As physicians, we have been well trained to understand the pathophysiological processes that bring about death and how to best manage them. We know very well the scientific language of death: organ failure, sepsis, cardiac arrest, etc.

But we are arguably ill-equipped to deal with some of its social and personal consequences. Informing a family member of a loved one’s death is perhaps the most difficult and uncomfortable conversation that we have in the emergency department, especially for those of us who are early in our careers.

We have all attended the funerals of loved ones and friends. Condolences are exchanged. Brief words. We know, having been in those situations, it is a person’s presence or past relationship that gives weight to those words, not the words themselves. But in the ED there is frequently no past relationship. We are not the family physician who talked a mother through the anxiety of her husband’s job loss. Nor are we the pediatrician that observed the child pick up two blocks one year and three blocks at the next visit.

We were not “there” for them before. Our first encounter with the patient and or family may, in fact, be at the time of the death. Without any past relationship, words by default take on great importance.

The day my grandfather passed away, my uncle got a call from a health care provider informing him that his father had “expired.” The matter-of-factness and apathy in the man’s tone was akin to the automated voice that lets you know your prescriptions are ready to be picked up from the pharmacy. It did not sound like an empathetic human being who had ever been on the receiving end of such a call.

Humans probably should not “expire.” While “expire” would certainly qualify as a synonym for death, it connotes a fixed, unavoidable end. In a way, it negates or ignores the possibility of afterlife, something I am sure the health care provider did not consider with his choice of words. Just think about what happens when milk expires: it goes bad and you throw it out.

“Breaking bad news” is by no means easy. The language of death is admittedly very nuanced and difficult to navigate. The weight of the circumstances greatly magnifies small differences in gesture, tone of voice, and connotation. The conversation will constitute a meaningful part of how the family views and comes to terms with their loved one’s death. There are no metrics for how much these discussions matter, but some studies have looked into what exactly is important for surviving family members.

In 2000, Jurkovich published in the Journal of Trauma a study evaluating family perspectives on communication of bad news by health care providers. The bad news being communicated in this study was that of death that occurred after arrival at the hospital, either in the ICU setting or in the emergency department: 69% of patients died within 2 days, and 83% died within 1 week. Surviving family members were given a survey tool to evaluate the importance of certain aspects of the communication of such news.

In order of importance, the families were found to value the attitude of the news-giver; clarity of the message; privacy of communication; the news-giver’s knowledge and ability to answer questions.

How do we translate those results into practice?

First, we should prepare ourselves mentally for the discussion. Briefly rehearse what will be said and review any pertinent clinical information in case the family has questions. Have the discussion in a quiet setting that will provide privacy and minimize interruptions. The importance of speaking in understandable, non-medical words cannot be overstated. Fewer things will place a greater distance between the provider and the recipients of the information.

Empathetic statements such as “I am very sorry” are simple but are important for family members to hear.

These discussions will continue to be difficult to have. There is no Survey Monkey feedback. No family reaction will let you know that you did a great job. There is really no such thing as a great job. In a sense, it will always feel like a “did the best I could” scenario. It is just the nature of the discussion.

Asking a colleague to join you in talking with the family may provide some objective feedback on how to improve. But ultimately each family and clinical situation will be different. We can only be mindful of some simple things and do the best we can.

Dr. Kazzi is an emergency medicine resident at SUNY Downstate Medical Center in Brooklyn, N.Y.