A new diagnosis of a serious, potentially life-limiting illness is a turning point for patients and clinicians alike. For patients, a diagnosis signals entry into what one writer called “the country of illness” - a complex world involving loss, decisions, therapies, waiting, and work. For physicians, the capability to make these diagnoses and the responsibility that follows is powerful and, more recently, an unintended consequence of high-tech medicine. When diagnostic technology was limited, patients knew they had a serious illness only when symptoms became severe. Now, many diagnoses are made well before people experience any problems, and the medical literature contains a great deal of information, available to physicians and patients alike, about what a diagnosis means in terms of early death, complications, disability, and therapies that can modify the course of the illness. Physicians find themselves talking about life-limiting illness, diagnoses, and interventions earlier than ever before in the trajectory of illness. Thus, what the medical literature has called “breaking bad news” has become a fundamental task in the communication repertoire.

We would like to rename this task from “breaking bad news” to “talking about serious news.” After years of teaching “how to break bad news,” we have become concerned that framing the task this way tacitly encourages a view of this skill as information dumping. “Talking about serious news” frames the task more constructively for the physician and the patient.