Navigating Difficult Discussions

Giving bad news or even doing something that seems rather benign like prescribing patients a new medication can sometimes be difficult for them. Rebecca Andrews, MD, FACP, professor of Medicine and director of Primary Care, UConn Health says one of the most important starting points when counseling patients and having conversations that bring them news is to come from a place of empathy.

“I would encourage providers to think about any conversation as potentially difficult; what one person finds upsetting might be different for someone else. And you don’t always know what’s going on in the person’s mind, so approaching with empathy and the possibility that you might need to navigate tough waters is one piece of advice,” Andrews said. 

She says it is important to not sugarcoat the truth but get to the heart of the matter. And she says giving patients the reasons for their recommendations is a keystone in having a difficult conversation.

Andrews presented a scientific session, Communicating Effectively When You Don’t Want to: Practical Strategies for Difficult Conversations with Patients, Staff, Administrators and Other Clinicians at this week’s ACP conference being held in San Diego.

When there are treatment options be sure to offer them so patients can regain some control over the situation.

And when talking with staff or colleagues and broaching a conversation with them, Andrews says it helps to come with curiosity and interest in the person. “I might be talking to a physician colleague and there might be something going on in their life that they have kept private that is affecting their performance at work, or their arrival time—be willing to hear that first rather than make assumptions,” Andrews said.

For staff, she says it can also be helpful to drop what might be a power differential between the provider and the support person and see how they are doing before jumping into what might be a reprimand or something more serious.

Contagion spoke to Andrews about the value of harnessing this skill and offers some resources on the topic.