Stop explaining, stop talking.

One of the places in medical education where I am well-convinced that we are still failing our trainees is teaching them how to have hard conversations. It’s simply not a part of the curriculum, so they rely on role modeling; as we know, that role modeling is as likely to be negative as it is to be positive. We also know that our students lose empathy over the course of their clinical training, and that the loss of empathy contributes to physician burnout and all of the negative repercussions associated with burnout.  And, of course, there’s the simple issue of the fact that no one actually enjoys delivering bad news and having hard conversations with patients and families.  It’s emotionally easier to not have the talk, or to deliver platitudes, or even to provide that little bit of false hope they can grasp on to so you don’t have to be the bad guy or bad girl.

The erosion of empathy has been a long interest of mine for both personal and systemic reasons.  Personally, I know I suffered from a tremendous (and in hindsight somewhat embarrassing) loss of empathy during the 100+hour workweeks of my residency, and that paucity of empathy applied to pretty much everyone, not just patients and families. I’m not saying I do it right 100% of the time now, but I’ve at least developed a tool set so that I’m usually aware if I’m entering an empathy-loss danger zone. And, of course, I’m interested at a systemic level because of the impact that empathy loss has on professionalism and our ability to work effectively as a team member or leader.

In order to remind everyone about the difference between empathy (healthy, connecting) and sympathy (not healthy, disconnecting), here’s a brief video lesson:


So, empathy is feeling with people. Courses are being developed to help us respond to patients and families in a more empathetic manner, and those courses often prescribe similar interventions:

  • Give the patient/ family, not the computer, your undivided attention.
  • Sit down!
  • Avoid medical jargon. Remember that part of medical school was learning that 2nd language of medicine- how would you explain this to your Aunt Velma, the 3rd grade teacher?
  • How you say it may matter as much as what you say.
  • If the patient is telling you about their feelings, don’t respond to them with facts. Doing so implies that you’re not hearing them.
  • When you’re scheduling a hard conversation, allow more time than you expect it to require.  This is not a time to be in a hurry.
  • Stop explaining. Stop talking.  Sit in the silence, no matter how uncomfortable it makes you. I love the quote that “doctors are explainaholics” (because we are).  Again, stop talking. It’s amazing what you can learn when you give people time and space to share with you.

As an additional aside, I would add that fostering these communication skills is also helpful for having hard conversations as a leader. While some of the details are different (you can probably use medical jargon with a junior colleague if it’s needed), all of the other rules absolutely apply.

Empathy is hard. It requires work, and it’s something we have to practice routinely in order to become good at it- much like being a surgeon, being a musician, or being a person. We need to recognize when we’re offering up unhelpful silver linings (or sandwiches) rather than genuinely connecting.  It’s scary, but it’s also worth it for our patients, their families, our colleagues, and ourselves.


5 thoughts on “Stop explaining, stop talking.

  1. I think it is difficult to even role model these difficult conversations. For example, I’m a third year on my surgery rotation. We recently had a patient die unexpectedly in the OR. The attending surgeon and anesthesiologist left the residents and students in the OR while talking with our patient’s family. While I don’t expect them to have taken everyone, I would hope at least one or two of us could go. While I understand our presence in the room may upset some families, we can’t learn to have these conversations if we never observe them. Throwing trainees into the deep end once they become attendings will be more upsetting to families than having one or two trainees present.

    1. Eddie, you are 100% correct. We have to consciously walk a line between including people so they can learn and not letting a family meeting turn into a “show.” I recently had one where I started excusing people simply because we had too many people there for the sake of curiosity- but taking a learner or two, it’s almost always good.

  2. Fantastic post Amalia! The importance of empathy cannot be overemphasized during medical training and in clinical practice. Loss of empathy really is a sign of overwhelm and of potential danger ahead. I love this video Brene Brown narrated and am so glad you shared it because she illustrates the true meaning of empathy well.

    Fortunately as you have indicated empathy can be fostered and learned.

    Thanks for sharing!

    1. My junior partner and I now have a running joke thanks to this video. “Mmm…want a sandwich?”