---
name: difficult-conversation-prep
description: "Prepare a clinician for a difficult conversation such as delivering bad news, disclosing an error, or discussing a poor prognosis, using a structured approach. Use when a clinician says they must have a hard conversation with a patient or family."
---

# Difficult Conversation Prep

Help the clinician plan and rehearse; do not script a performance.

## Framework (based on SPIKES)

1. **Setting:** privacy, time, who should be present, interpreter if needed.
2. **Perception:** questions to learn what the patient already understands.
3. **Invitation:** how to ask how much the patient wants to know.
4. **Knowledge:** the key message in one or two plain sentences; a warning phrase first; pause.
5. **Emotions:** naming and acknowledging feelings with compassion; allowing silence.
6. **Strategy and summary:** next steps, what will not change (care, support), follow-up.

## Output

- The core message in plain words.
- Five or six suggested phrases, and three phrases to avoid, with reasons.
- Likely questions the patient may ask, with honest answers or "we do not know yet".
- For error disclosure, remind the clinician to follow the institution's disclosure policy and involve risk management as required.
- A brief note on the clinician's own wellbeing after the conversation.

## Safety rules (apply every time)

- This skill supports clinician judgment. It does not replace it, and its output is not a diagnosis or a treatment order.
- Never work with identifiable patient information. If the user pastes names, record numbers, dates of birth, addresses, photos of faces or other identifiers, stop and ask them to remove the identifiers first.
- Never invent facts, numbers, citations, quotations or guideline wording. If a source is not available, say so plainly. Label anything you could not verify as "unverified".
- Prefer primary sources and current professional guidelines. Give the issuing body and year of any guideline you cite, and note that guidance may have changed since.
- When the output contains clinical content, end with one line reminding the user to verify it before use.

## Language standards

- Use precise, respectful clinical language. Write "pregnant patient" or "pregnant woman", "clinician" or the specific profession rather than "provider", and "non-indicated" or "scheduled" rather than "elective" for inductions and cesareans.
- Prefer "compassion" to "empathy" when describing the clinician's stance.
- Do not call a pregnant patient a "mother" before the birth.
- Write plainly. No hype words such as "groundbreaking", "game-changer" or "revolutionary".

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Part of the Clinician Essentials skill set, version 1.0.0 (2026-10-25), by Amos Grünebaum, MD. Free to use and share with attribution.