Chapter 1: Communication essentials

What to say, what not to say

The palliative care expert says
Dr. Mike Harlos identifies common communication pitfalls. (3:22)Video transcript
I've been there
Neenu explains the cost of thoughtlessness. (3:22)Video transcript

There are common statements that are well meaning but can be hurtful. In his book Scenes of Compassion, American Paramedic Captain Timothy Dietz, identifies several comments paramedics should avoid. To assist you, some alternative statements are provided that are respectful and help to build relationships. 

Open ended prompts that are exploratory, relationship building, and respectful also can work well.

Below are examples of what NOT to say. Click on the buttons to reveal what to say and why.

You are strong and handing this very well.

This statement may speak to your own need for someone to be strong. It’s usually an attempt to coach the person and is often not appreciated by families, who may feel their struggles aren't being seen. Almost no one feels strong during these trying times. With the right words, strength can be respectfully acknowledged while at the same time validating how hard it is to be “strong” in the circumstances.

What to say: I hope you don’t mind me saying so, but I admire the ways you’re managing the stress of all this. It can't be easy.   

I know how you feel; I totally understand.

It’s impossible to know how someone else really feels. Even if someone you cared about died recently, the experience won’t be the same. While this may be a well-meaning attempt to empathize, it shuts down a conversation instead of opening one up – and in so doing may anger the person. Try instead to invite the person to tell you something about their relationship with the patient and the feelings they now have.

What to say: I can’t begin to imagine what you’re feeling. Would you like to tell me a bit about how things are for you just now?

Time heals all wounds.

The passage of time may help as the grieving person begins to integrate the loss and perhaps gain insight. However, most people won’t hear or appreciate that sentiment in the immediate aftermath of a death.

What to say: I can’t speak to the future. It may be very difficult in the time ahead, and I hope you’ll find ways to take care of yourself. 

She led a good life.

This deflects the conversation away from the person’s grief, much like the statement, “Look on the bright side.” It also is an assumption. Do you know for a certainty the person led a “good life?” It’s best to avoid making assumptions.

What to say: Do you want to tell me about your sister and her life?

Be thankful for what you have.

The only message families will hear is: “Things could be much worse so stop complaining.” 

What to say: Tell me about what’s working and what’s not working so well for you at the moment?

This deflects the conversation away from the person’s grief, much like the statement, “Look on the bright side.” It’s also is an assumption. Do you know for a certainty the person led a “good life?” It’s best to avoid making assumptions.

What to say: Do you want to tell me about your sister and her life?


Referring to patients and family 

Avoid using the term “loved one” as the relationship may not be grounded in love at all. Also avoid terms like "dear" or "sweetie" or "honey" which can be seen as condescending. Instead, refer to the person by name or relationship. 


Conversation Prompts

How was Fred feeling when he woke up this morning? 

 How long has your sister been experiencing this symptom?

Avoiding jargon

Avoid the trap of using medical jargon such as acronyms and terminology unique to paramedics and health care. Most families won’t understand; they may be too embarrassed to ask for an explanation or worried you’ll be upset if they interrupt. Their anxiety will increase if they don’t grasp the information you’re sharing.


Conversation Prompts

Avoid:  He’s febrile and tachypnic. He also clearly has edema. Do you know if his venting PEG has been bothering him?

Instead say:    He has a fever and his breathing is rapid. He also seems to have some swelling. Has he complained of any pain here (pointing), where he had this procedure done?  


Words to use  Words not to use
She has a fever. She's febrile.
He's dying.
He's slipping away.
He's died.
He's passed on.

In most situations, use clear terms like “dying,” “dead” and “died” rather than euphemisms such as “passed on.” These can be misleading and open to various interpretations.