Takeaway
Before delivering difficult news to patients, build rapport through conversation and presence. The trust you establish will allow them to receive the message not from a stranger, but from someone who's already shown they care.
Connecting with patients | August 20, 2026 | 2 min read
By Sebastian Stein, MD, Centro Latinoamericano de Economía Humana, Montevideo, Uruguay
I was a medical student the first time I understood that one room could hold four entirely different worlds at once. By the door, an 18-year-old post-op from a motorcycle accident and his mother perched at the edge of his bed. Across from him, an older man with advanced lung cancer, his wife beside him. By the bathroom, a man with decompensated chronic kidney disease. And by the window, an older woman, alone. And CT scan on her chart showed an abdominal mass.
The ritual of mate
I followed the doctor into the room and waited. Who would he approach first? He stopped into the center of the room. In one hand, a mate, a traditional Uruguayan herbal infusion, shared among those gathered through a single metal straw. In the other, a thermos of hot water.
“How could Nacional play so poorly against Peñarol?” the doctor asked. Uruguay divides cleanly in two in terms of football (or soccer, as it is called in the U.S.)—you either support one or the other, Nacional or Peñarol, and there’s no neutral ground. The 18-year-old was a Peñarol fan. The man by the bathroom, a Nacional fan. The wife of the patient with lung cancer covered her mouth to hide a smile. The doctor refilled the mate in the middle of the debate and passed it to the young man’s mother. The woman by the window said something under her breath that made everyone laugh, including herself. 15 minutes. One thermos. Four corners, softened into a circle.
Delivering hard news
The doctor then pulled a chair close to the woman with the abdominal mass. Not at the foot of the bed, but beside her. It seemed she sensed what he was going to say. He spoke quietly. The mass. The next steps. What it likely meant. She didn’t say anything at first.
The room was filled with a warm feeling from the light-hearted football debate. The physician placed his hand over hers, and she turned her palm up to hold it. That was it. No other words needed. She’d spent 15 minutes laughing with this man, passing the same mate, sipping from the shared straw. He was no longer a stranger. He was someone she already knew, telling her something difficult to process.
Lessons learned
Uruguay’s public hospitals don’t always have the resources needed to provide optimal care. The rooms are crowded, the waits are long, and the mate isn’t a hygienic ritual. But it’s an intimate one, and it invites closeness. That doctor taught me lessons I’ve taken into clinical practice.
1. Build trust and rapport before delivering hard news.
The football debate, the ritual, the laughter. None of it was wasted time.
2. Sit beside, not above.
Pulling up a chair and sitting at eye level beside the patient conveyed more than any words could. This simple gesture conveyed respect and presence.
3. Let silence do some of the work.
The patient didn’t need the silence filled. Holding hands was enough.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.