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

How to Respond to Unexpected Things Your Patient Tells You


When a patient shares something that really catches you by surprise, listen closely and ask open-ended questions to fully understand their perspectives.

“I don’t want to do this anymore,” my patient said softly. I paused and moved closer to the bedside, hoping I’d heard wrong. “I don’t want to do this anymore,” he said again.


An episode of severe pain had landed him in the ED. That’s where we met, not long after the emergency physician looked at his CT scans. Bad news. I walked in to admit him to the hospital for further tests and was immediately kicked out by his family. “We don’t want to talk,” they said. I apologized and turned around, embarrassed I’d intruded on a private moment of grief for the sake of a physical.


Now, both the healthcare team and the people close to him were in action. Tests, labs, tissue samples, procedures. None of this aligned with what he told me. “Do you want my help in talking to everyone about this?” I asked.


“Why do you think I told you?” he said, smiling.


I found the senior members of the care team. Where to start? His words would derail the carefully laid plans for the day. But I had to move forward, he trusted me to help him. Later that afternoon I returned to the patient’s room, sitting with his worried loved ones. I felt a nudge at my elbow from the experienced social worker who was with me. I cleared my throat and said, “Your dad shared something with me today and I’m hoping we can talk about it.” We started a hard conversation. It wasn’t easy or perfect, but it was a start.


Over the years I’ve learned not to panic when a patient statement catches me by surprise. Instead, if someone is trusting me with something, I listen, sit with them, ask open-ended questions, pay close attention to the answers, and then ask if we can work together on next steps. Here are 4 tips for doing this:


1. When a patient shares a powerful statement, ask if they can tell you more.

Don’t assume you know what they mean or jump directly to planning.


2. Honor your patient’s trust.

Once you’ve explored what they mean, acknowledge the importance of what they’ve shared. Ask if they’ve told this to anyone else or if they want to. Sometimes you may be able to help them navigate this conversation with their loved ones. Other times they may want to talk with just you. Either way, respect the trust they place in you.


3. Leave space for emotion.

When talking with loved ones in crisis, remember that change and loss are hard. Resist the urge to fill pauses in the conversation.


4. You don’t have to figure it all out in one conversation. 

Being present and open is a great start. Offer to help figure out next steps together.


For more great tips, please check out: Vital Talk Communication Guide




This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.