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THE etiquette OF ILLNESS

It can be difficult to know how to behave around someone who is sick, and many people, fearing they will make a mistake, end up shying away when they're needed most.

Expressing concern doesn't have to be intimidating, said Susan P. Halpern, a social worker and author of The Etiquette of Illness: What to Say When You Can't Find the Words.

Halpern suggests people start with, " "I've been thinking about you.' Or a fairly neutral question is, "How are you doing today?' "

Separating the illness from the person can keep you in the best frame of mind to offer support and attention, said Dr. P.M. Forni, author of Choosing Civility: 25 Rules of Considerate Conduct and co-founder of the Johns Hopkins Civility Project.


"Rule No. 1 is to ask the person with the illness how they want to deal with it," said Dr. David Spiegel, professor of psychiatry and behavioral sciences at Stanford University.

Those offering support don't have to become paralyzed with self-consciousness because patients live with their medical problems all the time, Spiegel said.

"You're not going to send the person into a cycle of despair if you ask them about their cancer or heart disease," he said. "If they say no, take no for an answer and if they say yes, then pursue it."

Halpern agreed, noting that well-wishers who doubt their abilities may want to ask, " "Was that okay what I just said to you?' We don't ask for feedback enough, so we don't know if we're doing a good job and if we've responded to that person accurately."


Here are several approaches to consider when reaching out to an ailing loved one or co-worker, according to experts:

RESIST THE URGE TO BE OVERLY OPTIMISTIC OR CHEERFUL. Giving "premature, superficial reassurance" alienates patients, Spiegel said. "What they're really doing is telling (the sick person) to keep it to themselves," he said, noting that patients may have reason to be negative. Prognosticating that an ill friend can recover in a month when the outlook is unclear can annoy her and make everyone uncomfortable, Forni said. "Treat the ailing person, as much as you can, as you were used to treating him or her when he or she was not sick."

APPROACH, DON'T AVOID. For people who see each other only once a year, it can be jarring to witness a loved one's decline. "It can be painful if you can visually see the change and they see you register it," Spiegel said. "The thing to do is not to avoid the person but to approach. It's bad enough if they're not looking well. It's worse if they're not looking well and people stay away from them."

STAY AWAY FROM INTRUSIVE QUESTIONS. Let the sick person disclose details about the illness, its origin and prognosis if he's feeling up to it, especially if it's someone you don't know very well such as a co-worker, Forni said. "Many people are unwilling or not inclined to disclose a lot about their illness, and we should respect that," he said. "A visit to a patient is not about you. It's not a fact-finding mission. It's not looking for fodder for gossip." A general statement of concern can suffice, Spiegel said. "People do feel vulnerable when talking about their health status, and it's appropriate to acknowledge what you've heard and say it back and say, "I'm worried about you.' "

BRING A SMALL GIFT OR NEWS OF THE OUTSIDE WORLD. If the sick person is a co-worker, talk about what's happening in the office. If it's a relative, engage in news about the family. If you're close with the person, offer a hand or foot massage. When it comes to gifts, bringing food that fits dietary restrictions or an object with personal meaning is often appropriate, though no one should feel compelled to bring something, Halpern said.

LIMIT THE ADVICE YOU GIVE. Giving a sick friend a list of things she should be doing to accelerate her healing can be a burden, Halpern said. "The offering should be, "This worked for me. You might be interested. Call me when you are. I can give you a name when you're ready.' "

SPEAK FROM THE HEART. "Find out what you're feeling for the person," Halpern said. "It might be admiration for their strength. Find what's been meaningful in your relationship." It's acceptable to look forward to returning to a favorite activity together if that's realistic.

TAKE THE OPPORTUNITY TO HEAL OLD WOUNDS or to say what you feel for the person if his or her condition is grave. "Stop and consider this may be your last chance to interact with that person," Forni said, noting that bringing up difficult times from the past may upset some patients while it may comfort others if expressed with a conciliatory tone. "Think what is best for you only after you have thought what is best for that person."

NONVERBAL COMMUNICATION IS BETTER THAN NONE AT ALL. "Sometimes you don't have to say anything," Forni said. "You look someone in the eye in an affectionate way and squeeze their hands. That speaks volumes."