Telling people about your diagnosis: Ring Theory and the inner circles

There is no single right way to do this, but there is a useful frame. In 2013, the Los Angeles Times published a short essay by clinical psychologist Susan Silk and her co-author Barry Goldman called "How not to say the wrong thing." It introduced what is now widely known in palliative literature as Ring Theory. The essay is barely 700 words long and has been cited in medical communication guidelines, hospice training, and grief counselling for over a decade.

This article explains Ring Theory, applies it to a Dutch context, and gives practical scripts for the conversations you will face.

Where Ring Theory comes from

Susan Silk had cancer. After her surgery, a colleague she barely knew came to visit her in hospital and complained at length about how upsetting Silk's illness was for the colleague. Silk realised something was structurally wrong with how people direct their feelings during a crisis.

She drew it as a set of concentric rings. The person facing the crisis sits at the centre. The next ring is the person closest to them — usually a spouse or partner. The next ring is the next-closest, and so on outward. The rule of Ring Theory is simple:

Comfort goes in. Distress goes out.

You can complain, cry, panic, fall apart, ask for help — but only to someone in a ring further out than your own. To anyone in a ring closer to the centre than you, you offer comfort.

That is the entire framework. It is short because it has to be. People under stress cannot remember complicated rules.

The rings, in a typical Dutch household

The map is yours to draw. Most people doing this for the first time end up with something like this.

Centre: the patient. This is you. Everything starts here.

Ring 1: the partner or spouse. The person you live with, the person who will be present at most appointments, the person whose life will change next-most after yours. In a same-sex couple, in a long-term cohabiting relationship, in a registered partnership, this ring is the same.

Ring 2: children, including adult children. Their world is also rearranging. A teenage child needs different information from a five-year-old, and an adult child living abroad needs different information from one living next door. The ring contains them all; the conversations differ.

Ring 3: parents and siblings. Often the people who have known you longest. The conversation here can be uniquely hard because the parent–child relationship reverses.

Ring 4: close friends and chosen family. People you would call before you would call a sibling. In Dutch life this often includes a few neighbours and a few colleagues who have become friends.

Ring 5: wider friends, extended family, work colleagues, employer. People who matter and who will need to know, but whose role is to support rather than to be supported.

Ring 6: acquaintances, neighbours, the school community, online networks. The people who hear last, often through someone else, and whose primary job is to let you live your life.

The map is not a hierarchy of love. It is a map of who can carry what.

How the rule works in practice

The rule says: comfort in, distress out. Two examples make it concrete.

A friend in Ring 4 hears the news. She is shocked and frightened. She wants to call you and cry. The rule says: not to you. Not to your partner in Ring 1. Not to your children in Ring 2. She can call her own partner, her own friends, a therapist, a Luisterlijn volunteer, anyone in a ring further out than hers. To you, she offers steadiness. She brings food, sits in the waiting room, listens.

Your sister in Ring 3 hears the news. She is angry at the medical system, at the situation, at how unfair it is. The rule says: not at you. She can be angry at her husband, at her own friends, at the universe in her own home. To you, she brings calm.

The rule is not about suppressing feelings. It is about directing them.

Who tells whom, in what order

Most people find the following sequence makes the news survivable.

1. Tell your partner first, in private, with time. Not in a corridor or by text. Plan a quiet evening or a weekend morning.
2. Decide together what each child needs to know, when, and from whom. The Dutch palliative communication guidance from the KNMG and Pallialine recommends honest, age-appropriate language. (See the article on talking to children.)
3. Tell your parents and siblings before they hear it from someone else. A short call is enough at first. The longer conversation can come later.
4. Choose two or three close friends to be your inner support circle. You do not have to brief everyone. You can ask one friend to coordinate.
5. Decide what you want your wider circle to know, and how. A short message via WhatsApp groups, a one-paragraph email, an update from your partner — any of these is acceptable. Some people delegate the announcement entirely.
6. Tell your employer when you have decided what you want to ask of them. In the Netherlands, you are not legally required to disclose your diagnosis to your employer (the bedrijfsarts may know more), but you usually need to discuss adjustments to work.

There is no obligation to tell anyone. Privacy is part of dignity.

Scripts for different rings

For close family (Ring 1 to 3). "I had test results this week. The diagnosis is X. I want to tell you what we know so far, and then I want to tell you what I need from you." Then state one or two concrete needs: a hand to hold at the next appointment, help with the children's school run, time to be quiet together.

For an inner circle of friends (Ring 4). "I want you to know what I am dealing with. I am not asking you to fix it. I am asking you to keep being yourself with me. Specifically, X would help."

For colleagues and employer (Ring 5). "I am dealing with a serious health issue. I will need to adjust my work for the next months. Can we talk about how?" You decide whether to name the diagnosis. Many people give the bedrijfsarts the medical detail and the employer only the practical implications.

For the wider circle (Ring 6). A single message, sent once, on your terms. "Some of you have heard. I want you to know directly that I am receiving treatment for X. I am not always able to respond. The best way to help is by Y. Please understand if I do not reply quickly."

For people who do not yet know how to behave around you. "I appreciate you reaching out. I am not up for talking today. I will call you when I want to talk." This is a complete sentence.

Boundary-setting

Ring Theory gives you the right to refuse conversations that would cost you energy you do not have. Some phrases people use:

• "Not now. I will let you know when I want to talk."
• "I am keeping this between a small circle for the moment. I will let you know when that changes."
• "I love you and I do not want to discuss it today."
• "Please do not share this with anyone else. I want to be the one to tell people."

Ask your inner circle to honour your boundaries with people further out. A trusted person can become a gatekeeper: "She is resting today. I will tell her you called."

Children are a special case

Children are inside the rings, not outside them. Dutch palliative communication guidance from the KNMG and Pallialine is explicit: children pick up on a serious diagnosis whether they are told or not, and the absence of information tends to be more frightening than the information itself. The age and developmental stage of each child shapes what to say and when. The article on talking to children explains the principles in more depth.

Decide together with your partner who tells the children, in what setting, with what words. Plan for repeat conversations: children process serious news in pieces, often returning to the same question weeks later.

What if someone breaks the rule

It happens. Someone in a wider ring calls you in tears and turns the conversation into their own grief. A colleague tells you you should be eating differently. A distant relative posts about your diagnosis on social media before you have told your own brother.

You do not have to manage their feelings in the moment. A gentle reframe is enough: "I cannot hold this conversation right now. Please call X if you need to talk it through." Or, with someone who has overstepped: "Please take this down. I have not yet told everyone."

You are allowed to be the one who matters in your own crisis.

Where to find help in the Netherlands

In the app

In the Personal Portal, Stage 9 (Telling People) lets you build a notification list ordered by ring — who hears first, who hears later, with notes for each.

Join the beta ->

Closed beta — access by invitation.

Sources

1. Susan Silk and Barry Goldman, "How not to say the wrong thing," Los Angeles Times, 7 April 2013 — the original Ring Theory essay, widely cited in palliative communication literature. https://www.latimes.com/opinion/la-xpm-2013-apr-07-la-oe-0407-silk-ring-theory-20130407-story.html
2. KNMG — Gespreksvoering aan het einde van het leven, professional guidance on end-of-life conversations. https://www.knmg.nl
3. Pallialine / IKNL — Communicatie in de palliatieve fase, clinical guideline for communication in palliative care. https://palliaweb.nl