How to Have a Difficult Conversation About Brain Illnesses

How and When to Talk about Your Illness

Choose the Right Place and Time

Find a place and time where you will be uninterrupted. Try to choose a private and comfortable location, such as an office or bedroom where you can close the door as needed.

Turn off your cell phone, Blackberry, land line and the television. When discussing difficult topics such as a terminal diagnosis or a diagnosis of Alzheimer's or dementia, it is important to be fully focused on the conversation.

Choose a time when you and the person or people you need to speak with are more or less relaxed and not focused on another activity, such as preparing dinner or picking up kids from school.

Be Honest and Realistic

Most people who are receiving bad news, especially a medical diagnosis related to their brain health, already have some idea that there is a problem. They might even intuit that the problem is serious. Bearing in mind the constraints set by how much detail they want to know, be as honest as possible about the topic at hand and the likely outcome.

However, miracles do happen, and people who have some optimism and hope - however unlikely - have a higher quality of life and are more motivated to do what they need to do. Always allow room for hope.

Show Empathy

A gentle touch, the offer of a tissue to wipe away tears, even a moment alone while people absorb what you have talked about are all ways to let the people in the conversation know you understand their feelings about these difficult matters.

Expect some anger at times, and try not to react. Anger is a normal reaction to bad news.

Things You Should NOT Say or Do:

  1. Don't use the phrase "I know how you feel"
  2. Don't use euphemisms for the diagnosis or the prognosis
  3. Don't fill silence with more words
  4. Don't ignore cultural or language barriers

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American College of Physicians


Written by Madeline Roberts Vann, MPH

Reviewed by George T. Grossberg, MD

St. Louis University School of Medicine

Department of Psychiatry