Many TCF role-plays include a difficult moment: a relative who is angry, or a patient who does not want to follow advice. The criteria reward the same sequence each time: acknowledge the feeling, explore the reason, explain in plain English, negotiate a plan, and check understanding. Below you will find a template for difficult conversations and two worked examples with model conversations.
Difficult conversation template
1. Acknowledge. "I can see you're really [frustrated / worried / upset], and I'm sorry [about the situation]."
2. Explore. "Could you tell me what's worrying you most about [topic]?"
3. Explain. "Let me explain what's happening. [Short, honest explanation in plain English]."
4. Negotiate. "What if we [compromise or next step]? How would that work for you?"
5. Check and close. "So, to make sure we're on the same page, [summary of the plan]. Is there anything else I can help with?"
Example 1: an angry relative (medicine)
Setting: emergency department
Relative: the son of an 81-year-old patient who has been waiting four hours for scan results after a fall. He is angry about the wait.
Task:
- Acknowledge the son's frustration and apologise for the wait.
- Explain that the scan has been done and is being reported.
- Explain why the result is needed before decisions are made.
- Reassure him that his mother is being monitored.
- Offer a time when you will update him.
Relative: Four hours! Nobody's told us anything. Is anyone actually looking after her?
Candidate: I can hear how frustrating this has been, Mr Grant, and I'm sorry you've been left waiting without an update. That shouldn't happen. Can I explain where things are up to?
Relative: Go on, then.
Candidate: Your mother's scan has been done. It's now with the specialist doctor who reads the images, and we're waiting for their report. We need that report before we decide whether she needs any treatment for her hip, so we can make the right decision rather than guess.
Relative: And in the meantime she's just lying there?
Candidate: I understand why it looks like that. The nurses are checking her blood pressure, pulse and pain regularly, and she's had pain relief. Is there anything about how she seems that's worrying you right now?
Relative: She seemed a bit confused earlier.
Candidate: Thank you for telling me. That's important. I'll check on that myself straight after we finish. I'll come back to you within the hour with the scan result or an update, whichever comes first. Would that be alright?
What earns marks: the apology comes before the explanation, the doctor does not blame colleagues or promise a time they cannot control, and the son's new concern about confusion is taken seriously instead of being brushed aside.
Example 2: a reluctant patient (physiotherapy)
Setting: outpatient physiotherapy clinic
Patient: a 67-year-old, three weeks after knee replacement surgery, who has stopped doing their home exercises because of pain.
Task:
- Find out why the patient has stopped the exercises.
- Explain why the exercises are important for recovery.
- Suggest taking pain relief before exercising.
- Agree a manageable exercise routine.
- Check the patient understands the plan.
Candidate: Mrs Ahmed, you mentioned the exercises have been difficult. Could you tell me more about what's been happening?
Patient: They just hurt too much. I thought I was making it worse, so I stopped.
Candidate: That makes sense. If something hurts, it's natural to worry you're doing damage. Some discomfort is expected at this stage, and it doesn't usually mean harm. Can I explain why the exercises matter so much right now?
Patient: Okay.
Candidate: In the first few weeks, the new joint can stiffen quickly if it isn't moved. The exercises keep it bending, so you can walk and climb stairs more easily later. One thing that often helps is taking your pain relief about half an hour before you start. How would you feel about trying that?
Patient: I could try. But all of them, three times a day?
Candidate: Let's make it manageable. What if we start with just the two most important ones, twice a day, and build up from there?
Patient: That sounds more doable.
Candidate: Great. So that I know I've explained it clearly, could you tell me what you'll do before each session?
What earns marks: the physiotherapist asks before persuading, validates the fear of harm, explains the reason in plain English, and negotiates a smaller plan instead of repeating the full programme.
Phrases that work in difficult role-plays
| Situation | Phrase |
|---|---|
| Anger | "I can hear how frustrating this has been, and I'm sorry." |
| Fear | "It's completely understandable to feel worried about that." |
| Refusal | "Can you help me understand what's making you unsure?" |
| Misinformation | "That's a common thing to hear. Can I explain what the evidence shows?" |
| Compromise | "What if we start with... and see how you get on?" |
For more wording, see the TCF Speaking phrases guide. To practise these conversations with an AI patient who reacts to what you say, try a free role-play in the Exam Hero question bank.
