By Johnny Green –
Here are some great frameworks to add to your toolkit.
1. Breaking Bad News (SPIKES Framework)
DO:
“Is this a good time to talk?” (Setting)
“What do you understand so far?” (Perception)
“I’m sorry to tell you…” (Knowledge)
Silence + tissues > “Don’t worry” (Empathy)
DON’T:
Blurt out diagnosis abruptly
Say “You’ll be fine”
2. Consent (POWERCHART Mnemonic)
Cover:
Procedure
Outcomes
Why needed
Efficacy
Risks
Choices
Helpful questions?
Any concerns?
Reassurance
Time
Script: “The LP takes 15 mins. Main risk is headache (1 in 10). Alternatives are blood tests but they’re less accurate.”
3. Angry Relative (CALM Method)
Script:
1. “I hear how frustrated you are.” (Connect)
2. “It’s awful seeing her in pain.” (Acknowledge)
3. “What’s worried you most?” (Listen)
4. “Antibiotics won’t help viruses, but we can…” (Manage)
Never: Argue or say “That’s not my problem.”
4. Handovers (SBAR Template)
30-Second Script:
S: “This is Dr. Lee referring Mr. Khan, 55, with STEMI.”
B: “BP 90/50, given aspirin + morphine.”
A: “Needs PCI within 90 mins.”
R: “Can you accept him now?”
5. Capacity Assessment (4 Checks)
Ask:
1. “Can you explain your condition?” (Understand)
2. “What did I say about risks?” (Retain)
3. “What are pros/cons of leaving?” (Weigh)
4. “What’s your decision?” (Communicate)
If no capacity: Involve seniors + document.
Top 3 Life-Saving Tips
- Pause 3 seconds after bad news
- Nod + “Mm-hmm” to show active listening
- Safety net everything: “Return if ‘X’ happens.”