If you must have a tough conversation what is the most important factor in the conversation? Oddly enough, it is not the conversation itself. It is preparation. Before you communicate with another person, such as a patient, you must be prepared for it. Select the three items you want to communicate. A good formula for this is that the first item states exactly what the situation is, the second item states why it is important, and the third item states the recommended solution. In any tough conversation following some pattern of no more than three items and repeating those items so that the conversation is clear will help avoid inflaming the situation and making it even worse.