Empathy and difficult conversations

“Empathy and sensitivity” is one of the three assessed domains. Look for empathy in what an option does: listening, acknowledging a concern, explaining honestly or arranging help. You can recognise someone’s distress without agreeing with everything they say or promising a result.

The GMC expects you to treat patients with kindness, courtesy and respect, to respect their dignity and privacy, and to be considerate and compassionate to those close to a patient.

Responding when someone is upset

Strong options usually do some of the following, roughly in this order:

Find a suitable place and time. Allow privacy and enough time to listen.
Listen and acknowledge. Let the person say what is wrong, and recognise how they feel.
Clarify the facts. Ask what’s happened and what they understand so far.
Explain honestly within your role. Say what you know, what you don’t know and who can answer the rest.
Agree a next step. Arrange a senior conversation, follow up a delay, or explain how to make a complaint.

Weaker options skip straight to defending the team, blaming a colleague, making promises you cannot keep, or ending the conversation.

Angry patients and relatives

Usual starting point: stay calm, take them somewhere private, listen to the concern and address it or arrange for someone who can.

What could change it:

Safety. If someone is threatening or violent, protecting yourself, staff and patients comes first. Withdraw and seek help, such as security.
Confidentiality. Before discussing a patient’s care with a relative, check the patient’s wishes. Anger does not create a right to information. See patient decisions and confidentiality.

Acknowledge what’s gone wrong and explain what you know. Keep speculation about a colleague’s fault out of the conversation.

Complaints

The GMC says you must respond promptly, fully and honestly to complaints, and must not allow a patient’s complaint to adversely affect the care or treatment you provide or arrange.

Usual starting point: try to resolve the concern directly if you can, and tell the person how to raise a formal complaint if they want to. The Patient Advice and Liaison Service (PALS) in England, or the local equivalent, can help them find the right route. Let your senior know.

Common weak options include discouraging a complaint, treating the patient differently after one, or responding defensively. Telling someone how to complain is not an admission of fault; it respects their right.

Breaking bad news and uncertainty

As an F2, you may not be the right person to give significant new diagnoses, but you can still prepare and support.

Usual starting point: do not give significant news you are not equipped to give, or that the patient has not yet heard from the responsible team. Explain the limits of what you know or can discuss, and arrange for the right person to speak to them promptly. Answer honestly within your competence.

What could change it: if the patient directly asks and you know the answer, outright deception is not acceptable. “I want to make sure you get a full explanation. I’ll ask the doctor responsible for your care to speak with you” can be an honest next step if you follow through. Only promise a time once it’s confirmed. “Everything is fine” would be misleading if you know it isn’t.

Give news privately, check what the person already understands, and offer the chance for someone they choose to be present.

Cultural, religious and personal needs

The GMC says you must treat patients fairly, must not discriminate, and must not let your personal views affect your relationship with them or the treatment you provide or arrange. You must not express personal beliefs in ways that exploit vulnerability or could cause distress.

Usual starting point: ask the patient what matters to them and accommodate reasonable requests, such as a clinician of a particular sex, dietary or prayer needs, or a family member being present.

What could change it: where accommodating a request would cause clinical harm or significant delay, explain the situation honestly and look for the best available alternative. If you have a conscientious objection to a procedure, you must ensure it does not prevent the patient from accessing appropriate care.

Intimate examinations and chaperones

Before an intimate examination, explain why it is needed and what it involves, get consent, and offer a chaperone.

Usual starting point: offer a chaperone and respect the patient’s choice. If no chaperone is available and the examination is not urgent, postponing until one is available is often more appropriate than proceeding.

Weak options include proceeding without explanation, using a relative as a chaperone by default, or examining under pressure to save time.