The results are back and they're not good. You have to say so plainly, in English, to someone who will stop hearing you about four seconds in — and then make sure that what you said is what she takes home.
The Scene 🎬
She knows before you speak. Everyone does — it's in how the appointment was made.
You are the doctor. The scan is back, it shows what you suspected, and Marta Nowak is sitting in front of you having taken the morning off work. You have to tell her, explain what happens next, and be certain she leaves with an accurate picture rather than the one her fear invents in the car park.
Two things make this hard in a second language. The first is that plain words are essential and plain words are the ones that feel bluntest to say — there is a strong pull towards softening it into vagueness, and vague is cruel, because she will fill the gaps with something worse. The second is that "Do you understand?" gets a yes from absolutely everybody, and tells you nothing.
The skill here is a small set of phrases that let you be plain, and then check properly.
In your culture, how directly is bad medical news given? Is it given to the patient first, or the family?
Has anyone ever explained something important to you badly? What was missing — the information, or the way it was delivered?
YouThe doctor. Certain of the medicine, working in English, and aware that how you say the next four sentences is what she'll remember for years.
MartaFifty-eight. She has guessed. She will stop taking anything in about four seconds after you say it, and she will say she understands when she doesn't.
First: read the conversation in the next tab. Notice how short the sentence delivering the news is, how long the silence after it is, and that the doctor says nothing at all until she does. Then watch how understanding gets checked — it is never "do you understand?".
The Conversation 💬
The same room, three weeks later.
YouCome in, sit down. Is anyone with you today?
MartaNo. My husband offered but I said — well. I said it was routine. It's not routine, is it.
YouBefore I start — what are you expecting me to say?
Marta…Something bad. You don't get a Tuesday appointment for good news.
YouI'm afraid it's not the news we were hoping for. The scan shows a narrowing in one of the arteries in your neck. That's what's been causing the episodes.
Marta…Right. Right. So it is — it's like my mother, then.
YouI'm going to give you a moment.
Marta…Sorry. Sorry. Go on.
YouDon't apologise. Let me answer the question you actually asked, because it matters. Your mother had a stroke. What you have is a warning sign that a stroke could happen — and it's one we can treat. Those are very different situations.
MartaTreat how? Is that an operation?
YouPossibly, and I'll come to that. In plain terms, what that means is the artery is furred up and narrower than it should be, so at times your brain isn't getting quite enough blood — which is why it happens when you stand.
MartaRight. Yes. That makes sense, actually.
YouWhat I'd like to do is start you on two tablets today and refer you to the vascular team, and the reason is that the tablets reduce the risk straight away while we're waiting for their opinion. Are you happy for me to go ahead with that?
MartaYes. Yes, whatever you think.
YouJust so I know I've explained it properly — what would you tell your husband when you get home?
MartaThat I've had a stroke but a small one, and I'm on tablets for it.
YouThat's the bit I've explained badly, then — let me go again. You have not had a stroke. There's a narrowed artery which puts you at risk of one, and everything we're doing today is to stop that happening. Nothing has happened to your brain.
YouCompletely different. Try that again for me — what do you tell him?
MartaThat there's a narrowing, and it's a risk, and I'm on tablets to stop it turning into anything.
YouThat's it exactly. I can't give you a guarantee. What I can tell you is that we've found this early, and early is the good version of this. If anything changes before the appointment, I'd rather you rang than waited.
From memory — don't scroll back up.
Before giving the news, the doctor asks one question. What is it, and what does it achieve?
Marta gets it completely wrong when asked to say it back. What did she think — and how would the doctor have known if she hadn't asked?
How does the doctor take the blame for the misunderstanding, and why does that matter?
1. "What are you expecting me to say?" It tells the doctor how much she's already guessed, so the news can be pitched to what she's braced for rather than dropped cold.
2. She thought she'd already had a small stroke. She'd said "yes" and "that makes sense" twice before that — so without the check she would have gone home, told her husband she'd had a stroke, and lived with it.
3. "That's the bit I've explained badly, then." It puts the fault on the explanation rather than on her comprehension — which is what makes it safe for her to be wrong again on the second attempt.
Useful Phrases 🧰
Ten phrases for giving news nobody wants and making sure it lands accurately. Every one works in any specialty — and several work far outside medicine. Say each out loud BEFORE you reveal it.
Say it like you mean it. Slow, level, and then stop. The commonest mistake — in every language — is to keep talking after the sentence that matters, because the silence is unbearable for the person who spoke. Everything you say in the ten seconds after the news is lost anyway. Say it, then let the silence do its work. It will feel much longer to you than to her.
🎯 Before you say it
Phrase 1
The job: finding out what they've already worked out, so you pitch it correctly. Which question?
A. "How have you been since we last met?"
B. "What are you expecting me to say?"
C. "Now, try not to worry before I start."
B — "What are you expecting me to say?" A delays and makes her perform small talk while she's braced. C is the worst thing available — telling someone not to worry before bad news guarantees they will, and spends your credibility before you've started. B is standard practice for a reason: her answer tells you whether you're confirming a fear or delivering a shock, and those need completely different next sentences.
Take it anywhere: "What are you expecting me to say?" — useful before any difficult news, clinical or not.
💔 Saying it
Phrase 2
The job: the warning shot — half a second that lets them brace. Complete it:
"I'm afraid it's not the news we were ___ for."
"I'm afraid it's not the news we were hoping for." Standard British clinical English, and it does one precise job: it signals bad news is coming without yet delivering it, giving the patient a beat to prepare. "We" is deliberate — it puts you both on the same side of the result. Follow it immediately with the plain fact; if you linger here, you're softening into vagueness and she'll invent something worse.
Take it anywhere: "I'm afraid it's not the news we were hoping for." Works for any bad result — medical, legal, an application, a test.
Phrase 3
The job: handling the silence after the news — without filling it. Complete it:
"I'm going to ___ you a moment."
"I'm going to give you a moment." Six words that convert an awkward silence into a deliberate one. It tells her the pause is intentional and permitted, so she doesn't feel she has to perform composure for your benefit — and it stops you filling the gap with information she cannot take in. Say it, then genuinely stop. Count to ten in your head if you need to.
Take it anywhere: "I'm going to give you a moment." Any time you've said something that needs absorbing.
🔎 Explaining plainly
Phrase 4
The job: switching from clinical language to everyday language, out loud, so she knows the next sentence is the one to hold on to. Complete it:
"In ___ terms, what that means is…"
"In plain terms, what that means is…" Announcing the translation is as useful as the translation. It tells her that what follows is the version to remember, and it gives you licence to be simple without seeming to talk down — you've flagged that you're choosing to be plain, not that you assume she's slow. It also buys you a second to find the simple words in English.
Take it anywhere: "In plain terms, what that means is…" Essential in any expert-to-non-expert conversation: law, finance, engineering, IT.
Phrase 5
The job: proposing what happens next, with the reason attached — because a plan without a reason gets agreed to and not followed. Put the pieces in order:
and the reason is…What I'd liketo do is…,
"What I'd like to do is ___, and the reason is ___." The second half is what produces compliance. Patients who know why they're on a tablet keep taking it; patients who were simply told to take it stop when they feel better. "What I'd like to do" is also gently collaborative — a proposal rather than an instruction — which sets up the consent question that follows.
Take it anywhere: "What I'd like to do is ___, and the reason is ___." One of the most useful professional frames there is.
Phrase 6
The job: getting explicit consent, simply. Say it out loud, then write it.
e.g. "Are you happy for me to go ahead?" Short, unambiguous, and it requires an actual answer. "Happy" is doing something specific — it asks about her comfort, not just her permission, which leaves room for her to say no or hesitate. Note that consent is asked after the plan and the reason, never before.
Take it anywhere: "Are you happy for me to go ahead?" Any point where you need someone to actively agree rather than passively not object.
✅ Checking it actually landed
Phrase 7
The job: finding out what they've genuinely understood. This is the most valuable phrase in the lesson. Which version actually works?
A. "Do you understand?"
B. "Just so I know I've explained it properly — what would you tell your husband when you get home?"
C. "Is that all clear?"
B — "Just so I know I've explained it properly — what would you tell your husband when you get home?" A and C get "yes" from virtually every patient, including the ones who have understood nothing — saying no means admitting you're slow, in front of a doctor, on a bad day. B is different in two ways. It puts the burden on your explanation, not her comprehension. And it asks for a real-world retelling, which is the only reliable test — Marta answers it wrongly, and that error is caught in the room instead of being lived with for years.
Take it anywhere: "Just so I know I've explained it properly — what would you tell ___?" Use it in any handover, briefing or instruction.
Phrase 8
The job: correcting a misunderstanding without embarrassing them — take the blame yourself. Complete it:
"That's the bit I've ___ badly, then — let me go again."
"That's the bit I've explained badly, then — let me go again." She has just got it seriously wrong, and how you respond decides whether she'll risk answering honestly a second time. Putting the fault on your explanation costs you nothing and keeps her willing to be checked again. Never "you've misunderstood" — even when they have.
Take it anywhere: "That's the bit I've explained badly — let me go again." Works with patients, clients, students, colleagues.
🤝 Closing honestly
Phrase 9
The job: reassuring without promising anything you can't deliver. Put the pieces in order:
What I can tell you is…I can't give youa guarantee.
"I can't give you a guarantee. What I can tell you is…" The two halves are inseparable. The first is honest and would be bleak alone; the second gives her something true and solid to hold — here, that it was found early. Patients trust a doctor who refuses to promise far more than one who says everything will be fine, because they can tell the difference and they remember which you said.
Take it anywhere: "I can't ___. What I can ___ is…" A universal frame for being honest about limits while still being useful.
Phrase 10
The job: setting the safety net — making it easy for them to come back. Say it out loud, then write it.
e.g. "If anything changes before then, I'd rather you rang than waited." "I'd rather you rang than waited" is the important half — patients routinely wait because they don't want to be a nuisance, and this removes that in advance by telling them which option you prefer. It's warmer and far more effective than "contact us if you're concerned", which leaves them judging whether their concern qualifies.
Take it anywhere: "I'd rather you ___ than ___." Any time you want someone to feel safe coming back to you.
🔑 Make them yours
Most of these work far beyond medicine — anywhere an expert has to tell a non-expert something serious. Fill the frames with your own work. Say each answer out loud before you type it.
"Just so I know I've explained it properly — what would you tell ___?" — who would your patient or client explain it to?
"In plain terms, what that means is…" — take something you explain often and put it in one plain sentence.
"I can't ___. What I can ___ is…" — where do you have to be honest about a limit?
Quick test: run it out loud using all ten, in order — what are you expecting → not the news we hoped for → give you a moment → in plain terms → what I'd like to do and why → happy to go ahead → what would you tell your husband → I explained that badly → can't guarantee, but → rather you rang than waited. Time the silence after phrase three. If it was under five seconds, you filled it.
Your Turn 🎭
Now you deliver it. Twice — once as the doctor, once as the patient.
Round 1 — you're the doctor
Use a real diagnosis from your own field, or borrow this one. She's just sat down.
Find out what she's already guessed.
Warn her, then say the plain fact in one short sentence. Then stop.
She's gone quiet. Say the six words and mean them.
Translate it, then propose the plan with its reason, and ask for consent.
Check she's actually got it — not with "do you understand".
She's got it wrong. Take the blame and go again.
Round 2 — now you're the patient
Swap. You're Marta: you've guessed, you stop hearing after the first sentence, and you will say you understand when you don't. Play it honestly — including getting it wrong when you're asked to say it back.
The doctor asks what you're expecting. Answer truthfully.
You've just been told. What actually comes out of your mouth?
You're asked what you'd tell your husband. Say the version you'd genuinely have taken home.
⚡ The twist
You finish, she's understood it correctly, and as she stands up to leave she says — lightly, already half out of the door — "I won't tell my husband yet. He's got his own results next week and I don't want to worry him."
She now intends to carry this alone for a week, and the thing you spent ten minutes making sure she understood is about to sit in her head unspoken. You have about twenty seconds. What do you say?
Before you close the tab…
Can you warn, then say the plain fact in one short sentence, then stop?
Can you sit in a silence for five full seconds without filling it?
Can you check understanding without ever asking "do you understand?"
Can you take the blame for a misunderstanding that wasn't yours?
Can you refuse to promise and still leave them with something solid?
The Echo 🕰️
Marie Curie carried tubes of radium in her coat pocket and kept a sample by her bed because she liked the light it gave off. Her laboratory notebooks are still too radioactive to handle safely — they're kept in a lead-lined box in Paris, and you sign a waiver to read them.
Nobody told her. Not because anyone lied, but because nobody yet knew how to say what they half-suspected, and the person best placed to understand it was the one holding the tube.
She died in 1934, almost certainly of the work. The hardest thing in medicine has never been finding out. It's the ten minutes afterwards, when somebody has to sit down opposite a person and say it plainly.