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A Piece of My Mind
April 24, 2013

One Last Teaching Moment

Author Affiliations

A Piece of My Mind Section Editor: Roxanne K. Young, Associate Senior Editor.

Author Affiliation: Beth Israel Deaconess Hospital-Milton, Milton, Massachusetts (

JAMA. 2013;309(16):1695. doi:10.1001/jama.2013.1803

Critical conversations can arise at any moment in care settings. How we respond can powerfully affect the patient's perception of being heard and supported and may influence the patient's capacity to trust us. Our capacity to respond, often with little time to reflect, prepare, and anticipate the interaction, is governed not by whether we have memorized a script designed to show caring or compassion, but our ability to acknowledge and address, by both verbal and nonverbal means, the patient's vulnerability and need for support, even if we cannot offer any other hope than our presence. We can only do this if we are truly able to acknowledge, access, and engage the human values that are universally needed in such settings1: a genuine desire to care and comfort, to respect, to support, and to validate the patient's circumstances and experience. As physicians, we may have difficulty accessing some of these, as to do so requires us to acknowledge and address our own vulnerability and sense of helplessness in such conversations.

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