Bad tidings and the hospitalized patient

The physician in hospital practice may be faced with a situation in which a patient under his care suffers a bereavement or some other unexpected tragedy but is unaware of the fact. Three such cases encountered in the context of our psychiatric sonsultation service are presented. Factors influencing the decision as to whether, when and how the patient should be informed are considered. The complex psychodynamic situation which arises and involves the patient, his family and the medical staff is described. Stress is laid on the role played by archaic fears of being the bearer of evil tidings. The situation is seen as being ideally handled by the direct treating physician in conjunction with the family, the extent of psychiatric intervention being dictated by the needs of each of the parties concerned. Ideally the patient should be told as soon as his physical and mental condition are seen as conducive and preferably before he leave hospital.