White Coat, Black Art

Faced with a difficult conversation? 5 tips to connect with empathy

Dr. Kathryn Mannix has had thousands of heart-wrenching conversations over her three-decade career as a palliative care physician, psychotherapist and trainer. She offers five tips for anyone who is faced with leading a challenging conversation.

An open mind and a cup of tea can help with connecting, says palliative care physician.

Retired palliative care physician Dr. Kathryn Mannix has talked to thousands of families about the death of a loved one. She has shared what she learned about navigating these challenging conversations in her new book, Listen: How to Find the Words for Tender Conversations (Darren Irwin)

Originally published on Jan. 7, 2022

Dr. Kathryn Mannix opens her new book with the sentence, "I can't find the right words." It captures that awkward moment before you start a challenging conversation, yet feel overwhelmed at the task.

Mannix is an expert in finding the right words in those moments. In her new book Listen: How to Find the Words for Tender Conversations, the U.K. author draws on her decades of experience as a palliative care physician, psychotherapist and trainer to create a guide to what she calls "tender conversations."

(Supplied by Kathryn Mannix)

Mannix likes the word "tender" because tenderness implies empathy: a sense of recognizing the vulnerability in both yourself and the person you are speaking with. "Tender" means not abandoning the other person to their suffering; it means acknowledging and validating their suffering. 

"It's about being intentionally, fully present," she told Dr. Brian Goldman, host of White Coat, Black Art.

Mannix compares a tender conversation to examining a patient whose belly is swollen with pain caused by an inflamed appendix. With both situations, you must proceed with care and presence, and with a promise to stop immediately if the patient requests it. This approach acknowledges the presence of pain and the need for sensitivity. 

As a palliative care doctor, Mannix has talked to countless families about the death of a loved one. She realized that the techniques that she's learned are "not just about end of life conversations, but about all those conversations that we feel a bit daunted about."

Here are five tips she offers to anyone who is faced with leading a challenging conversation.

1. Start with a cup of tea

Mannix tries to begin all tender conversations by inviting the other person to the conversation. Sitting down and offering a warm beverage is a way of doing this. It puts your humanity front and centre. This is a particularly important gesture when there is a power imbalance, she says. It's a way of breaking out of a professional role: "It is a signal that we are now becoming people with each other." She says offering a cup of coffee or tea is a way of saying, "I'm here with you."

2. A conversation should be like a dance

Mannix compares these tender conversations to two people dancing. One person leads, but never forces. There is a constant rebalancing and give-and-take. Asking questions can be a way of opening up someone to a possibility. In this way, the leader's role flips. They become the listener and can guide the conversation to where it needs to go.

3. Be curious, open-minded and humble

Instead of dispensing advice, she advises to ask open-ended questions, such as, "Do you have any information about this situation? Have you ever dealt with a problem like that in the past? If a friend had a problem like this, what would you advise them to do? What worries you the most about the situation?" Help name someone's worst fear and give them space to hold it, she says.

4. Never use the phrase, "At least…"

A big mistake is trying to fix the other person's problems or offer false reassurances: "If you feel 'at least' coming out of your mouth, it doesn't matter what else you're going to say. It's the wrong thing to say," Mannix said. Helping them to look on the bright side is a well-intentioned, but hopeless and potentially hurtful strategy, she said. Avoid phrases like, "At least your wife has a job" or "at least you're young enough to get pregnant again," she said.

"The bright side is not where they are, and it doesn't really matter whether that's a pregnancy loss, whether it's a redundancy," said Mannix. "The right thing to say is probably nothing, except,"I'm really sorry, this must be so painful for you. I haven't got any words that are going to make this any better, but I'm prepared to just sit here and be with you.'"

WATCH | Dr. Kathryn Mannix talks about using "at least" during difficult conversations:

"'At least' is the wrong thing to say": Dr. Kathryn Mannix

2 months ago
Duration 2:45
Dr. Kathryn Mannix talks to Dr. Brian Goldman on how the phrase "at least" is the wrong thing to say during difficult conversations.

5. Use the power of silence

Mannix believes that one of the most powerful tools for a tender conversation is silence. "It's just to shut up, get out of the way verbally and allow the person to feel those sorrowful or angry feelings and just be present." The feeling of wanting to fill the silence is well-intentioned, but it can be misguided. "It's incredible how much people want to help," said Mannix, "but oftentimes, the most valuable gift at a moment of crisis is silent companionship."

Mannix pointed out that all her strategies are rooted in empathy. Her advice reminds us to take our armour off and just be with the person in pain. 

"When we're trying to talk to our teenagers and they don't want our advice, it's because we're telling, not asking." she said. "It's because we're imposing, not inviting. So this isn't just about medical conversations. This is how we deal with each other when the stakes are high and how that works in conversations right across life."

Written by Jeff Goodes. Produced by Jeff Goodes and Dr. Brian Goldman. Animation by Ben Shannon.