When emotions run high, especially negative ones, we don't know what to say and often retreat.

The NURSE acronym may help emotional conversations: Name, Understand Respect, Support, and Explore.

Naming the emotion, an especially powerful tool, exposes and acknowledges the discomfort.

The next time you are faced with a tough emotion, pause and start by naming it.

“Will I lose the ability to walk?”“How long do I have to live?”“Don’t take away my driving.”“Don’t you care about me?”

I hear these tough questions almost every day as a neurologist.

These conversations are hard, no matter how long you’ve been practicing. There’s no script for balancing truth and hope.

One acronym that has helped me is “NURSE,” a tool used in palliative care. The concept of “serious illness conversations” has emerged from the recognition that these discussions are filled with emotion...and that doctors are not necessarily good at them.

It may sound mechanical to use an acronym, but the acronym is just a pause button.

I’ve found that this approach has helped even beyond the clinic setting.

It may help you as well.

I find naming to be the most powerful step: It makes the invisible visible.

The moment you name the emotion, the conversation changes.

Once I do this, I often don’t need to recall the rest of the acronym. The conversation begins to flow, often in a deeper and more meaningful way.

For example, I may start with: “I hear sadness. And frustration.”

That’s often all it takes to unlock the conversation.

Or I can be even more explicit: “Let’s first acknowledge that this is an incredibly difficult situation you are facing—and perhaps not what you expected in retirement.”

You don’t have to get it right.

In fact, being wrong can be even more powerful.

“I’m not sad, doc. I’m kind of angry. This isn’t fair.”

“It’s not that. Ever since my friend Tom died, I haven’t enjoyed golf that much anyway. I worry about my wife. I don’t want to be a burden.… I don’t want to go to a nursing home.”

Sometimes patients are understandably frustrated with the medical system, and, to a certain extent, at me, as a provider.

I used to get defensive. (“It’s not that I don’t care. This is a difficult disease, and I’m trying my best.”)

Now I do something different.

“I’m sensing that you may be frustrated with the medical system and perhaps with me. I truly wish I could offer a cure. This is a challenging disease, and I feel that sadness too.”

From there, I can move into the rest of the NURSE framework.

“Naming the emotion” seems to dissolve the invisible wall we often place between ourselves and others, allowing the conversation to reach a deeper level.

Many of us were taught the same rule: Don’t say how you really feel.

The Irish, despite their warmth, are often described as stoic, suffering pain silently. In my own Japanese culture, silence is often valued with proverbs such as “silence is golden.” Men, in particular, are often socialized to suppress emotion.

I was recently reading Lonesome Dove by Larry McMurtry. Without giving away spoilers, a central tension in the novel is whether one character can reveal a deeply personal truth to his son. And as good a writer as McMurtry is, I was literally yelling at the stubborn cowboy.

If he did not know how to start, all he had to do was acknowledge the difficulty: “This is very uncomfortable for me to talk about, but…”

So the next time emotions rise, whether your own or someone else’s, pause.

If you don’t know what to say, start here:

Bruno MK, Jiao J, Kramer NM, Ivancic M, Chou C, Shurer J, Carroll T; CurePSP Centers of Care Palliative Care Working Group. Serious Illness Conversation in the Care of Atypical Parkinsonian Disorders: A Practical Guide for Neurology Clinicians. Mov Disord Clin Pract. 2026 Feb;13(2):344-358. doi: 10.1002/mdc3.70300. Epub 2025 Aug 21. PMID: 40842097; PMCID: PMC12911517.

Childers JW, Bulls H, Arnold R. Beyond the NURSE Acronym: The Functions of Empathy in Serious Illness Conversations. J Pain Symptom Manage. 2023 Apr;65(4):e375-e379. doi: 10.1016/j.jpainsymman.2022.11.029. Epub 2022 Dec 12. PMID: 36521764; PMCID: PMC10883350.

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