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It’s All in the Delivery: Improving Healthcare Starting with a Single Conversation

It's All in the Delivery: Improving Healthcare Starting with a Single Conversation

By: Anthony J. Orsini, D.O.
Publisher: West Essex Press
Publication Date: March 2020
ISBN: 978-1-09830-447-8
Reviewed by: Barbara Bamberger Scott
Review Date: April 1, 2020

Anthony Orsini, the author of the fact-filled book It's All in the Delivery, is a medical practitioner who has devised his own method of patient care based on better communication.

Anthony J. Orsini, whose memories comprise a portion of this guide, always wanted to be a doctor, and undertook one of its more difficult specialties, neonatology. In that field, there were many stressful occasions to give bad news to parents of a newly born or very young infant. That, and an experience he had had during his studies of observing a doctor he much admired conveying bad news badly and admitting it, gradually spurred him to tackle the problem of practitioner-to-patient interaction as his personal passion.

In a brief historical survey, Orsini points out that only recently, in the late 19th century, did science begin to undertake compassion as a major component of a doctor’s methodology. Once modern medicines and new technologies were discovered and “doctors were holding instruments instead of hands,” the template for medical practitioners became a generally accepted neutralization of feelings. This trend continued, until some stumbling blocks arose, among them the recent trend for medical facilities to conduct patient surveys that emphasize customer service. Another is malpractice suits, 71% of which, Orsini reports, are based around miscommunication on the part of the physician.

Learning of a training program using actors, often amateurs, to play the role of patients so that prospective doctors could practice delivering bad news, Orsini went a step further, engaging professional actors and setting up realistic situations for training residents and senior physicians. This facilitated the gradual design of The Orsini Way, also known as “Breaking Bad News: P.R.O.G.R.A.M.” The acronym stands for Plan/Position, Review, Observe, Gradual/Genuine, Relationship, Accountability, and Meet. These steps, illustrated in text and photographs, are based on three essential principles: the patient/family should feel that the medical practitioner understands and cares, that s/he is the expert and will lead them to the next steps, and that s/he will not abandon them.

Orsini’s vivid medical case studies lend credence to his highly organized text, underpinned by the positive testimonials of participants in his BBN P.R.O.G.R.A.M. He offers simple directives for a practitioner-patient/family session: set up chairs in preparation for a meeting; make sure the doctor is positioned close to the family, not at a “professional” distance; reach out with the hand to symbolize compassion rather than holding it up as a signal of control; break bad news gradually; imagine oneself in the situation of the person receiving the news; and make a commitment to stay in touch through all future phases of treatment. The BBN P.R.O.G.R.A.M, so clearly delineated, promises authentic outcomes, not only to practitioners searching for new approaches, but for anyone who has ever been a patient, hoping for a sense of security and real comfort when it is most needed.

Quill says: Orsini’s method has already met with acclaim and his book will doubtless find a solid niche in a new age of medicine, as outreach and communication will take their rightful place in patient care.

For more information on It's All in the Delivery, please visit the author's website at:

Author Interview

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