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I’m a world expert on breaking bad news. Not because I’m some sort of empath or have any special degrees in psychology or grief management. But after several decades as an active neurosurgeon in major medical centers/trauma centers, I’ve had to break god-awful news to enumerable people—individuals whose loved ones have been killed, or are in coma, or are paralyzed from the neck down, or cannot move one side of their bodies, or can no longer speak; individuals with a newly discovered brain tumor that will take their life within a year or two, or whose entire body is riddled with cancer; whole rooms of family members who know the news about their loved one will be horrific but need to hear it from “the expert.” Do it enough and you hopefully get good at it—at easing the sting of the news without beating around the bush or soft pedaling it, at being honest but not brutal, at limiting the downstream emotional damage for everyone affected.
“TEACH”
Hopefully, most people don’t have to break such awful news or don’t have to do so with frequency. But I have to think that many of the concepts and strategies I learned through decades of delivering such information may be useful to others when facing fraught situations and communications. I’ve grouped them under the acronym “TEACH,” but for temporal purposes, I rearranged the lettering to “AETHC.”
Assess
Ask what the recipient(s) understand about the situation at hand. This will help you assess where they are in the information stream and their ability to process the forthcoming information. It will also help you identify any misinformation they may be holding onto or any misunderstanding of the preliminary information they have encountered. Also, if you are talking to a group, it allows you to identify the “key” people who must come away understanding the situation and their specific needs.
Adjust
You will have to adjust your information transfer to the recipient’s level of technical sophistication (medical or otherwise) and emotional state. You may have to greatly simplify the information or may be called upon to discuss highly nuanced concepts. Depending on the recipient’s emotional state, you may have to limit the information to the bare minimum for now, or you may need to discuss what is happening in exquisite depth and detail.
Educate
You may have to impart highly technical information (e.g., in a medical scenario). Don’t just deliver facts. Teach the components necessary for an appreciation and understanding of the facts. Initially, seek to simplify. You can always get more specific and detailed in future discussions. Solicit and answer questions. Don’t be afraid to say “I don’t know” when you don’t know. Ask the recipient(s) to repeat key points to you. Consider the use of educational materials (I used pre-made pamphlets a lot). Refer to useful websites. Gently correct misunderstandings and/or misapprehensions.
Empathy
Put yourself in the recipient’s shoes for a moment. Allow yourself to experience some of their pain and anxiety. Feel with them, not just for them. It will help you connect. But don’t wallow in it. Stay focused. You have a mission to accomplish.
Touch
Touching another person in a fraught time is so very human, almost primal, and can be calming and reassuring. It can build connection. A hand on a shoulder or on a hand is even expected in many situations and will convey more than most words can. Don’t act like there is a force field around them.
Trust
It is critical that the recipient(s) trust you as a reliable source of information. Lose the recipient’s trust, and it doesn’t matter how important or how accurate the information you are divulging may be; it won’t be received or accepted. Play the role that the situation demands. If, for example, you are a physician, look and maintain the professionalism and demeanor of a doctor. Many of the other components in this piece will help you establish and maintain trust.
Honesty
People have remarkable perceptive skills, even in fraught situations. They will know if you are misrepresenting information, hiding information, or pretending you know more or less than you do. You must seek to be honest at all times.
Even if the information is dreadful, you gain nothing by “sugar coating” critical information or “beating about the bush.” It helps no one. It can lead to false hope and permanent misunderstanding, dissolving any trust and connection you have established. On the other hand, people will respond positively to your honesty in almost any situation. You become their go-to person for reliable information. Recognize, though, that you don’t have to brutalize them with hyper-detailed, data-overloaded, or graphic honesty. Sensitivity in information transfer is always required.
Connection
The recipient needs to feel a level of connection with you. Even if you have never met before. Along with a sense of trust, a sense of connection will afford you much more leeway in what you say and how you say it.
No one is perfect at this. You will be tense and cautious. You will say things you wish you hadn’t. But you will be forgiven many missteps if trust and connection has been established. And the recipients will remember the interaction forever—for good or for bad.
Sit down whenever you can with the recipients. Make frequent eye contact. Don’t convey that you are hurried or harried. Many of the other elements discussed here will help strengthen a sense of connection.
Clarity
You can talk to someone for hours, but you have lost them if they don’t understand what you are trying to convey. And remember, the recipient will have difficulty processing cleanly due to related anxiety, fear, grief, sadness, and often anger. It is critical, then, to present the information in a straightforward and orderly fashion. Try to be succinct rather than overly verbose.
Stay away from technical jargon (e.g., “medicalese” in healthcare scenarios). Simplify without changing the nature of the information. Similes are often useful in clarification. Cliches are cliches because of their universality and recognition. Ask directly, “Do you understand what I’m saying?” Solicit clarifying questions. Know the key points you need to make—write them down if need be. Practice what you will say prior to engaging. Don’t try to wing it.
Circle Back
Repeat important concepts. Be willing to circle back (often multiple times) to solidify the most important information. Remember, the recipient may only process a fraction of the critical information in the first go-round.
This discussion will be continued in an upcoming piece.
