By Dr. Anthony Policastro

One of the things you learn in medicine is that giving bad news is usually associated with a period of the patient digesting that information. During that period of time, they are not attentive to anything else the physician is saying.

In pediatrics this frequently centers around significant birth defects. Parents have waited nine months for a healthy newborn. When they hear otherwise, they tend to immediately go into the stages of grief. 

The first of these is denial. They cannot believe this is true. Maybe the physician has made a mistake. Maybe they heard wrong.

While this is going on, they tend to not hear the information that follows. The bottom line is that physicians need to understand this. It means repeating the same information at a later time.

It helps to write things down or make them available electronically. However, there needs to be a realization that doing so might actually invite more questions. If those questions are not answered, it can breed confusion.

Add to this the fact that there are so many questions that they often are not all remembered. Therefore, the family also needs to keep a running list of questions so that none are forgotten.  

There are also some expectations that the physician needs to understand. One of the things I knew about parents whose infants had birth defects was the “Why” question. Why did it happen? What caused it?

A standard part of my explanation involved addressing that. Sometimes we have an answer. Then it can be explained. Sometimes we do not have a specific answer.

For example, we know that many birth defects are what we call multifactorial. That usually means that the patient needs to have a certain genetic setup. Then there may be an exposure to a factor that causes the birth defect.

One example of this is fever. We know that maternal fever during pregnancy can increase birth defect risk. But it does not happen to every baby whose mother had a fever.

One thing that parents do when there is no obvious reason is try and come up with their own explanation. I used to make sure that there were two items I covered in detail. 

The first is to tell the mother that there was nothing she did that caused this to happen. There were a number of times, I had mothers chalk up a birth defect to a fall they had during the pregnancy.

The second is to tell the mother that there was not something she neglected to do that caused this to happen. Again, some mothers I spoke to tried to blame it on missing prenatal vitamins for a period of time.

If we do not specifically address issues like this, a parent may spend the rest of their life blaming themself for something that they never caused.

Bad news is difficult to give because of the reaction it gets from the patient. However, there are some things to remember when doing so that will help lessen that reaction.