In settings involving the communication of bad news,
especially when there is no appropriate biomedical response,
the strength of such a therapeutic relationship will be tested,
and its value quickly becomes obvious.19 The physician who
can communicate bad news in a direct and compassionate
way will not only help the patient cope, but will also strengthen
the therapeutic relationship, so that it endures and further
extends the healing process. Specific communication skills
that involve preparing in advance, validating emotions, and
dealing with family members have been described for this
difficult setting