When Patient Portals Break Bad News

Electronic patient portals facilitate communication between providers and patients, but they can complicate the art of breaking bad news. Nearly half of oncology patients will view their diagnosis on a patient portal before speaking with a provider. Physicians and advanced practice providers receive training on how to deliver bad news in person and over the telephone. This is done in an empathetic and supportive manner. The patient's emotions are acknowledged, and questions are answered. While surveys of patients suggest that most people prefer an in-person or telephone conversation to receive bad news, the electronic portal can undermine this delicate conversation when oncology reports are prematurely accessed. Military providers should be aware of the impact electronic portal usage may have on patients. We provide suggestions for providers to adjust their practice accordingly, such as warning patients about their early access to results prior to a planned follow-up visit. We also suggest that MHS GENESIS, the electronic health record for the Military Health System (MHS), allows for sensitive reports to be released to patients after the results are discussed rather than automatically after 36 hours. Electronic portals streamline patient-provider communication and increase transparency; however, we should consider that the task of delivering bad news was never meant for computers.