When treatment fails or no treatment exists, clinicians must share a truth no one wants to hear. Such moments may evoke grief for a patient’s suffering, sorrow for family members and friends, and a painful awareness of the limits of medicine. Yet medical culture has often regarded physicians’ self-disclosure and visible emotion, including tears, as potentially unprofessional. Many clinicians worry that such responses may discomfort patients or undermine professional credibility. A new study suggests this concern may be largely unfounded, at least as judged by members of the general public responding to carefully constructed hypothetical scenarios.
The study, published in the Journal of General Internal Medicine, was conducted by Staeck and colleagues, who examined how physician self-disclosure and emotional expression during communication with patients shape perceptions of serious illness conversations. Using a factorial vignette-based survey of 1,572 members of a Swiss general-public sample, the investigators assessed ratings of comfort, trust, compassion, and professionalism. Among the participants, 10.8 percent reported having a chronic illness themselves, while 23.0 percent reported that someone close to them had a chronic illness. Participants responded to written descriptions in which a physician expressed sadness and, in one scenario, teared up.
Within these written scenarios, brief self-disclosure and verbal expressions of sadness were associated with higher ratings across all four outcomes: comfort, trust, compassion, and professionalism. Expressions of sadness accompanied by tearing up were associated with higher respondent comfort, trust, and compassion, without significantly reducing perceived professionalism. In other words, far from damaging the doctor’s standing in the eyes of the public, visible emotion appeared to strengthen it. The study also identified differences in ratings across language groups, underscoring how the meaning and acceptability of clinician emotion may vary across linguistic and cultural contexts.
The research carries several methodological strengths that lend weight to these conclusions. The factorial vignette survey design allowed the investigators to evaluate the independent contribution of several communication elements within a standardized serious illness conversation. The large sample allowed quota-based recruitment by age, gender, and three languages. Multilevel analyses accounted for repeated vignette ratings, supporting robust comparisons across the scenarios. This design means that the effect of each communication element, such as words of sadness or tears, could be isolated from other features of the encounter.
Important limitations temper the interpretation. Because the study elicited responses from members of the public to written hypothetical scenarios, rather than from patients or family members in real clinical encounters, it provides indirect, hypothesis-generating evidence about how clinician emotion is experienced during actual serious illness conversations. Written vignettes cannot capture tone of voice, silence, facial expression, eye contact, gestures, or other body language, all of which shape how emotion is perceived in a real consultation. The authors acknowledge these constraints while arguing that the study still provides useful, much-needed insight into public expectations of emotionally responsive, trustworthy serious illness communication.
The effects were not uniform across all respondents or situations. The influence of self-disclosure and emotional expression varied by participant age and educational level, particularly for perceived compassion and professionalism. Compared with younger respondents, older respondents generally rated smaller gains in perceived compassion from physician self-disclosure and emotional expression involving words and tears, whereas the effects of these behaviors on professionalism ratings tended to be more favorable in older respondents. Across several educational groups, the effects of verbal expressions of sadness accompanied by tears on perceived professionalism were less favorable than in the apprenticeship group. Some positive effects also diminished in specific situations, including encounters with more experienced physicians or in conditions of a shorter prior relationship. Emotional expression, the authors conclude, is at least partly relational and context-dependent: what one person experiences as compassionate and reassuring may be perceived differently by another.
Staeck and colleagues also caution against using self-disclosure or emotional expression as scripted communication techniques. Performed emotion may be perceived as insincere and may increase clinicians’ emotional burden. If such expressions primarily serve clinicians’ own needs, they risk being experienced by patients as sympathy rather than empathy or compassion. The distinction matters. A patient-informed framework generated by persons living with cancer distinguishes sympathy as a pity-based response that may remain centered on the observer, whereas empathy goes beyond recognition by seeking to understand suffering through emotional resonance. Compassion builds on empathy by adding a relational and action-oriented commitment to address the person’s suffering and needs.
The editorial accompanying the study suggests that a brief statement such as, “I am truly sorry that we have reached this point,” can acknowledge the gravity of the situation without placing emotional responsibility on the patient. Personal disclosure or emotional expression may be appropriate when it serves the patient’s needs rather than those of the clinician. An important clinical and ethical boundary is ensuring that emotional expression acknowledges the patient’s suffering rather than shifting attention to the clinician’s own distress. Notably, scenarios involving uncontrolled distress, sustained crying, or situations in which patients feel compelled to comfort the clinician were not components of the survey, so the findings cannot be extended to those extremes.
The broader context for clinicians is significant. Serious illness care often entails repeated engagement with suffering, uncertainty, and loss, potentially inducing emotional disequilibrium among clinicians. Suppressing or avoiding emotion may contribute to detachment, emotional fatigue, and burnout. Connecting emotionally with patients begins with recognizing them as people first and acknowledging their fears, hopes, relationships, and sources of meaning. Emotional intelligence to recognize one’s own emotions and the emotions of others may help to deepen clinician-patient relationships, make work more meaningful, and paradoxically mitigate the emotional angst of bearing witness to suffering.
Future research directions are clearly mapped. Studies should examine how patients and families with lived experience of serious illness conversations could explore which forms of clinician emotion build trust and comfort, and which create distance or undermine a therapeutic relationship by shifting attention away from the patient. Such work should include communication by interdisciplinary team members such as nurses and allied health professionals, involving patients and family members across diverse linguistic, cultural, and healthcare settings. Further research is needed in acute care settings, including the emergency department and intensive care unit, where critical illness may confront patients and families with a new diagnosis and rapidly changing trajectory, and where therapeutic relationships may be newly formed or not yet established. In the intensive care unit, the 3 Wishes Project, an end-of-life intervention in which clinicians elicit and implement personalized wishes that honor dying critically ill patients and comfort family members, illustrates how clinicians, patients, and families can exist in the same emotional space, and a recent scoping review supports the positive influence of emotional connection and tangible acts of compassion on surviving family members and multidisciplinary staff. Taken together, the new findings challenge the assumption that physician self-disclosure or emotional expression is inherently unprofessional, shifting the question from whether clinicians should express or suppress their emotions to when, how, and why their emotions may best enrich the clinical encounter and promote humanism in healthcare.
Subject of Research: Public perceptions of physician self-disclosure and emotional expression during serious illness conversations
Article Title: Clinician Emotion in Serious Illness Conversations
Article References: Kuriyama, A., Kuehn, R., & Cook, D. J. (2026). Clinician Emotion in Serious Illness Conversations. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10887-5
Image Credits: AI Generated
DOI: 10.1007/s11606-026-10887-5
Keywords: clinician emotion, serious illness conversations, physician self-disclosure, vignette survey, patient trust, professionalism, compassion, empathy, palliative care, communication, Switzerland, burnout
News Source: Ophelia Keating. (October 30, 2026). When Doctors Show Emotion: Public Perceptions of Serious Illness Conversations. Scienmag.
