I read with interest the article by Suri et al. [1] on the harms and benefits of sharing ‘‘tragic knowledge’’ with patients. However, I want to clarify that there have been no good studies to indicate that unrealistically optimistic patients benefit at the end of life. In fact, a study looking at patients with advanced cancer found that those who were overly optimistic were more likely to receive aggressive treatments and die while on a ventilator—all without survival benefit [2]. Studies that have pointed to the psychological benefits of unrealistic optimism in cancer patients are flawed because they are overwhelmingly cross-sectional in their design and do not take into account the emotional distress of patients and families when death is imminent. As a palliative care physician, I have seen this lastminute realization be accompanied by the awareness that there is no longer the opportunity to put affairs in order or to engage in meaningful legacy work. Take the 40-year-old woman with widely metastatic breast cancer who refuses to acknowledge that she only has weeks to live. She does not talk to her children about why she is becoming frailer by the day. Some may argue that this avoidance is allowing her to live more fully in the moment with her children. However, her last days may be filled with fear and regret. Not only is this difficult for the patient, but the last memories her family have of her will be marred by her existential distress. This is important to acknowledge for two reasons. First, it emphasizes the need to move beyond the traditional dyadic physician–patient model of medicine. When appealing to the ethical principles of beneficence and non-maleficence, we need to shift to a more relational model of care—taking into the consideration the wellbeing of not only the patients, but also of those closest to them. Second, recent findings looking at what makes us happy have revealed that there is a marked difference between our experiences and our memory. As noted by the Nobel Prize-winning psychologist Daniel Kahneman in his 2010 TED talk [3], there is a ‘‘difference between being happy in [one’s] life and being happy about [one’s] life.’’ A so-called ‘bad death’ can negate all the good that death avoidance provided, but good prognosis and goals-of-care discussions can help people shift from the former to the latter. However, until surgical curriculums view these discussions as a skill that is as important to teach and evaluate as the dissection of anatomical planes, physicians will continue to cause iatrogenic harm through the omission or ‘mis-sharing’ of information with patients. The challenge in teaching such a skill is that it cannot be approached in a prescriptive way, but rather must be viewed as a delicate dance—ever evolving and often times circuitous. But learn it we must, because, as the anti-hero surgeon of Abraham Verghese’s novel Cutting for Stone [4] so adroitly put it, ‘‘What treatment in an emergency is administered by ear?’’ The answer is ‘‘Words of comfort.’’ I. Ying (&) Division of Palliative Care, University of Toronto, Toronto, ON, Canada e-mail: irene.ying@utoronto.ca