There is a scene from the Netflix show, Sexual Education in which two siblings are sitting in the waiting room of an emergency department (or A&E as the Brits call it). They had been called in because their mother was admitted to the hospital and they were awaiting news. Eventually, someone comes to call them in to talk to them but instead of bringing them to a hospital bed, the door opens to a private sitting room.
I remember that scene clearly because, while nothing was said, the implications were clear. The news was dire. In the show, the characters find out that, indeed, their mother had died.
That scene came back to me as I was reading Microskills: Small Actions, Big Impact by Dr. Resa E. Lewiss and Dr. Adaira Landry. One passage in particular stayed with me, not just because of what it said, but because of what it made me remember.
I’ve written before about how medicine must be a safe space and why we have to protect that. This passage reminded me that the soul of medicine is not abstract. It lives in the people who show up along the way, the ones who teach us how to sit with someone’s grief, how to deliver truth with care, and how to carry the hardest moments with clarity and compassion.
And sometimes it requires taking people into those rooms to give them the worst news of their lives.
Learning to Deliver Bad News
The story in the book was about learning how to give bad news. In emergency medicine, this is a skill we are expected to learn early: how to be clear and direct, but still kind. We must stay grounded in the face of someone else’s fear. And, most importantly, we must give them the clear information they need to understand that someone is very sick or has died. The last thing anyone needs in that moment is more confusion when they are already in pain. Our job is to reduce fear, not add to it.
That is why we use a structured approach when we deliver devastating news. It is not because we are cold or robotic. It is because doctors are human too, and it is hard to speak into someone’s heartbreak. There were times I would feel emotional, but that moment was not about me. The structure helps us make sure we do not miss anything important. It stops us from softening the truth too much, speaking too quickly, or forgetting what the family needs to know. We cannot remove the pain, but we can remove confusion and be empathetic.
Medical Education is an ongoing set of skills
I learned this skill about six months into my residency. I was working in post-Katrina Louisiana, in an ER filled with trauma, loss, and very sick patients. I had already seen death, but our attendings usually spoke to the family in those cases.
One day, Dr. Mike Cuba turned to me and said, “All right. It’s time. You’re doing this one.” Or, in true Southern fashion, “Alright, you’re up.”
He did not leave me to figure it out alone. He gave me a way to walk through it step by step. He explained how to say it, when to pause, and how to listen. He made sure I knew how to offer presence and empathy as well as the needed information. He taught me not just for that family, but for all the ones who would come after.
That was almost 20 years ago. I still use what he taught me every time I speak to families. And I have taught it to others.
Why Structure Matters in the Hardest Conversations
Clear, step-by-step communication is not just for the physician’s benefit. It is for the patient and their family. In moments of high emotion, even the most experienced doctor can let their tone, pace, or choice of words dilute the message. A structured approach protects the truth. It ensures that even when our own voices shake, the person in front of us hears what they need to know. This is not about detachment. It is about discipline. We can be deeply human and still precise. We have to be.
Passing the Skill Forward
While I have said these skills are not about ‘me’, we don’t forget them or take it for granted. We do get affected; some patient stories have stuck with me for decades. Ultimately, we all have grief and loss in our lives. This is a needed understanding that only comes with experience of being a doctor and human.
Every time I teach a trainee how to deliver bad news, I think of Dr. Cuba standing beside me in that Louisiana ER. His lesson was about more than the right words. It was about presence, compassion, and the courage to speak with honesty.
These skills are not documented in medical charts or measured by exams. They are passed from one doctor to another. With each passing on of those skills, they evolve. If we do not teach them, they disappear. I make a point to hand them down every chance I get.
The Quiet Promises We Keep
In medicine, we take a public oath. But we also make quieter promises. We promise to keep learning, not just from textbooks or conferences, but from the hardest moments we live through. Every patient lets us into their story, and we carry that into the future.
We promise to teach what we have learned, because someone once took the time to teach us. And because we want those who come after us to be a little more prepared than we were.
Most of all, we promise to remember and to do better: the patients, the teachers, the lessons that shaped us, the words we said when there were no right words, and the wisdom someone handed to us when we needed it most.
I am grateful to my attending for trusting me with one of the hardest moments in medicine and for doing it with patience and care. I have never forgotten it. And I am grateful to Resa E. Lewiss and Adaira Landry for writing Microskills and prompting this memory.
We do not practice medicine alone. We never have. We always strive to do better and be better. That is the nature of our oath.
If this resonates, subscribe below. I write from the intersections of medicine and meaning, technology and trust, healing and humanity. These stories aren’t just about being a doctor. They’re about what it means to show up, to witness, and to keep learning long after the training ends.
So true! I remember the first time I heard an attending deliver bad news. As a medical students, I was amazed by her compassion. I soon learned there’s a method. Structure helped me take her off the pedestal and learn the method myself.