As medical professionals, few challenges rival delivering serious news to patients, especially when we lack straightforward solutions. We must delicately balance honesty with empathy. Too much blunt truth risks appearing callous; too much gentle reassurance may obscure the gravity of the situation.
How we deliver serious news profoundly influences the medical decisions that follow. Patients need both accurate information and the emotional capacity to thoughtfully evaluate their options. In the absence of either, we may wonder: “Does this person truly understand their situation?” or “Is this choice really what they want?”
Despite the frequency of these conversations, most medical professionals receive little formal training in facilitating bedside discussions where emotionally-charged, complex medical decisions must be made. Here are five simple but powerful phrases that can transform these difficult conversations such that both you and your patient will feel more prepared for the important decisions ahead.
- “We are in a different place now.”
Before jumping into making medical decisions, it is crucial for patients to understand the reason for the conversation in the first place. The clinician needs to make it clear that as a team, they can’t keep doing what they’ve been doing up to this point. “We’re in a different place now” is a gentle and clear statement that establishes a pivot point in the patient’s illness trajectory. It acknowledges that previous approaches may no longer be appropriate, and it sets the tone for a conversation about shifting treatment goals.
- “I’m worried that treatment will do more harm than good.”
When facing an incurable illness, many patients are willing to try anything for a chance to have more time. It’s common for patients and families to ask, “Isn’t there a chance that more chemotherapy could help?” or “Isn’t there a chance dialysis could turn things around?” From their perspective, they have nothing to lose if another treatment attempt fails. Clinicians, however, know that some last-ditch efforts to extend life carry the risk of paradoxically shortening life instead, as can be the case with systemic cancer treatments in the last months of life. Responding to a request for non-beneficial treatments or interventions with “I’m worried that will do more harm than good” compassionately and succinctly communicates the risk of suffering without proportional benefit.
- “Help me understand your priorities.”
This request underscores the seriousness of the situation while simultaneously inviting the patient to participate in shared decision-making. It communicates that their personal values are both valuable and necessary in order to move forward. Using “priorities” rather than “wants” underscores that difficult tradeoffs lie ahead — perhaps between quality of life and longevity, alertness and stronger pain control, or care at home and a facility. For patients struggling in the wake of hearing difficult news, an invitation to discuss their priorities may be a more emotionally accessible question than “What are your goals of care?” Taking inventory of priorities can help the patient articulate what constitutes an acceptable quality of life and what factor will influence their choices.
- “Who else do you need input from?”
This question demonstrates empathy by acknowledging that the situation is serious enough to warrant careful deliberation rather than an immediate response. Additionally, the patient’s response provides insight into their readiness to make decisions during the current conversation. If the patient does not seem ready to make a decision, You will have a better understanding of their circle of trust and potential participants for follow-up discussions.
- “Would a recommendation be helpful?”
Like the previous question, this phrase helps gauge how certain a patient feels about the decision in front of them. It can also clarify how involved they want you personally to be in their decision-making process. Most importantly, it offers an opening to suggest what would be considered medically preferable based on your professional experience. Offering a recommendation that synthesizes your medical expertise and the patient’s values is essential for moving forward and providing validation to the patient about their decision.
While you won’t use every phrase in every conversation, these tools can help when discussions stall or when emotions run high. They create space for patients to process information, clarify their values, and make decisions that align with both medical realities and personal priorities. The next time you feel stuck in a difficult conversation, these five phrases may help you — and your patient — find a way forward.
You may also be interested in: “How to Talk to Your Patients about End-of-Life Care: A Conversation Ready Toolkit for Clinicians” or “How to Have Conversations with Older Adults About “What Matters”: A Guide for Getting Started”.
Matthew Tyler, MD is dual board certified in internal medicine as well as hospice and palliative medicine. He has over a decade of clinical experience caring for patients and their families in hospital, clinic, and home based settings.
Matthew is a passionate believer in the power of social media for public health education. His teaching focuses on palliative care facts (and myths) so that patients and families can advocate for the support they deserve. Matthew’s videos have garnered millions of views across a variety of social media platforms including Instagram @howtotrainyourdoctor, Facebook, TikTok, YouTube, and www.howtotrainyourdoctor.com.