These professionals share the news no one wants to hear. Their tips and techniques for navigating tough conversations

“Your application has been rejected…”
“The diagnosis isn’t good…”
“The boy said ‘no’…”

Doctor / Patient

DR.Thomas (Tovia) Berk was working as a neurologist at New York University hospital when Mimi, a young newlywed, came into the office with her husband, complaining about neck pain.

“It’s probably nothing serious,” Mimi explained. “I have an old neck injury from when I was in an accident as a teenager. Now I’m a preschool teacher and I bend down a lot to help the kids — that’s probably what’s been making it worse lately.”

Her husband concurred. “We just want to be sure that everything’s all right.”

Dr. Berk looked over her old charts and did a thorough exam. “Well, everything looks good,” he said. “But as long as you’re here, let’s do an MRI to see how your old neck injury looks.”

He sent Mimi to get an MRI and, one hour later, saw the results on his screen. There was a large tumor wrapped around her cerebellum like a boa constrictor. This was the last news he wanted to share with a young newlywed and her doting husband, but they were waiting for him in his office.

“Did anyone tell you anything at the MRI?” he asked Mimi.

“They found something on my brain,” Mimi replied.

“That’s right.” Dr. Berk turned his computer to show Mimi the image of the tumor. “We don’t know exactly what it is, but we know it’s not benign. You’re going to have to go to the emergency room tonight or tomorrow first thing in the morning for surgery. Do you have any questions for me?”

Her husband had turned white as a ghost, but Mimi was very stoic. “How long will I be in the hospital?” she asked. “What are the possible complications?”

Dr. Berk answered her questions as well as he could, explaining what the process would be like, but also admitting that as a neurologist, not a neurosurgeon, he didn’t have the answers to all her questions.

Mimi went to the hospital first thing in the morning and had the malignant tumor removed. She needed chemotherapy afterward but, fortunately, she was soon well enough to return home.

As a neurologist, headache specialist, and the medical director of Neura Health, Dr. Berk often has to have hard conversations with patients, but this stands out in his mind as particularly difficult, since Mimi was very young, and the diagnosis was so unexpected.

“In medical school, they teach you the ‘Ask, Tell, Ask method’ when conducting conversations with patients,” Dr. Berk recounts. “First, I ask the patient, ‘What do you know about the prognosis?’ Then I explain more about it. Then I ask, ‘What questions do you have for me?’ ”

In addition to his medical training, Dr. Berk’s Talmudic training — he spent four years at Ner Yisroel, two years at Toras Moshe, and has finished Shas six times — has influenced how he speaks to patients. “More than anything, my learning has taught me anavah. There’s so much we don’t understand. I’ve learned to be okay with not having all the answers, and educating myself if there’s something I don’t know. It’s taught me to always think, ‘Are there other possibilities?’”