the following items:

-How often the doctor asks for the family’s opinion

-If the doctor listens to what the patient and the family suggests

-If the doctor gives the patient and family options or if he simply states the course of action

-The demeanor of the doctor when they are breaking the bad news

-How the doctor transitions from breaking the bad news to deciding the course of action

2.     After you have evaluated all aspects of the interaction and taken notes, evaluate your experience. How did the doctor’s demeanor affect the patient’s cooperativeness in decision-making? Do you think the doctor should include the patient’s family members when making decisions or just strictly make decisions with the patient? How did the healthcare provider handle upset patients/family members?

3.     After analyzing your notes and the questions above, write a 500-800 word reflection about your experience.

Think about the following questions to guide your reflection:
-What were your expectations before you shadowed the physician? Did the experience live up to your expectations? If not, why was this?

-What did the physician do well when breaking bad news? What did you feel as though the physician could have improved on?

-How did the patient and their family handle the news? How did the physician react to their emotions, or lack thereof?

-How did this activity make you feel regarding your potential future job in the medical field?

Author: Stephanie Hayden & Kennedy Karem