For residents & attendings · Serious news conversations
The biopsy is back. Rehearse the part where they ask if you’re sure.
You know SPIKES. You don’t know what your voice does when the spouse starts crying mid-sentence.
Tomorrow at 2:40 you tell a patient their imaging confirms what everyone feared. You’ve read the AFP guide. You’ve memorized Setting, Perception, Invitation, Knowledge, Emotion, Strategy. What you haven’t done is sit in the room while Maria says “Are you sure? I feel fine” and her husband asks you to wait until their daughter’s wedding in June. Kommi puts you in that exam room first — with a patient who denies, shuts down, or demands every detail — so clinic isn’t your first take.
The protocol isn’t the hard part.
Every communication module has the same SPIKES mnemonic: private setting, assess perception, get invitation, deliver knowledge in chunks, respond with empathy, summarize strategy. You have the framework. What you don’t have is muscle memory for when Maria interrupts after your warning shot and says “I don’t want to hear this without my son here” — and you have eleven minutes left in the slot.
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What’s at stake
A badly handled disclosure erodes trust, triggers complaints, and follows you home. Research shows physician stress around bad news doesn’t fade with years in practice.
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Why you procrastinate
You’re afraid of the crying, the anger, or your own urge to soften the prognosis. You keep re-reading the chart instead of hearing yourself say the words out loud.
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What CME can’t do
SPIKES lectures and PDFs teach the steps. They can’t simulate the spouse going silent for twelve seconds while you wonder if you moved too fast through Knowledge.
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What an SP session costs
Standardized patient slots book weeks out and happen in front of faculty. You need a rep tonight in the call room — not one graded OSCE next month.
Sample roleplay · 3 minutes
“Are you sure? I feel fine.”
You’re Dr. Elena. Maria’s CT showed progression. You’ve delivered the warning shot. Now she pushes back — and her husband is in the chair beside her.
You (Dr. Elena)
“Maria, I wish I had different news. The scan shows the spots we were watching have grown, and there’s a new area in the liver. This confirms what we were concerned about.”
Maria (your patient)
“Are you sure? I feel fine. Maybe it’s inflammation from the medication. Can we repeat the scan? I read online that sometimes these things look worse than they are.”
Carlos (spouse)
“Wait — can we wait until our daughter’s wedding in June before we tell her anything? She’s already stressed about the venue.”
Your move
- → Name Maria’s denial before restating what the imaging shows
- → Pause the staging details and ask what she understood so far
- → Acknowledge Carlos’s timing worry, then clarify what Maria needs to know now
Each choice changes how Maria and Carlos respond. The room gets heavy. You practice staying present without hiding behind pathology jargon — or catching yourself when you’re about to offer false reassurance just to end the silence.
Then the coach reads you back to yourself.
Not a checklist score. Not seventeen communication tips. One observation about what you did, one adjustment for the Emotion step, one sentence you can carry into tomorrow’s 2:40 slot.
Sample coach debrief
“You delivered the warning shot clearly and named the liver finding without euphemism. When Maria denied the result, you immediately launched into staging details and treatment options — that skipped the Emotion step and left Carlos unheard.
Try next time: Pause after denial: ‘I hear that this doesn’t match how you feel. The radiologist and I both reviewed the images — can I show you what we’re seeing?’ Then check what Carlos needs before moving to next steps.
Carry into tomorrow: ‘This is difficult news, and we’re going to take it one step at a time. First I want to make sure you understand what the scan shows — then we’ll talk about what comes next.’”
Questions clinicians ask
- Is this a replacement for CME or standardized patient training?
- No. Kommi helps you rehearse the conversation before it happens. Documenting in the chart, involving palliative care, and following your institution’s disclosure protocols is still on you. We help you hear yourself deliver serious news clearly the first time.
- I already know SPIKES. Why do I need this?
- Because knowing the mnemonic and performing under emotional pressure are different skills. Three minutes in a simulated exam room catches whether you hide behind jargon, rush past Emotion, or offer false hope when the patient shuts down.
- Can I practice different patient reactions?
- Yes. The roleplay adapts when you choose different responses — a patient in denial, one who demands every statistic, a spouse who redirects to logistics. Run the same disclosure three ways in fifteen minutes between patients.
- I only have one difficult disclosure this month. Is $11.99/mo worth it?
- One communication-skills workshop costs more than six months of Kommi. You also get unlimited sessions across every scenario we ship — informed consent conversations, medical error disclosure, end-of-life planning talks. Most clinicians find a second scenario within the first month.
$11.99 a month.
A coach with a calendar runs two hundred dollars an hour. Kommi runs roughly forty cents a day — and is awake when you can't sleep, which is when most of these conversations are actually being rehearsed anyway.
We don't have a free tier, a team plan, or a premium upsell. One price, no pricing page riddle. If we add tiers later, we'll do it because users asked — not because a growth deck did.
About forty cents a day.
- Two free sessions before billing starts
- Then $11.99 a month — about forty cents a day
- Unlimited sessions — any conversation you can describe
- A coaching read after every session, and your progress over time
- Cancel in two taps; 7-day refund if you change your mind
One conversation you’d have talked yourself out of is worth years of this. Or just sleep better on Wednesday. Either way.
Run your first rehearsal — free →US only at launch. We'll get to the rest of the world.
The conversation is on Thursday. Begin tonight.
Three minutes. Two free. 7-day money back after that.