How to have a difficult conversation with kindness

Raising concerns with a colleague is one of the hardest situations you can face. You might second-guess what you have noticed, hope things will settle on their own, or worry about how your colleague will react. But in many cases, taking the first step, thoughtfully and with kindness, can make a meaningful difference.

Why your colleague may hesitate to seek help and how it affects your response

When you are worried about a colleague, it helps to understand that many doctors find it difficult to ask for help. Stigma around mental health, concerns about confidentiality, fears about professional consequences and perfectionism can all make it hard for a doctor to reach out. For more senior doctors, identity is often closely tied to their work, so any suggestion that something may be wrong professionally can feel threatening and overwhelming.

However, sometimes an approach from a colleague is the first step towards helping a doctor who is struggling to cope. 

Understanding this is important because it shapes how you approach the conversation. A gentle, respectful check in is much more likely to be received positively than a direct or formal confrontation. Keeping in mind the potential barriers which may prevent a colleague from seeking help will help you to approach your colleague with empathy, patience and sensitivity, and create the best chance for a constructive discussion.

Uncertainty about mandatory reporting can also be a barrier, both for the colleague who may fear professional consequences, and for you if you are unsure of your obligations. Mandatory reporting obligations relate to four types of notifiable conduct by a registered health practitioner. The obligation to make a report has a high threshold and exists where there is a reasonable belief that the conduct poses a risk of harm to the public. Further detail is available in our factsheets Mandatory notifications about health practitioners and Mandatory notifications by treating practitioners.

Many concerns which doctors hold about colleagues in everyday practice generally do not meet the mandatory reporting threshold. Mandatory reporting obligations are also not a barrier to having a supportive conversation as the appropriate first step.

Preparing to approach a colleague

Don’t approach your colleague impulsively. Before you speak to your colleague, think about:

• what you are concerned about and why;
• how you intend to raise the topic; and
• the potential responses which your colleague may offer.

It is important to be aware of how the conversation may evolve so that you are ready to respond, rather than going in unprepared and being surprised by your colleague’s response. In addition to taking time to prepare yourself for the conversation, also seek your own supports before you begin. Your MDO, a senior colleague, or doctors’ health services can help you consider the risks, the possible explanations for what you’ve observed, and how to plan the conversation.

When you approach your colleague, they may be relieved and grateful that you’ve noticed they are struggling and open to accepting your offer of support. 

If you are working in a practice and you are not the practice owner, make sure the person who has that responsibility is involved or at least aware that you have concerns and are going to have the conversation. If you are not the right person to undertake the conversation, identify who is. This might be someone who the doctor trusts or is more likely to engage with.

Opening the conversation

Research from Vanderbilt University demonstrates the effectiveness of a tiered intervention model which provides “the right level of conversation or action at the right time”.  The Vanderbilt Promoting Professionalism Pyramid supports professionalism and early intervention, and suggests that a cup of coffee is often an effective way for a peer to undertake an informal check in and deliver feedback. Having a cup of coffee is respectful, private and peer to peer and focusses on opening the door to communication rather than delivering a formal message.

A gentle invitation such as "Do you have time for a coffee?" or "Do you want to go for a walk?" creates space for a genuine human interaction and is less likely to be perceived as confrontational. Once you are away from the immediate bustle of work, you can express what you have noticed in a calm, first-person way:

"I have noticed a few things lately, and I am concerned about you. I wanted to check in."

You do not need a script, and you do not need to list every concern. Be aware that reading examples like a checklist can feel accusatory and may shut the conversation down. Instead, raise one or two things that prompted your worry, then give your colleague the chance to respond without interruption or judgement.

It may help to share some of your own experiences, moments of struggle, stress or vulnerability. This normalises seeking help and shows that you are not expected to be perfect.

Where the conversation may lead

Once the discussion starts, it can go in many directions. Your colleague might be relieved, defensive, embarrassed or surprised. They may disclose something significant, or they may not be ready to talk. This is why planning matters. Thinking ahead about possible responses allows you to stay calm and supportive in the moment.

If the situation raises immediate patient safety concerns, there may be a need for you to escalate the issue. If there is no immediate risk to patients, your colleague may simply need time off, support from their GP or encouragement to seek the appropriate assistance.

Remember that this is not about taking on the role of  being your colleague’s treating doctor. Addressing the issue does not mean that you have to solve their problems, and you do not have to carry responsibility for the situation on your own. You can reach out to your MDO, your practice manager or doctors' health services if you need guidance or support.

Your role in this first conversation is to check in and to offer a safe place and person to speak to. Sometimes people may not realise how much their situation is affecting their work or their personal life until someone gently brings it to their attention.

Having an informal and empathetic conversation can be an ideal way of opening communication.

Following up: the conversation isn’t the end

Checking in after the initial discussion is just as important as starting it. A short message, a quiet conversation in the corridor or another coffee invitation sends a clear signal that your concern is ongoing and genuine.

If your colleague is away from work, a brief text to see how they’re going can mean a lot. If they’re still struggling, encourage them to stay connected and seek ongoing support from their treating team (their GP or mental health clinicians).

Small ongoing communications after the initial approach are very important and meaningful. 

Take home messages

No difficult conversation will ever feel perfect. But doing nothing carries a greater risk.

Always approach your colleague from a position of kindness. If you cannot do this then you are not the right person to be involved. Always be prepared, open, and give your colleague the space to speak without judgement. Share your own humanity.  Keep in touch after the initial communication, because one conversation is rarely enough.

Small acts of compassion can have a profound impact. A gentle check-in, a cup of coffee or a quiet walk to show you care can change the trajectory of a colleague’s wellbeing and, ultimately, protect patients and empower the profession as a whole.

Further resources

Avant collection - Health and wellbeing