Fallowfield L
CRC Communication & Counselling Research Centre, London Hospital Medical College.
Lancet. 1993 Feb 20;341(8843):476-8. doi: 10.1016/0140-6736(93)90219-7.
When bad news is broken insensitively the impact can be distressing for both giver and recipient. For the recipient especially, the effect can be longlasting. Poor training in communication skills leaves most doctors unable to give bad news appropriately. Doctors must realise what impact the news can have on the patient; must overcome fear of being blamed for the message and of a sense of failure for not being able to improve the situation; and must learn how to cope with the recipient's reaction. Doctors should prepare adequately for the meeting, ensure that the patient has understood the message, and see to the patient's immediate needs after the interview. If diagnostic investigations or therapeutic options are being discussed at the same time, giving the patient an audiotape recording of the interview is helpful.
当坏消息被麻木不仁地告知时，其影响对传达者和接受者来说都可能令人痛苦。尤其是对接受者而言，这种影响可能会持续很久。沟通技巧培训不足使得大多数医生无法恰当地传达坏消息。医生必须意识到这个消息可能对患者产生何种影响；必须克服因传达此消息而被指责的恐惧以及因无法改善状况而产生的挫败感；并且必须学会如何应对接受者的反应。医生应该为会面做好充分准备，确保患者理解了所传达的信息，并在面谈后关照患者的即时需求。如果同时在讨论诊断检查或治疗方案，给患者提供面谈的录音带会很有帮助。
