Communication

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Communication

• James G. Adams, MD
• Professor and Chair
• Dept of Emergency Medicine
• Northwestern University
• Feinberg School of Medicine
• Northwestern Memorial Hospital
• Chicago, Illinois

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What if you could

• Ensure you have a fulfilling year
• Be respected
• Be effective
• Feel appreciated
• Minimize frustrations and irritations

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Wait, there is a problem

• A lot of the work will not be fulfilling
• A lot of people will not be respectful
• We cannot always be effective
• We will not always be appreciated
• There will be a lot of frustrations and
  irritations

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You are making the schedule

• One of the junior residents submits an extensive
  list of days requested off, more than can be
  accommodated
• You ask which requests are the highest priorities
• You make the schedule to the best of your ability

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• The resident sends this message
• I cannot believe you made me work on Friday
  April 24. I specifically requested this day off.
  I would appreciate it if this does not happen
  again.

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Hint 1 Only if we recognize our emotions we can
control them

• Recognize your emotions and reactions
• You cannot control how you feel but you can hold
  back your response.
• Take time to consider the situation
• Dont gossip, but seek the insight of another

He who the gods wish to destroy they first make
angry. Socrates
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These lessons are broadly applicable

• The hints, tips and lessons described here are
  broadly applicable, now and in the future.
• Intra-residency conflicts
• Inter-departmental conflicts
• Personal conflicts
• Communication challenges anywhere, anytime

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Lesson 1 We are emotional beings, we are not
rational

• Our primitive instinctive responses rule us
• Fight or flight
• We have a constant voice in our heads that create
  our reality, our perceptions
• We can change the voice
• We can re-frame

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With this hint and lesson, we can choose our
action

• Ask for clarity,
• I dont understand
• Caution we may think we are rational, but we are
  often still emotional. Evaluate yourself Only
  when you are capable of thinking good thoughts
  about this resident should you have any
  discussion
• Are you ok?
• We are on different wavelengths here
• Is there something going on that I dont know
  about?
• Get advice, know when to elevate the issue
• Make sure you have backup
• Stay shoulder to shoulder

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Hint 2 Anticipate bad behavior and prepare

• Get the ground rules straight
• I am here to take care of you, but
• Lower expectations
• Everyone will be treated unfairly
• Everybody will be cheated, lied to, and otherwise
  mistreated
• If we all work together to accommodate each other
  we can minimize these problems, but it is up to
  you, whether you are willing to give
• If we are not all flexible and generous, then we
  all will be mistreated
• That has nothing to do with me, we all have to
  stay together
• Set rules, policies, guidelines

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Lesson 2 Set expectations and lower expectations

• Set rules, standards,
• Lower expectations
• Ensure fairness.
• Fairness is not equality. Establish expectations
  of variability
• Never reward bad behavior
• Give the bad shift to the complainer

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We are always striving, stretching,
overextending, reaching for grass that is
greener, But before we get ourselves trapped,
we better make sure that those who are behind
us Are really our friends
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Hint 3 Gain insight and increase influence

• People are not against you, they are just for
  themselves
• Everyone is behaving absolutely
  rationallyaccording to them
• Figure out their needs and motivations and you
  can create a solution
• If you can quiet your own instinctive reactions
  and judgments, you can understand the other
  person and then be highly effective at figuring
  out a solution

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Lesson 3 Active listening and building
relationships increase your influence and power

• Build social capital
• Establish your reputation
• Invite early contact
• Be generous
• Do small favors
• Get in synch with your residency director and key
  faculty leaders

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Interdepartmental conflicts

• Others are behaving emotionally but they think
  that they are behaving rationally
• They are acting in their own interest. They are
  not really against you, they are just for
  themselves.
• Your route to success

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Lessons

• Hint 1 If we recognize our emotions we can
  control them
• Lesson 1 Quiet our emotional impulses so that we
  gain insight and control
• Hint 2 Anticipate bad behavior and prepare
• Lesson 2 Set expectations
• Hint 3 Gain insight and increase influence
• Lesson 3 Active listening and building
  relationships increase your influence and power

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Then when conflict comes

• A tense, but quiet disagreement occurred between
  the ED attending and trauma attending when it was
  suggested that a patient be kept in the ED for
  several hours of observation instead of being
  admitted.
• When the ED attending could not get the trauma
  attending to admit the patient, the ED attending
  said, You are just a big fat f---ing baby.

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Shift to positive language

• Positive language reinforces good behaviors and
  creates an effective and happy environment
• The housekeeper
• Saving lives
• The technician
• You just saved this persons life!
• The nurse
• The saint
• The doctor
• My hero

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Hint 4 Your communication skills help you gain
control

• Your words can help you gain control
• Your body language matters
• Your communication skills matter

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Lesson 4 The norm of human reciprocity

• Your route to control
• People react, respond and mirror the emotions of
  the other.
• Kindness and compassion or
• Anger and frustration
• When it is not going well, recognize it, distance
  yourself and reestablish a new norm.
• Practice!

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Lessons we need to learn

• Hint 1 If we recognize our emotions we can
  control them
• Lesson 1 Quiet our emotional impulses so that we
  gain insight and control
• Hint 2 Anticipate bad behavior and prepare
• Lesson 2 Set expectations and lower expectations
• Hint 3 Gain insight by listening
• Lesson 3 Active listening and building
  relationships increase your influence and power
• Hint 4 Use your communication skills to help
  you gain control
• Lesson 4 The norm of human reciprocity

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Learning

• A brand new intern presented a case of a young
  woman with low abdominal pain and minor vaginal
  bleeding. Asked by the attending, Well what do
  you think? the intern said, Well, I think she
  is ok and can probably go home and follow up.
• The attending asked, What does the pregnancy
  test show?
• The intern said, Uhh
• To which the attending replied

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• What? What? Why do you hate her? What did she
  ever do to you? You are trying to kill her! Why
  dont you just go get a gun and make it a clean
  kill!

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Hint Domination does not yield long term success

• Domination yields temporary satisfaction
• Domination prevents long term fulfillment,
  relationships, happiness

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Lesson If you try to dominate you will always be
fighting

• Learn lessons 1-4 to minimize the need to
  dominate
• You will gain respect, happiness, fulfillment and
  minimize your conflicts and frustrations

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Lessons we need to learn

• Hint 1 If we recognize our emotions we can
  control them
• Lesson 1 Quiet our emotional impulses so that we
  gain insight and control
• Hint 2 Anticipate bad behavior and prepare
• Lesson 2 Set expectations and lower expectations
• Hint 3 Gain insight by listening
• Lesson 3 Active listening and building
  relationships increase your influence and power
• Hint 4 Use your communication skills to help
  you gain control
• Lesson 4 The norm of human reciprocity

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• Ensure you have a fulfilling year
• Be respected
• Be effective
• Feel appreciated
• Minimize frustrations and irritations