[Competent dialogue management : Delivering bad news].

Ophthalmologists in hospitals and private practices are repeatedly confronted with difficult conversations and the transmission of bad news. A good doctor-patient communication is based on respect and empathy and includes verbal and nonverbal interactions. An important conversation requires a sound preparation by the doctor, an environment that is as undisturbed as possible and a time frame that is not too short. The communication should be honest and understandable and tailored to the retentive abilities of the patient. The setting, perception, invitation, knowledge, empathy, strategy (SPIKES) protocol provides a guide for an important conversation. After the bad news, a break for processing and reaction is necessary for the patient and the responses should be received in an empathetic and nonjudgmental manner. The goal is that the patient is able to accept the bad news, a joint consensus about how to proceed can be reached and the patient feels supported and well cared for.