There’s a disconnect between how we treat sick people and how they want to be treated, according to Letty Cottin Pogrebin, author of the new book How to Be a Friend to a Friend Who’s Sick.

We stay silent. We say stupid things. We go from being sensitive, sensible, kind adults to rambling niceties or making downright rude remarks.

Illness, understandably, makes us nervous.

Fortunately, Pogrebin’s book helps us navigate the muddied waters of illness and mortality. It’s packed with practical tips and valuable insights.

Pogrebin was inspired to write the book after observing the varied reactions from her own friends to her breast cancer diagnosis. Some friends misunderstood her needs and acted awkwardly. Others were supportive and compassionate.

In the book, she shares these personal experiences, along with powerful accounts of people offering support to others. She also shares the words of almost 80 of her fellow patients at Memorial Sloan Kettering Cancer Center. She interviewed these individuals to find out how they really wanted to be treated.

Here’s a snippet from Pogrebin’s book on communicating with a sick friend.

What Not To Say To A Sick Friend

Pogrebin advises against saying phrases like “Everything happens for a reason” and “You need to be strong for your kids.”

Even seemingly positive statements become anything but. For instance, let’s say you’re trying to cheer up a friend who just received a cancer diagnosis. You might say something like, “I know ten women who’ve had breast cancer, and they’re all doing fine” or “My sister had a double mastectomy, and she’s climbing mountains!”

One cancer patient told Pogrebin that these comments were insulting and dismissive. They also didn’t mean anything to her: “Every woman and every cancer is different,” she said.

Another seemingly positive but problematic phrase is “You look great.” According to Pogrebin, when you focus on your friend’s appearance, it can discourage them from telling you how they truly feel; if they don’t look good, they won’t believe anything you say; and if you don’t compliment their appearance in the future, they might assume they look worse.

What To Say To A Sick Friend

Pogrebin stressed the importance of being honest with your sick friends. She also notes that everyone should be able to say these three statements: “Tell me what’s helpful and what’s not;” “Tell me if you want to be alone and when you want company;” and “Tell me what to bring and when to leave.”

In addition to honesty, it’s also important to express empathy and availability. Pogrebin includes a list of seven phrases that sick people want to hear. All of these include empathy or availability or both elements.

  • “I’m so sorry this happened to you.”
  • “Tell me how I can help.”
  • “I’m here if you want to talk.”
  • “Just give me my marching orders.”
  • “That sounds awful; I can’t even imagine the pain.”
  • “I’m bringing dinner.”
  • “You must be desperate for some quiet time. I’ll take your kids on Saturday.”

The Commandments of Conversing

In her book, Pogrebin features a list of 10 commandments for conversing with sick friends. For instance, she suggests celebrating your friend’s good news and not downplaying their bad news. This doesn’t mean sugarcoating or “slapp[ing] a happyface decal on a grim diagnosis,” she writes. Instead you can say, “Tell me what I can do to make things easier for you — I really want to help.”

Also, treat your friends the same way you always have, but don’t forget their new circumstances. For instance, tease and joke around with them, but “indulge their occasional hissy fits.”

Talk about other things. According to Pogrebin, this helps “speed the journey from the morass of illness to the miracle of the ordinary.”

Similarly, emphasize their skills and talents, which will help them feel valued. This can be anything from asking a poker aficionado for pointers on playing to asking a retired teacher for guidance on college applications for your teen.

Unless you’ve been there, avoid talking about yourself or telling your friend that you understand what they’re going through. Avoid complaining about comparatively small things. (“Don’t tell someone with congestive heart failure that you have a migraine headache, as painful as it may be,” Pogrebin writes.)

Before saying anything, make sure you know the facts of your friend’s sickness and situation. Pogrebin shares the story of one woman who had three friends tell her that they were glad the cancer was caught early. It wasn’t.

Don’t treat your friend like a child or pressure them into being positive. Positive thinking can help people endure tests and treatments, but it’s not a cure. Don’t imply that negative thinking caused or exacerbated their illness. As Pogrebin says, the last thing your friend needs to be doing is blaming themselves.

When thinking about how best to approach a sick friend, Pogrebin quotes Hillel’s famous words: “Do not say unto others what you would not have them say unto you. All the rest is commentary.”