Whilst examining the patient, the clinician should be developing not only a view of the problem, but also the way to most effectively explain the situation to the patient.

if it is. or may be, bad news, it may be useful to give the patient warning before a word is spoken - by the use of nonverbal cues, particularly facial expression. It is preferable to have any accompanying relative present, with the patient's agreement, as a common, automatic reaction to unwelcome news is dissociation, which prevents the patient taking in anything else.

The way in which the doctor presents the information is as important as the substance of the information; compassion is as important as factual accuracy. This is also important when convoying 'good' news. Otherwise patients may get the impression that they have been accused of wasting a clinician's lime. Although all patients should have the opportunity of having their condition fully discussed, some patients, especially the elderly, do not wish a detailed explanation, Denial is a coping strategy. Such patients' wishes should be respected. The key to success is the ability to be natural and flexible and to recognise that each patient presents a unique situation. The principles of communicating the content include the following.

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