UNITED INTERNATIONAL MEDICAL SCHOOLS
Difficult Discussions in Medicine: Saying What No One Wants to Hear​
​
Some moments in medicine stay with you long after you’ve left the room. Not because of the diagnosis or the treatment, but because of the conversation. Breaking bad news is one of the most emotionally complex parts of being a doctor—and yet, it’s something that most students aren’t formally taught until much later in their education. That’s what made the Difficult Discussions in Medicine workshop at Evolence such a meaningful and eye-opening experience.
​
Led by Dr. Celina Gupta, an LF1 graduate now working in the NHS, the session introduced students to the SPIKES protocol—a structured and compassionate way to approach difficult conversations with patients. Designed for situations where life-changing or upsetting news need to be delivered, SPIKES gives clinicians a practical framework for navigating emotion, uncertainty, and the human side of care.
Each letter in SPIKES represents a step in the process:
-
S – Setting: Create a private, calm space for the conversation. Don’t rush it.
​
-
P – Perception: Ask open questions to understand what the patient already knows or suspects.
​
-
I – Invitation: Let the patient guide how much they want to hear. You might ask, “Would you like a family member to join us?”
​
-
K – Knowledge: Deliver the news clearly and honestly— “I’m afraid it’s cancer”—without fancy medical terminology.
​
-
E – Emotion: Pause. Give them a moment. Acknowledge their reaction, but don’t assume you know how they feel.
​
-
S – Suggestion: Talk about what comes next. Reassure them that they won’t go through this alone.
What made this workshop so engaging wasn’t just the structure—it was how we applied it. Through realistic case studies, students took turns stepping into the clinician’s shoes, practicing how they would deliver bad news using SPIKES. Going around the room, we shared our versions of each step, received gentle feedback, and saw how small changes in tone or language could shift the entire conversation.
Having attended this workshop myself, I can honestly say it left a strong impression. Even as a student still early in medical training, it made me realize how much more medicine is than diagnoses and prescriptions. It’s also about connection, trust, and knowing how to be there for someone in their worst moments—without trying to fix their feelings or rush their grief.
Dr. Gupta’s experience and openness made the session feel safe and grounded. She reminded us that it’s okay not to have the perfect words. What matters more is presence, empathy, and the willingness to sit with someone in their pain.
Workshops like this are rare, but they’re the kind that shape who we’ll be when the white coat comes off and the hard conversations begin.