Delivering eye care is appealing to most of us because it is science, and diagnoses are often “black or white”. Either a patient has a problem, or he doesn’t. But what happens when we are faced with telling a patient some bad news? Suddenly, the familiar science turns into the art of communicating, and we are on shaky ground.

Without question, this is a deal breaker in terms of patient–doctor relations. Deliver the news well, with compassion, and you’ve earned a fan for life. But deliver it in a methodical, impersonal manner, and you’ve not only alienated a good patient, but you’ve done harm to him as well.

In this impersonal, digital, fast-paced world, taking the time to deliver unfortunate news carefully is more important than ever. So, how do we practice the “art” of delivering bad news?

The news we have for patients may range from “You’re not a good candidate for wearing lenses overnight” to “You have a suspicious pigmented spot in the back of your eye that could be a problem.” My personal experience—and the advice of experts1,2—has led me to derive a protocol for delivering bad news.

1. Take your time. There’s no better way of communicating concern for your patients than this. Talk slowly. Relax your posture. Sit down with your patient at eye level.1 This gesture says, “You are important to me”. A patient who feels valued is a loyal patient.

2. Get to the point. Provide details and reasons after you deliver the bad news. The patient is waiting for the verdict, and it is frustrating for him to have to wait.

3. Allow the patient time to process the news. After hearing bad news, a patient’s head is reeling. He needs time for it to sink in. Don’t be afraid of silence during this time. It may take a few minutes before the patient responds, particularly if it is exceptionally bad news.

5. Be prepared for an emotional response. Tears and anger are to be expected. Reflective listening, or empathetically stating what you see, is an effective technique when dealing with emotions. Offer tissues when needed.

6. Give the explanation. Provide answers as you are best able without using a defensive tone of voice. The bad news you are delivering may be a result of your patient not achieving the comfort or vision with contact lenses that he expects. Reframing the situation may help.1 Understand that although a patient’s anger may appear to be directed toward you, he most likely is actually mad at the situation.2

7. Allow the patient to ask questions. Encourage communication by asking, “Do you have any questions?” Reassure your patient that questions may occur to him later and that he should feel free to call for clarification should he need it.

8. Offer hope. Is there any good news you can give? If so, be sure to end your patient’s appointment on this note. Sometimes just sincerely saying, “I’ll be here to help you however I can” is sufficient. Make suggestions for support services, talking books, magnifying lenses, driving services and counseling. These resources can be a great help for someone adapting to a big life change.

9. Think of how you would like to be treated. The golden rule does work! When in doubt as to what to do, ask yourself, “What would I want someone to do if the roles were reversed?” Although it sounds simple, this is sometimes a difficult exercise. The terminology, equipment and diagnoses have a certain familiarity to us that a patient doesn’t share. This is a new experience for your patient; try to understand it from his perspective. Doing so can provide an extra dose of patience for a busy practitioner who has other patients waiting.

There are as many suggestions on how to handle the delivery of bad news as there are eye care practitioners, and the ones I have listed here may not be right for you and your temperament. But take the time to evaluate your own techniques. Ask yourself, “Can I be doing better?” Make time to chat with other practitioners and share ideas.

Few tasks are as challenging or as rewarding as developing an expertise in the “art” of delivering bad news. I look forward to hearing what works best for you.