Don’t Hide Behind the Bushes
I once heard a lecture by the author of the famous book, When Bad Things Happen to Good People. In his lecture, Rabbi Kushner chronicled his emotions after being told that his son would die at an early age. When the news became public, he said he noticed that his friends came by to visit less often and the neighbors seemed to hide behind the bushes when he pulled his car into the driveway; a phenomenon that I have since called the "Bushes Effect". Why were they hiding behind the bushes? It's simple, they were avoiding the uncomfortable conversation. Often when someone receives tragic news we want to help but just don't know what to say. We feel uncomfortable and awkward. So instead, we try to avoid contact all together by hiding behind the metaphorical bushes. Rabbi Kushner ends his lecture by giving the best advice I have ever heard: "Say you're sorry and just shut up."
Whether you are discussing tragic news with a patient or consoling your teenager after breaking up with her boyfriend, silence can be a very powerful tool. Being silent doesn't mean we don't know what to say. On the contrary, it means we know when it's best to say nothing.
Sitting quietly while a patient or family member cries is not an easy thing to do. As physicians, parents or friends, we have a deep desire to say something or do something to help. This is particularly a problem with physicians who train for years learning how to heal. When the news is not good, we don't know what to do. We feel awkward, so we speak endlessly about the pathophysiology of a disease or explain the events that led to the tragedy. Intuitively, we know that the patient is in no state to process all of the information we are giving them, but we continue to speak, not because it's helping but because it makes us feel better.
Talking endlessly is, in fact, counterproductive. We simply can't fix the situation by speaking. We can only help by just being there. Sitting quietly with a patient after delivering bad news tells the patient or family member that you are comfortable with the situation and in no hurry to leave. It tells them that you are there for them and immediately builds a strong relationship.
In the end, after hearing tragic news, your patient wants to know three things: that you are here for them, that they can depend on you to carry them to the next step, and that you are not going to leave them. All three of these can be accomplished simply by sitting quietly.
So, the next time you are delivering bad news to a patient or sitting with your daughter while she cries over a boyfriend, resist the urge to speak. It won't be easy. Simply say you're sorry and just shut up.
I hope you will continue to read my blog.
Anthony Orsini, D.O.
Neonatologist & Vice-Chairman, Winnie Palmer Hospital for Women and Babies in Orlando, FL
Founder & President, BBN