Robert Buckman. 223 pages. Baltimore: Johns Hopkins University Press; 1992. $15.95.

In a recent exercise at our medical school, expert physicians from different specialties demonstrated for medical students the process of giving a patient bad news. Each clinician gave the same patient (a trained actress) the news that she had breast cancer. Students commented afterward that none of the physicians really listened to the patient, none gave her the chance to share her concerns, and none directly responded to her questions. These same observations are heard whenever patients talk about their physicians. As physicians we are too often guilty of not listening to our patients and of not knowing how to discuss bad news.

Everyone has a general feeling about what constitutes bad news. Further, most of us have been in situations in which we have needed to tell others news that will negatively and drastically alter their view of the future. Fewer physicians, however, have developed an ability to relate this news with compassion, empathy, and a facility to handle various responses from the patient. Medical textbooks and books on doctor-patient relationships acknowledge the importance of giving patients bad news, but none address the issues with practical suggestions, case scenarios, or detailed explanations.

This short, easy-to-read book fills this void and has a great potential to improve the way clinicians understand the process of breaking bad news. The book features clear writing, believable examples, and practical suggestions. Topics such as basic communication skills and a simple six-step protocol for breaking bad news fill the book's six chapters. The chapter entitled "The Patient's Reaction" is particularly enlightening; it details the basis of specific patient reactions to bad news and offers concrete suggestions for how to deal with these reactions.

One problem with the book is the redundancy between chapters. Several chapters would be more effective if they were less rambling. Despite these flaws, clinicians of every specialty and skill level will benefit from How to Break Bad News. Further, it should be required reading for all medical students and residents who plan to take care of people.