“What are you most afraid of?”

By Nettie Reynolds, MDiv, hospital and hospice chaplain, retired

During my years as a hospital chaplain, I heard patients express fear in many different ways. Some asked countless questions about procedures, others worried about the transition back home, and some wanted someone to stay in the room a little longer. And there were patients who simply looked at me and said, “I’m afraid.”

For anyone working in healthcare, those words can bring an immediate desire to help. We want to offer reassurance, explain exactly what’s happening, or find something that will make the person feel more comfortable. Often, that’s exactly what patients need. But before we reassure someone, it helps to understand what’s causing their fear.

“What are you most afraid of?”

I remember a patient preparing for open-heart surgery. He told me he’d watched a lot of “Grey’s Anatomy,” and much of what he knew about cardiac surgery came from the show. He was particularly worried about pain during recovery and the possibility of depression afterward. He was hesitant to raise these concerns with the medical team, especially given how much information was already being discussed about the operation itself.

Patients bring their own experiences and expectations into every healthcare encounter. Someone preparing for surgery may be less worried about the operation than about who will care for their spouse during recovery. A patient receiving a serious diagnosis may be thinking about the cost of treatment or how their illness will affect their children. A dying patient may be worried about pain management, being alone, or feeling as though they have no say in the dying process.

One question I’ve found particularly helpful is simply asking patients, “What are you most afraid of?”For clinicians, this is an opportunity to practice empathic listening: listening not to immediately “fix” the concern, but to help reduce the patient’s emotional distress. Taking time to let patients express and process their distress can also improve overall emotional well-being.

When patients express their fears

A 2024 study published in “Patient Education and Counseling” examined how clinicians responded when patients expressed emotions during medical encounters. Researchers found that patients rated communication more positively when healthcare professionals engaged directly with their concerns, for example by taking time to share relevant information. Passive responses were associated with less favorable ratings.

Much of healthcare involves finding answers and helping people through difficult circumstances. Clinicians offer reassurance every day, whether they’re explaining a treatment plan, checking on someone after surgery, or answering the same worried question for the third time. But there are also moments when a patient’s fear doesn’t have an immediate solution. A diagnosis is still uncertain. A family is waiting for test results. Someone is facing an operation with risks that can’t be eliminated.

It’s natural to search for something encouraging to say. We want to fill uncomfortable silences or help someone see that things could turn out well. Yet a patient who says they’re frightened isn’t necessarily asking to be talked out of that feeling. They may just need you to sit down next to them and listen. Sitting at eye level with the patient matters, especially when someone is lying in bed looking up at everyone who enters the room.

Listening without trying to fix

Patients may talk about their family, regrets, unfinished conversations, faith, or the absence of faith. Someone frightened by an upcoming procedure may be remembering a painful experience from an earlier hospitalization. Or, in the case of the patient I mentioned earlier, watching a medical drama had heightened his fear of the procedure and of how it would change his life afterward. The patient’s initial expression of fear isn’t always the whole story. A simple acknowledgment helps the conversation continue. Saying “That sounds frightening” or “Tell me more about that” invites the patient to elaborate.

When fear doesn’t go away

Not every conversation ends with a patient feeling less afraid. A patient can understand their diagnosis, have their questions answered, and still be frightened. Someone nearing the end of life can accept what’s happening and continue to fear what lies ahead. Healthcare professionals encounter this regularly, especially when caring for people with serious illness or uncertain prognoses. What we can offer is an honest conversation and a willingness to stay with someone through an uncomfortable moment. Being present without being able to resolve everything is part of the work. When fear becomes overwhelming or interferes with a patient’s ability to cope, chaplains, social workers, mental health professionals, palliative care specialists, and other members of the clinical team can provide additional support.

Before you offer reassurance

When a patient says they’re afraid, three questions can help guide the conversation:

1. Have I asked what they’re most afraid of?

The concern may differ from what the medical circumstances suggest.

2. Have I acknowledged what they’re telling me?

A moment of listening can help patients feel comfortable saying more.

3. Am I responding to what matters to this patient?

Clear information, practical support, just simply listening, or the involvement of another care team member may be what they need.

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