Words Matter: The Way Physicians Deliver “Bad News” Can Result in Detrimental Consequences

Delivering medical diagnosis is a sensitive practice that requires deliberate and thought out action. Of course, this isn’t always the case, and sometimes patients receive bad news in a way that might feel cold and apathetic. The American Journal of Roentgenology recently published a report documenting two cases in which patients committed suicide after receiving letters from their physicians detailing “bad news”. The report ultimately determined that doctors should take precautions when delivering an unwanted diagnosis, and that “bad news” is best expressed in person.

In the first case, an Israeli man who suffered from depression was diagnosed as lung carcinoma. When he received a letter from his radiologist and oncologist stating, “Pathological uptake in a mediastinal lymph node, less prominent than before”, he committed suicide several hours later. The man’s attorney insisted that the doctors were aware of the patient’s fragile mental state, and should have known that mailing his diagnosis could trigger a violent reaction. In the end, the judge ruled in favor of the man, explaining that “the defendant could have sent the results directly to the referring physician…who would be able to explain the clinical implications of the results of the report.”

In a similar case in Missouri in 1984, a woman was diagnosed with lung cancer and underwent a brain CT scan before her treatment. Although the neurologist determined the scan to be normal, the unit’s staff had to submit a Medicare claim form. The neurologist wrote “brain tumor” as a provisional diagnosis to comply with payment regulations. Due to the woman’s request to receive all insurance form copies, she read the document with the diagnosis, and became deeply depressed. That night she committed suicide.

In both lawsuits, the physicians were accused of aggravating their patients’ severe depression. According to a study described in the report, 70 percent of physicians believe that receiving these reports via postal service could “unnecessarily frightened” patients.  The Colorado Supreme Court ruled that doctors are negligent when disseminating information in this way. The judges wrote, “in recent years, however, while psychiatry and psychology may not be exact sciences, they can now provide sufficiently reliable information concerning causation and treatment of psychic injuries. Therefore, if the defendant’s conduct is negligent in causing either bodily harm or emotional disturbance to another, the defendant is not protected from liability.”