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Being taught how to teach


Delivering bad news
Harold Lambert Physician
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That's another big theme that... the whole theme of communication with patients, and patient relations generally was purely implicit. It was what you picked up by what you saw for good or ill and, and I suppose what your own nature was. No, I mean, I don't think at all, I don't think anyone discussed the question of how to break bad news, what to do with dying patients, and they were all things which I found terribly difficult and, and painful and, you kind of had to learn as you went along, and although I think because of my age, I think there's a lot of... a certain amount of nonsense about the intensity and level of... of modern discussions. I do think I would have probably done it a lot better than I had done... if I'd had some teaching about, about it. You go, tend to go on making the same mistakes which...

[Q] On the other hand you've done a lot of deep thinking about it probably.

Yeah, yeah. Yeah. I think also things like patient's responses to bad news, denial. I think I told you a story about, a patient which told me what denial was about. When I... my second job was the, the surgical professorial unit with, again, a very excellent boss called Robin Pilcher, not widely known in the world, but a brilliant diagnostician, a very stern man. He seemed very yield... unyielding, unbending, but he was an okay chap and, and the children loved him. And there was a man who came in with cancer of the bronchus, widely spread to everywhere, totally untreatable, even now. I mean, cancer of the bronchus, as you know, hasn't come on all that much.

[Q] No.

I mean there's, there's treatment for one form of it, but it's amazing that most of it is as bad as it was when I was a student. So, what... I asked the ward sister to ask his wife to stay after visiting hours because I wanted to have a chat with her and she came with her sister. So I explained as best I could what the situation was and I think I came to the point, which is hard to do as you know, and told her what the... you know, it was really bad news and he didn't have long to live and stuff and there was a pause and she turned to her sister and she said, 'Thank God it's not TB'. And that taught me more about any textbook or any teaching or any lecture about denial. I mean obviously you knew exactly what was going on, but... and we've all had millions of experiences like that, but that, and I think really it's the individual episode that sticks in your mind. I mean I've listened to a million lectures in my time and I can't remember any of them, but I remember that woman perfectly clear, and I remember other things of the same ilk where you thought, that's what's, you know, what's important, what's going on.

British doctor Harold Lambert (1926-2017) spent his career tackling infectious diseases, helping in the development of pyrazinamide as an effective treatment for tuberculosis. He also published work on the rational use of antibiotics and was a trustee and medical advisor for the Meningitis Research Foundation.

Listeners: Roger Higgs

Roger Higgs was an inner city GP for 30 years in south London, UK, and is Emeritus Professor of General Practice at Kings College London, where he set up the department.

He gained scholarships in classics at Cambridge but changed to medicine after a period of voluntary work in Kenya in 1962. He was Harold Lambert's registrar for 18 months in the early 1970s, the most influential and exciting episode in his hospital training. He set up his own practice in 1975. He helped to establish medical ethics as a practical and academic subject through teaching, writing and broadcasting, and jointly set up the 'Journal of Medical Ethics' in 1975.

His other work included studies in whole person assessment and narrative in general practice and development work in primary medical care: innovations here included intermediate care centres, primary care assessment in accident and emergency departments, teaching internal medicine in general practice and establishing counselling services in medicine.

He was made MBE in 1987 for this development work and now combines bioethics governance, teaching and writing with an arts based retirement.

Tags: Robin Pilcher

Duration: 3 minutes, 3 seconds

Date story recorded: October 2004

Date story went live: 24 January 2008