Knowing when to explore a little more, and when to slow down or stop entirely, is a subtle communication skill. It’s one that demands patience and a willingness to bend. It requires recognition of many signs, and knowing what to do when you see those signs.

The truth is we’re often pressured to “get more” in medicine: get more information, get more closure, get more agreement with medical recommendations, get more clarity on discharge plans. As clinicians, we certainly feel the pressure of hospital lengths of stay and other statistics; as patients, the medical facts and plans may not always line up with emotional currents.

Recognizing when communication becomes pressured can be challenging. Sometimes there are non-verbal patient signs like breaking eye contact or shifts in body posture (or family members not responding to calls). We may start to feel an internal sense of frustration or judgment, and use labels in response to conflict. It may feel necessary to have a family meeting every day to get our point across.

Initially, the best course of action may be empathetic exploration (ie “It must be exhausting talking about this so often”). But there may come a time when the best course is to acknowledge that we’ve gone as far as we can for now. Shifting into anticipatory guidance and helping your patient think about things to ask in the future can be helpful. Writing down questions for your patient to consider, or talk over with family, is a great strategy. Giving your patient an Advance Directive to review once they get home can also spark important conversations that are too hard, or scary, to have in the hospital. Updating PCPs so they can take the next steps in conversation is also a great idea.

But when all is said and done, I think recognizing that not all situations will have a perfect, neat, satisfying resolution is healthy, and helps set more achievable, humanistic expectations for those of us who practice medicine.