How to approach difficult conversations with patients?
As clinicians, we often see patients avoiding the conversations that matter most (about risks, interventions, or end-of-life care) because they’re uncomfortable. Unfortunately, avoiding these conversations doesn’t make them easier. It only makes them harder for both the patient and the family.
I recently experienced this personally when my mum ended up in hospital after a fall. Sitting by her bedside, I had to navigate topics no one wants to discuss - home safety modifications, surgical risks, and CPR preferences. At first, she dismissed me: “I don’t need rails, Dan, I’m not old.” But after a fall where they thought she had broken her neck, denial wasn’t protective; it was risky.
To help mum make a decision, I used the same approach I use with patients. I defined the likelihood and the consequences of the event:
Likelihood of an event: Low, medium, or high.
Consequence if it occurs: Mild, moderate, or severe.
For my mum, the risk of another fall was high, with potentially severe consequences. I also reframed the decision from “feeling old” to “feeling safe”. The change helped her engage and make choices she could live with.
Why this matters in practice
In chronic pain management, surgical decisions, or advanced care planning, it’s easy to default to vague reassurances: “It’ll be fine.” Hope is valuable, but hope alone is not a clinical strategy.
A strategy is:
Engage the patient, family and key others in the conversation.
Explore what the patients would want in worst-case scenarios. (This is a really difficult bit)
Build a shared decision based on three scenarios:
Patient gets better
Patient gets worse
Or patient stays the same
Write down decisions and confirm everybody understands.
These structured discussions don’t remove uncertainty, but they make family discussions easier, and they make difficult decisions more comfortable when you know the person you’re making them for as part of the process.
Takeaway for clinicians
Don’t shy away from difficult conversations. Use structured frameworks, clarify risks and consequences, and align decisions with your patients’ values. Your role isn’t just to treat symptoms, it’s to guide, support, and create space for meaningful choices.
Because ultimately, clinical expertise is not just in procedures or prescriptions. It’s in helping people navigate uncertainty with clarity, courage, and compassion.
🎧 Want more practical tips on navigating tough conversations with patients? Listen to episode 32 of the It’s Not In Your Head podcast, where Justine and I break down real clinical scenarios and give tools you can use in practice.