Giving sad and bad news.

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.