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Bad news is bad news. There is no honest way around it. People living with multiple sclerosis (MS) are well aware of this fact. We receive bad news at a higher rate than most other people and we have, some rather grudgingly, come to accept this fact.

How we react to bad news is a completely different animal. Reactions vary as much as the people having them. 

There is not always a good way to tell a patient bad news, but it is always worth trying. Healthcare providers (HCPs) can consider breaking bad news as a process rather than a singular event. This approach can make it more manageable on both sides. Compassion for and the trust of MS patients is the beginning of that process. It starts before any specific piece of bad news. 

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Generally, there is no set definition of bad news. In health care, the definition tends to be simpler. Tests yield results. Results are good or bad, with a sliver of room for grey. If you are living with a chronic illness, the grey might be smaller. The grey of “we don’t know” or “let’s wait and see” feels like a harbinger of doom. This is one of the reasons that a doctor’s relationship with his/her patient matters. 

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When an HCP has taken the time to know the patient under their care, it generates a well of goodwill and trust that can be drawn upon at difficult times. The time that would normally be spent considering how to break the bad news could be better spent contemplating the issue at hand. 

People living with MS are used to being told unfavorable healthcare news. From the time of initial diagnosis, we are prepared for bad test results to appear. It may be related to new symptoms or relapse or a change in status. MS presents itself nearly everywhere in the body, so the opportunities for undesirable outcomes are par for the course. How it is presented by the HCP does make a difference because we are still human beings who are not immune to pain.

Be upfront about receiving the results and reviewing them. It is disingenuous to start a song and dance when it is likely an appointment was made specifically to discuss results. Pleasantries, please. The old soft shoe? No, thank you. If it is unclear how to broach the subject appropriately for a specific patient, it is never a bad idea to let the patient lead the discussion. 

You might ask if they have any questions about the purpose of the test or if there are any questions about the process. The patient’s response might provide clues on how to proceed. It could even solicit an answer that will solve the “how to break it” quandary. Whichever way it is given, the bad news has to get to the MS patient. 

If breaking bad news is a process with a good relationship at the start and presenting the news in the middle, follow-up is the final part of the trifecta. Once undesirable results, or other information, is passed along there should be a period of time for the patients to ask questions or express their emotions. Getting bad news never gets easier. 

As a person living with MS, I do not shake off all bad news simply because I have gotten a lot of it. For starters, with MS there is always the potential for something new to pop up. The cold feet might be nerve damage. That new muscle tightness? It’s permanent. These are first-time issues.  

Think of it as going through the checkout line for each item on your shopping list. You do not get to do it all at once. You do not get to stay in place after each transaction. You go back in line every time. The MS HCP is the checkout professional in this process. It makes the return journey less bumpy for patients our HCP handles the transaction with grace. 

Doctors who have people living with MS as patients should get used to breaking bad news. MS is a chronic illness with the possibility of undesired outcomes at any time. The HCP who is better prepared to skillfully deliver bad news in the best way possible for each person is valued by their patients. It is a skill well worth learning.