Repair After a Misstep

Grief is dynamic and experienced differently by each person, which means not every interaction will land as intended.

Healthcare professionals will never be able to provide grief sensitive care perfectly 100% of the time.

At times, words or actions may miss the mark, and striving to avoid mistakes altogether can create distance or hesitation. A more grief-sensitive approach focuses on noticing missteps, examining how these missteps make you or the other person feel, and responding in ways that help restore connection, trust, and emotional safety.

Ruptures

Ruptures are breaks in connection, often small and unintentional, that occur when words, tone, or timing land poorly. When left unaddressed, these moments may affect trust with patients, families and other care partners, or colleagues over time.

Healthcare interactions often occur under conditions of limited time, competing demands, and heightened emotion.

This can create opportunities for rupture.

Ruptures can arise from many aspects of an interaction, including words, tone, body language, timing, or what is left unsaid. The presence of grief, whether related to a death or a non-death loss, can add another layer of complexity to these interactions.

Mentalization, the ability to consider how thoughts, feelings, beliefs, intentions, and experiences may influence behavior in oneself and others, can support self-reflection.

This reflective stance can help healthcare professionals recognize how personal assumptions and emotional responses may be shaping an interaction. When a rupture occurs, it may become easier to respond with curiosity rather than defensiveness and create opportunities for repair.

Repair is the process of recognizing and responding to a rupture in an effort to restore connection, trust, and understanding.

"Repair is tough. It brings us into contact with our own distress and guilt. And repair is critical."

Becky Kennedy, PhD / Clinical Psychologist and Author of "Good Inside"

Repair may be helpful when a patient, family member, or other care partner appears withdrawn, frustrated, or disengaged; expresses feeling dismissed, unheard, or misunderstood; when an interaction does not seem to have the intended impact; or when system-related challenges have strained trust or connection.

Social, cultural, and identity-related factors, including race, ethnicity, language, and experiences of marginalization, can influence how interactions are experienced, interpreted, and addressed.

Mentalization and cultural humility offer two complementary approaches for navigating these moments with greater reflection and curiosity.

Mentalization is the ability to consider how thoughts, feelings, beliefs, intentions, and experiences may influence behavior in oneself and others, can support self-reflection.
Cultural humility is a lifelong practice of self-reflection and self-evaluation that recognizes the limits of one's own perspective and encourages openness to learning from the experiences of others.

Approaching moments of tension with a mentalizing stance and cultural humility can help healthcare professionals avoid assumptions and remain curious about another person's experience. This reflective approach may make it easier to respond to ruptures with curiosity rather than defensiveness and create opportunities for repair.

In this video, Paola Ayora, MD, MPH, Assistant Professor of Child Psychiatry in the Child Study Center at Yale School of Medicine, reflects on noticing shifts in a patient's emotional response, responding with curiosity, and viewing repair as a natural part of clinical relationships.

Repair involves recognizing the rupture, acknowledging its impact, and taking steps to restore connection and clarity. It does not require a perfect script, but rather reflection, curiosity, and a willingness to re-engage.

Repair with a Patient, Family Member, or Other Care Partner

In emotionally charged situations, repair can help restore trust and strengthen communication. Acknowledging emotions, being transparent, and offering clear next steps can help patients, families, and other care partners feel heard and supported.

Putting it into Practice: Repair with a Patient, Family Member, or Other Care Partner

Scenario: A palliative care specialist responding to a patient’s family member or other care partner who is feeling anxious and seeking information about the patient’s prognosis.

Acknowledge the rupture: “It seems like you didn’t feel heard during the family meeting.”
Reflect on and acknowledge any contribution to the disconnection: “I focused on the medical details and may not have made enough space for your questions.”
Invite their perspective and listen without defensiveness: “Can you share what felt most important for you to understand?”
Clarify to ensure understanding: “I’m hearing that your main concern is having a clearer sense of how much time he may have. Did I get that right?”
Apologize when warranted, with specificity: “I’m sorry I didn’t explain that clearly earlier.”
Separate person from problem: “We share the same goal. We both want your dad to be comfortable and for you to feel as prepared as possible.”
Propose a path forward and invite collaboration: “These situations can change quickly, and I wish I could offer an exact timeline. What I can do is provide a direct update once a day about what we’re seeing and what it may mean, and ensure someone from the team checks in if there are significant changes. What else might help you feel more supported?”

Repair When the System Contributes to Rupture

Sometimes, ruptures arise from system-level factors such as delays, limited information, or uncertainty. Even when a healthcare professional is not directly responsible for the situation, repair may help restore trust and support communication.

Pausing, avoiding defensiveness, and listening with openness and intention can help de-escalate emotion and keep the focus on the patient and the people who love and care about them.

Putting it into Practice: Repair When the System Contributes to Rupture

Scenario: A nurse enters a post-operative room where an adult son has been waiting anxiously for updates about his father’s procedure.

Acknowledge the emotion and rupture: “I can see how worried you are, and it seems like the waiting has been really frustrating.”
Name the situation without defensiveness: “I was with another patient and came here as soon as I could, but I can understand how it felt like no one was paying attention.”
Validate the experience: “Waiting without updates can be really hard, especially when you’re worried about someone you love.”
Clarify what the person needs: “Can you tell me what information would feel most helpful for you right now?”
Acknowledge the impact: “You deserved clearer communication, and I’m sorry that didn’t happen sooner.”
Propose a concrete next step: “I’m going to check on your dad now and see what I can share. Then I’ll come back and explain what’s next in his care plan.”
Invite continued collaboration: “After that, we can talk about what would help you feel more supported while you’re waiting.”

Repair With a Colleague

Ruptures between colleagues can create tension and affect team functioning. Acknowledging and addressing conflict directly and respectfully can support trust and collaboration.

Putting it into Practice: Repair With a Colleague

Scenario: A nurse feels cut off by a physician during a fast-paced huddle. After rounds, the nurse addresses it in a private space.

Nurse: “Do you have a minute?”
Physician: “Sure, but I’ve got to head to the next patient soon.”
Nurse: “I’ll keep it quick. I value working with you, and that’s why I want to bring this up. During huddle when I started to share a safety concern, I felt cut off. I needed a little time to sort through my reaction before raising it.”
Physician: “Honestly, I didn’t even notice I cut you off. I was moving fast. Thanks for pointing it out.”
Nurse: “I get that it was busy. But when I wasn’t able to finish, it made me hesitate to bring up safety concerns. I know that wasn’t your intention, but it shook my confidence.”
Physician: “I hear you. I’m sorry my tone made you feel dismissed. Safety concerns need to come forward quickly. Next time I’ll slow down and make sure you can finish. Does that feel workable?”
Nurse: “Yes, thank you. I appreciate you hearing me out.”

In grief-sensitive care, not all ruptures result from words that land poorly. Repair may also be needed when a loss goes unacknowledged or grief is not recognized.

Patients, families, and other care partners may experience this absence as dismissal or lack of care.

Returning to acknowledge what was missed can help restore connection and reopen communication.

“I think the times where I really fumble with a grief experience is by avoiding it altogether.”

Elizabeth Peacock-Chambers, MD / Associate Professor of Healthcare Delivery and Population Sciences at UMass Chan Medical School - Baystate

There will be times when responding skillfully in the moment is not possible. In these situations, stepping back briefly can create space to regulate, reflect, and return with greater clarity and care. This can help prevent escalation and support a more effective repair later.

Revisiting After Reflection

Sometimes, awareness that something landed poorly or was overlooked emerges after reflecting on an interaction with a patient, family member, or other care partner.

In this video, Dakota Becker, MSW, LCSW, Clinical Instructor of Social Work at the Yale Child Study Center, discusses how healthcare professionals can revisit interactions that may have caused unintended harm.

In these situations, it can still be helpful to address the interaction. For example:

“I’ve been thinking about our conversation yesterday. I’m concerned that what I said may have felt dismissive, and that wasn’t my intention. I wanted to check in and see how it landed for you.”
“I've been thinking about our conversation yesterday and realized I did not acknowledge how much has changed for you since the diagnosis. I wanted to take a moment to recognize that.”

Even when the moment has passed, following up to acknowledge impact and invite the other person's perspective can demonstrate care.

Checking In With Curiosity

It may not always be clear how an interaction was experienced. When there is uncertainty about an unintended impact, a brief check-in can be helpful.

For example:

“I’m not sure how that came across. When I think back on it, it may have sounded harsher than I intended, and that wasn’t my goal.”

Then invite the other person’s perspective:

“How did that land for you?”

Check-ins like this can provide an opportunity to clarify misunderstandings and acknowledge impact.

Not all ruptures are recognized through self-reflection. In some situations, patients, families, and other care partners may be the ones to identify and name the impact of an interaction.

In this video, Thejal Srikumar, MD, MPH, Assistant Professor of Medical Oncology at Yale School of Medicine, discusses how healthcare professionals can respond when they realize, or are told, that an interaction had an unintended impact.

Healthcare professionals may also find themselves on the receiving end of interactions that feel hurtful, dismissive, or emotionally challenging.

Addressing the Impact of an Interaction with Patients, Families or Other Care Partners

Clinical settings can involve power dynamics and heightened emotions, both of which can shape interactions between healthcare professionals and patients, families, and other care partners. Ethical and legal responsibilities can further complicate moments of rupture within the care relationship.

Responding to a rupture may involve acknowledging the emotion behind the interaction, communicating understanding, and maintaining appropriate boundaries:

“I can see this is incredibly hard. I want to support you, and we need to keep this a respectful space.”

Addressing the Impact of an Interaction with a Colleague

At times, a rupture may involve an interaction with a colleague. In these situations, it can be helpful to begin by affirming the importance of the relationship.

“I appreciate working with you and that’s why I want to bring this up.”

Then introduce the concern:

“When the conversation moved on during the family meeting before I had finished sharing my perspective, I felt dismissed.”

In other situations, concern may arise after observing an interaction that appeared to create tension or disconnection for someone else. In these moments, sharing an observation with curiosity rather than assumption can create an opportunity for reflection and repair:

“I wanted to share an observation from rounds today. I noticed a change in the family's response after that exchange, and I wondered if they may have experienced it differently than intended.”

Managing Defensiveness

Even when intentions are good, hearing that something caused harm can trigger defensiveness. Framing the conversation as an invitation rather than a confrontation can help create space for repair:

“If you’re open, I’d like to share how that comment affected me.”

Balancing this with curiosity, rather than assumption, supports mutual understanding:

“I’d also like to better understand what you meant in that moment.”

Protecting Capacity

This kind of communication requires energy and emotional presence, which may already be limited for healthcare professionals, patients, families, and other care partners.

It is always appropriate to assess one’s own capacity and decide whether addressing the rupture will be helpful, or whether a pause is needed before responding.

When taking a pause, it can be helpful to communicate that intention clearly so the other person understands that the conversation is being delayed, not avoided.

Direct approach: “I need time to sort through my feelings because I did not appreciate what was said and want to make sure I can respond clearly. I'll reach out when I'm ready."
Less direct approach: “I'm feeling a bit overwhelmed right now with this interaction and need to take time. I'll reach out when I'm ready."

Either approach communicates respect for the relationship while allowing space to regulate.

This approach is not intended to excuse harmful behavior or accommodate repeated boundary violations.

It is most appropriate for situational tensions where preserving trust and continuity of care matters.

It can be difficult to learn new skills in moments of crisis. Practicing repair in lower-stakes interactions can help build confidence and preparedness for higher-intensity situations.

Everyday Opportunities to Practice Repair

Many repair moments arise in routine, day-to-day interactions, not only during crises.

Noticing and responding to these smaller moments can help build skill and confidence, making repair feel more accessible when stakes are higher.

Caregiver talking to older adult in wheelchair

The examples below offer simple lanauge that can be adapted to different settings and roles.

After sounding rushed with a patient: “I came in quickly and that may have felt abrupt. I’m sorry. What matters most to you right now so I can slow down and start there?”
When a patient's family member or care partner felt dismissed: “I don’t think I fully acknowledge what you shared about your child’s pain. I’m sorry. Can we pause and go back so I can better understand what last night was like?”
During team tension with a colleague: “I talked over you during huddle. I’m sorry. Can we revisit your concern and decide next steps together?”

Grief-sensitive care does not require getting every interaction right. What matters most is the ability to notice missteps, respond with humility, and re-engage in ways that communicate care.

When mistakes are met with compassion, curiosity, and repair, they can become moments that strengthen trust rather than undermine it.

Grief-Sensitive Communication: Patients, Families, and Care Partners