Use mnemonic 'FEARED' when breaking bad news. (A Structure For Difficult Conversations).

SEA ISLAND, GA. -- Call it the FEARED factor.

It's the apprehension young clinicians feel at the prospect of being the bearer of bad obstetric news, such as neonatal death, to distraught parents, Dr. James R. Woods said at an ob.gyn. meeting sponsored by the Medical College of Georgia.

But the mnemonic FEARED also can provide a structure for the difficult discussion that may prove pivotal with regard to future litigation. Follow this sequence, Dr. Woods advised:

* Facts. The first concern is to provide the parents with the facts of the case, based on the chart and hospital course, and to establish a foundation for the rest of the discussion.

* Empathy. Expressions of empathy should acknowledge that the caregivers will try to understand what went wrong and will help the family deal with the issues they face.

* Anger. The most difficult question the caregiver needs to ask is whether the patient feels angry, and if so, where those feelings are directed.

If the patient acknowledges anger toward the doctor, the follow-up response is quite straightforward: "I am sorry you feel that way, but it is understandable. Please tell me how you arrived at that conclusion," said Dr. Woods, professor and chairman of the department of obstetrics and gynecology at the University of Rochester (N.Y.).