Having difficult conversations with patients and their family is one of the most challenging yet important responsibilities in healthcare. These conversations can involve topics like delivering bad news, discussing prognosis, setting boundaries, addressing non-compliance, or managing unrealistic expectations.

Here are some steps you can implement to optimize difficult conversations you need to have with your patient.

• Prepare ahead. Know specifically what you want to discuss with your patient. Be familiar with the patient’s medical record and any other relevant information that might impact your conversation with the patient, such as the patient’s social history. Anticipate possible patient emotions and think about how you will respond. Make sure to choose a quiet, private space where you can communicate with the patient without interruptions.
• Use clear and compassionate communication. Be empathetic – for example, saying, “I know this might be difficult to hear,” or “this is not easy to talk about, but it is important”. Avoid medical jargon and use words the patient understands. Be honest with the patient and the family.
• Listen and validate. Let the patient or family express themselves without interruption. Listening is a powerful skill which builds trust, reduces anxiety, and can improve patient outcomes. Make sure you understand what the patient is saying. Repeat key phrases and ideas in your own words to show understanding. For example, “I hear you saying that…”  Acknowledge the patient’s emotions – for example, “it’s completely understandable to feel that way” or “anyone in your position might feel overwhelmed”.
• Collaborate with the patient on next steps. Discuss treatment options and patient preferences where appropriate. Ask open-ended questions such as, “what is most important to you right now?” or “how do you feel about the plan we are discussing?” If the patient is questioning a diagnosis or treatment plan, consider referring the patient for a second opinion.
• Follow-up with the patient. It may take some time for patients and their families to absorb the information you are sharing with them. Depending on the topic of the difficult conversation, it may be important to schedule a time to follow up with the patient to ensure that they understand the issue and future treatment options and to answer any questions they may have.

These difficult conversations can be emotionally taxing on the healthcare provider as well as the patient. However, they are a necessary part of patient care. By practicing compassionate patient care, being honest with the patient, and utilizing good communication skills, you can maintain a good physician-patient relationship and improve patient outcomes.

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