Female doctor explains difficult diagnosis to grieving patient.

How to Handle Difficult Patient Conversations


Patient education plays a critical role in easing tough medical situations

One of the hardest parts of a doctor’s job is telling patients something they do not want to hear. That could mean informing patients that you will not prescribe the opioids they have requested, or that the reason they are not getting better is because they are not complying with treatment recommendations, or that they are facing permanent vision loss. Delivering bad news is never easy. But there are some things you can do to help make difficult conversations with patients go more smoothly.

Addressing adherence

One challenging scenario doctors must face is how to talk to a patient who is not adhering to their treatment plan. This could be a patient who continues to smoke despite a diagnosis of Chronic Obstructive Pulmonary Disease (COPD); a patient who is not following dietary recommendations despite fluctuating blood glucose levels; or a glaucoma patient who doesn’t stick with their drop regimen despite elevated IOP. According to Catherine Hambley, Ph.D., in Physicians Practice, “These circumstances are not only frustrating, but can have potentially grave consequences.”

Proactive and positive patient education is the solution to nearly every instance of non-adherence.

Doctors must understand that there are many reasons patients do not follow their recommendations, ranging from skepticism that a treatment will work to fear that they are incapable of following through. Patient education is the solution in nearly every case. Explain to patients why you are recommending a certain medication, course of treatment, or lifestyle change. Show – don’t just tell – the patient what this will do for them. Studies find that narrated animation is the best way to communicate complex health information to patients, many of whom are visual learners.

For more on this topic, see the results of our new study: The Impact of Patient Education on Perception of Care

To ensure the highest likelihood of patients understanding and following through on your advice, be proactive and positive in your efforts, Hambley recommends. Educate them beforehand – not just after they fail to adhere – and focus on the positive results the patient will experience by following the treatment plan, rather than emphasizing the negative effects that could result otherwise.

How to give bad news

Of course, some patient conversations are more difficult than others. There is no easy way to tell someone that they have cancer, or that they will soon lose their vision, for instance. No matter what the circumstances or diagnosis, however, being empathetic is key. Patients consistently rank empathy as the most important quality in a doctor.

For more on this topic, see How Patient Education Can Help Build Empathy in Health Care.

Be honest and resist the urge to minimize the truth, wrote Linda Girgis, M.D., in Physicians Practice. “Patients deserve the full and complete truth, no matter how bad it is.” Then, stop talking and listen. Some patients may be stunned into silence, while others may have questions.

There is no way to predict how a patient will respond to bad news. Dr. Girgis has found that “some of them quite expected it and are fully prepared to face the outcome. Others are so shocked that they disbelieve the data. Some may stand steadfast in the face of the worst while others break down in great anguish.”

After delivering bad news, schedule a follow-up visit to discuss next steps, and suggest the patient bring a friend to be an extra set of eyes and ears.

While patient education plays a role in this scenario as well, right after delivering bad news is not the best time to relay complicated medical information. Consider sending the patient resources later by email, or schedule another visit to discuss next steps. Suggest they bring a family member or friend to that appointment.

An optometrist who experienced sudden vision loss wrote on VisionAware.org, “I prepared for my next ophthalmologist office visit by bringing a close friend. That extra set of eyes and ears helped me immensely. My friend replayed the doctor’s advice and findings and corrected my conclusions, which was extremely helpful.”

The importance of hope

Being on the other side of a difficult diagnosis changed this optometrist – who has since regained most of his vision. “In many ways, I believe I am a much better practitioner than before,” he wrote. “I will pause an extra minute to stand or sit squarely in front of each patient, eye-level to eye-level. I will look into each person’s eyes to search for any hint of disappointment, anger, or futility. I always speak more softly now. The tone of my doctor’s voice mattered very much to me, and I think it matters to my patients.”

He also emphasized that besides empathy and educational resources, there’s something even more valuable that doctors can offer patients in tough times: hope. “I now believe that no hope is ever too remote,” he wrote.

Dr. Girgis reaffirmed this point: “No matter how bad the news, we need to give our patients some hope,” she wrote, adding that “any doctor that has practiced for any length of time will share stories of patients whose [outcomes have] amazed us.”

Patient education has the power foster empathy and improve outcomes. Get in touch with us today for a trial of our interactive patient education software.

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