Breaking Bad (News) Lives On

says Anthony Orsini, DO, a neonatologist at Morristown Medical Center in Morristown, N.J.

Orsini is the founder of the Breaking Bad News (BNN) program – a model he developed to train both residents and experienced physicians in the oft-neglected art of sensitively and effectively communicating bad medical news.

Training consists of an individual 45-minute session that includes improvisational role-playing with professional actors who portray patients or family members. The session is recorded and reviewed by participants with a certified BNN instructor.

I’ll bet many healthcare providers can count on one hand the amount of time they’ve spent receiving any formal training in how to deliver bad medical news to patients and families.

And to make the challenge even more difficult, every situation is unique. There is no textbook answer on how to break bad news, and poor communication is the reason for 40% of medical malpractice lawsuits, according to a press release from the BNN Foundation.

Which is why Orsini developed the BNN model of experiential learning more than 10 years ago.

“We are meeting people at the worst moments of their lives. What we say and how we say it can make the experience even more devastating. But if it’s done well, that is the moment when healing can begin,” he said.

An essay in the Journal of Clinical Oncology tackled this problem. The authors noted five reasons why oncologists said they shy away from breaking bad news — such as patients will get depressed or they will lose hope. But the essayists noted that patients want to hear the truth.

Although Orsini has been practicing and pushing his Breaking Bad News model for 10 years, the training program was adopted for the first time only last year, by Goryeb Children’s Hospital of Morristown Medical Center.

It was an instant success, says Patricia Eaton, MD, a pediatric resident and graduate of the BBN program. “It brought me back to why I wanted to be a doctor to begin with.”

To date, more than 100 physicians from several specialties with various levels of experience have been trained.

“It seems almost cruel to give medical residents training in almost everything else in medicine and when this very important thing comes up, there is no experience and no guidance. I think it’s not a luxury to do something like this. It’s a necessity,” says Karen Knops, MD, chief of palliative care at Morristown Medical Center.

The BNN program has since expanded to two other New Jersey hospitals and plans are in the works to extend the program to neighboring states.

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