Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

How do you share hard news with your patient?


Read thoughtful tips from a pediatrician, chemical dependency specialist, critical care specialist, and a cardiologist.

Connecting with Patients | May 4, 2018 | <1 min read


Michael Crocetti, MD, Johns Hopkins Community Physicians

Sharing hard news with patients is one of the most difficult things we do.

When sharing hard news I suggest:

1.) Use plain language and succinctly share the news.

2.) Don’t surround the news with unimportant information that can distract from key points.

3.) Sit at the level of your patient, match their emotion in a caring fashion, and use a heart-head-heart communication style.

4.) After delivering the news stop talking and allow your patient to fully absorb the news.

5.) Use a caring touch if that’s what your patient needs and say, “We’ll get through this together.”

6.) Stay with your patient and give them the time they need to consider the information, listen, and answer questions with honesty.

Mike Fingerhood, MD, Johns Hopkins University School of Medicine

1.) Ask about your patient’s support system (family and friends) in advance, perhaps when you order lab tests.

2.) Be to the point in presenting the news.

3.) Have your patient’s support system present if possible to hear the conversation, as patients most often do not fully “hear.”

4.) Close with, “I’m here for you,” and, “can we talk again by phone later this week?”

What do you think?

Do you want to add to the conversation? Please share!

Panagis Galiatsatos, MD, Johns Hopkins University School of Medicine

Build on the relationship you have with your patient.

Your relationship helps with delivering the bad news, especially since you can draw from personal insight of the patient and their family.

Finally, avoid build-up and try to address the bad news first and let the remainder of the time be focused on next steps.

Roy Ziegelstein, MD, Johns Hopkins University School of Medicine

No one would think of walking into a packed auditorium to deliver Grand Rounds without preparing beforehand. Yet the truth is that years down the road, perhaps even days down the road, very few, if any, in the audience will remember what was said.


When you share difficult news with patients, everything you say and how you say it will be remembered. To deliver difficult news without thinking about how you will do that before walking in the room is irresponsible, in my view.


I try to put myself in the patient’s position. I try to “dose” information appropriately for the patient. Just like a person may not be able to take 12 pills at once, a long explanation with lots of information may not go down smoothly. I make sure that the patient has understood by using the so-called “teach back” method, and I make sure the patient knows I am available and will be there whenever needed.