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simont

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Mon 2010-08-30 11:25
A generalised musing

What's the best way to receive bad news?

Is it better to have something unpleasant announced to you completely out of the blue, so that you go straight from having no idea anything was wrong to being fully aware of what is? Or is it better to have some sort of foreshadowing, before the full awfulness is made clear to you?

One form of foreshadowing could be that you first find out that something is wrong, but don't know exactly what. So you might speculate as to what it could be, and think up a variety of possibilities. You'd turn those over in your head, and get used to them all at least in hypothetical terms. Then, when you find out for certain which one of them is true, you're at least slightly prepared for the blow, and you can also at least be relieved that it's none of the worse possibilities (assuming it didn't turn out to be the worst of the lot). On the other hand, if any of the things you thought of was much worse than the reality, you'd have suffered a lot of avoidable worry if it happened this way. (Also you might feel very silly if you'd overlooked the real answer when thinking up your various possibilities.)

Another foreshadowing option would be to get rid of the certainty rather than the detail: instead of knowing for sure that something's wrong but not knowing what, you might see hints that lead you to suspect the particular thing that's wrong, but not yet know whether or not it's true. That way you at least don't worry about totally different possibilities that are far worse than the real one, but you still have the opportunity to get used to the idea in your head before you have to deal with the certainty that it's happened.

If you think either type of foreshadowing is good, is there an optimum length of time between hint and revelation? Does it even count as foreshadowing if someone says ‘I'm afraid I've got some bad news for you’ a few seconds before telling you the whole thing? At the other extreme, once you've had the worrying hints, is there a length of time to spend worrying beyond which it was more painful done that way rather than less?

Or does the best one of the above options depend very much on what type of bad news it is? (What subject area, or what approximate level of badness, or some other distinguishing factor such as whether anything can be done to mitigate it.)

Or are these all much of a muchness? Perhaps with any bad news worth its name the unpleasantness of the thing itself vastly outweighs the differential nastiness of the various paths from blissful unawareness to horrible certainty.

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[identity profile] 1ngi.livejournal.comMon 2010-08-30 10:39
There's that bit in the Big Bang Theory where Leonard's mother comes to visit comes to mind:

Leonard: [nervously] So Mother, what's new with you?
Mrs Hoefstader: Well I've been have some interesting menopausal symptoms recently.
Leonard: [coughs] I was thinking of something a little less personal?
Mrs Hoefstader: Oh, let me see - oh yes, your Uncle Floyd died.
Leonard: [recoils in shock] Oh my god - what happened?
Mrs Hoefstader: His heat stopped beating. [stands up] I need to urinate.

Which for me perfectly shows why a gentle warning preamble is probably a good idea - for really bad news.

For minor things, I suspect it's better to just come out with a kind 'I'm really sorry - I couldn't get the Jedward tickets that you wanted for your birthday.'
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[identity profile] feanelwa.livejournal.comMon 2010-08-30 10:45
I prefer the first kind of foreshadowing because it's entirely up to me, rather than the second kind which means not only could all these things be wrong, but there's this person who probably has a position of responsibility for fixing whatever is wrong, who has been thinking that it's one particular problem and now if/when it turns out to be a different problem I not only have to do all the stuff to deal with the problem but I have to work on disillusioning this important yet probably moronic person of the preconceived idea they have that it's a different problem but won't yet tell me the full story. This is especially true with doctors where (a) they are the gatekeeper to ways of not dying, (b) they have the power to traumatise me for the rest of my life, (c) they usually have a whole lot of other information that they're not telling the patient because they decide you're stupid, (d) they passed medical school through being good at rote learning and therefore probably don't actually know how anything works or have the capacity to assimilate new information and figure out what it means, (e) they can and will prescribe drugs that make you too dizzy to make decisions properly, before they tell you the important information that you need to think about.

The best way to receive bad news is from a computer where you have access to all the relevant information and something to break. People somehow seem to be remeber to get offended by swear words in the most ridiculous circumstances.
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[identity profile] feanelwa.livejournal.comMon 2010-08-30 10:54
(Before any men point out that I am being a hypocrite by assuming most doctors aren't good at working things out yet object to doctors thinking I'm stupid:
1) It's my body and I'm the one who is helpless to fix it; their foolishness is more damaging than mine.
2) Doctors usually are a bit stupider than me but more intelligent than most of their patients.
3) They are relying on a bunch of notes in which any mistakes or inconvenient pieces of information* have been cunningly omitted by the person who heard them, I know what actually happened.)
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[identity profile] feanelwa.livejournal.comMon 2010-08-30 11:20
Also: I have Mondayitis, please excuse my non-obvious partial exaggeration and spelling mistakes.)
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[identity profile] feanelwa.livejournal.comMon 2010-08-30 12:53
I can see where you're coming from, but while some people don't want to hear everything, some of us really really do - and it's the information medical staff rarely seem to think is important that in the short term we really want to know, like "in a few hours, we want to do this routine procedure, in which the following things happen" and "when you wake up, there will be this kind of dressing, which will be removed in ... hours, which will hurt, so if you are going to stop taking opiates, after that is the best time". These are the things that differentiate patient from piece of uniformly consenting meat. I appreciate most of your patients are in extreme life or death situations and various states of consciousness; my perspective is from being awake and terrified by a sudden barrage of assailants who could consult me about what they're doing but chose to pretend my mind was not really there. Also, I would like to be the judge of my emotional strength, rather than somebody who has known me for two hours.

I do regret coming on so strong with the "doctors are stupid" angle, I'm sorry, that was unfair. I have met some doctors who listen and think and are great, and some who seem to just follow an algorithm of what step comes next even when presented with some really important information.
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[identity profile] feanelwa.livejournal.comMon 2010-08-30 13:54
I was under the impression you were in ICU all the time! Oops.
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[identity profile] feanelwa.livejournal.comMon 2010-08-30 12:40
I meant in a non-emergency scenario where the person actively asks the system for the information in a background of their own choosing, for example finding out your ancestors were slave traders in some kind of genealogy search. In an emergency situation where the status of the person and their support network is changing quickly and they are in a place they didn't choose to be, they need somebody like you. I should really have made the context I was thinking of clearer, sorry.
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(Anonymous)Mon 2010-08-30 10:55
What a pointless post. Your last few posts haven't been terribly good, either.

I have unsubscribed from your blog.
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[identity profile] xraycb.livejournal.comMon 2010-08-30 12:05
No foreshadowing required for this news, I feel.
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[identity profile] twigletzone.livejournal.comMon 2010-08-30 11:15
I would much rather be warned bad news is coming and given an idea what's in it by someone I know is on my side. I've spent too much time around people who like twisting any news they're trusted with to their own ends.
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[identity profile] sunflowerinrain.livejournal.comMon 2010-08-30 12:27
I'd rather have some warning and some hint as to what type of thing has gone horribly wrong, and I don't mind from whom. Sudden bad news can lead to the embarrassment of fainting, or the extra fright of heart-going-mad.

I agree with feanelwa that getting bad news online is useful.
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[identity profile] sphyg.livejournal.comMon 2010-08-30 13:46
> I agree with feanelwa that getting bad news online is useful.

Except when being dumped by email ;/
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[identity profile] feanelwa.livejournal.comMon 2010-08-30 14:08
Email is probably better than in front of a class you are teaching, or while trying to hide silently from prowling Nazis, or on a plane on the way to your honeymoon, or while holding a forehead-sized rubber stamp saying "I blow goats" with permanent ink all over it when your soon to be ex partner is an undertaker with ten funerals to do in the next week and all his colleagues off sick, or while trying to land a 747 full of screaming passengers with a stuck undercarriage and one engine. None of these things have happened to me, fortunately.
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[identity profile] ixwin.livejournal.comMon 2010-08-30 16:09
I'd rather have at a brief "I'm afraid I have some bad news" first, but then be told more or less straightaway. If there's going to be a gap of hours or days before being told the news, I'd actually rather the worse possibilities were eliminated in advance as in "I've got some bad news I'd rather tell you face to face, but it's nothing life-threatening"
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[identity profile] ewx.livejournal.comMon 2010-08-30 22:14
Conversely, what is the worst way to be told bad news?
I feel that an XML schema should be involved somehow.
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[personal profile] simontMon 2010-08-30 23:07
Via a UML diagram, perhaps?

(Post-pizza tonight briefly entertained the idea of translating pieces of Shakespeare into UML behaviour or interaction diagrams...)
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[identity profile] cartesiandaemon.livejournal.comTue 2010-08-31 11:23
Hm. I'm not sure if any sort of warning is necessary, rather than just traditional. But I think it probably is, if only to let you react in a socially appropriate way, rather than say "what, did you really say that?"

I think giving a sort of generalised warning is reasonable, and probably prefer the second of your options, but that's because what I really, really want to avoid is suggesting that the news might be worse than it is.

"I'm afraid I've got something to tell you" is just awful, because it makes you immediately imagine ALL the possible worse scenarios, and (I don't know if other people agree but) I really hate being momentarily terrified to no good purpose.

I'd prefer the warning clearly bounded above how bad the news way. If a close friend or relative hasn't died or been deported, you don't really want to spend much time imagining that they have, and if they HAVE you don't really want to spend much time worrying about the other one either.

And you REALLY REALLY don't want to spend that much emotional investment if someone wants you to make a minor, sensible and inconsequential change to a piece of software.
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[identity profile] meirion.livejournal.comTue 2010-08-31 13:11
Foreshadowing makes me catastrophise. Just tell me the bad news already and get it over with.
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[personal profile] rmc28Tue 2010-08-31 20:59
I hate all delay between hint that something is wrong and full detail. "I have some bad news" is all I need to get me to focus. I really really hate e.g. the kind of letter from the GP that says "please come and see me about your recent test result for X" because then I have too long to fill with worrying.

There are some things that may take a long time to unfold all the bad news (e.g. a cancer diagnosis - I am thinking of this rather excellent article on terminal illness), but the initial news "I have some bad news, I am afraid you have cancer of the X" is not one I want danced around.
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