DIFFICULT DIALOGUES: Giving and Receiving Bad News

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DIFFICULT DIALOGUES Giving and
Receiving Bad News

• Sandra L. Frazier, MD
• UABHS Physician Health Officer

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OBJECTIVES

• Participants will learn
• The importance of listening
• Different personality styles
• Formulas to give difficult feedback

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LISTENING

• THE MOST CRITICAL SKILL
• A success, business skill
• If you listen, they are more likely to
• Others must feel heard
• Traits of good listeners ?

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GOOD LISTENERS

• Look at you
• Eliminate distractions
• Respond verbally/nonverbally

• Ask questions
• Lean forward
• Occasionally nod their head

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WHAT IS YOUR PERSONALITY STYLE?

• Extrovert or Introvert ?
• Fast mover or Slow mover?

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E
RELATOR
INITIATOR
F
S
ANALYZER
DRIVER
I
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INITIATOR (SOCIALIZER)

• PROS
• Best brainstomer
• Energetic, creative
• Positive, upbeat

• CONS
• Not very practical
• Too chipper
• Loud, noisy

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DRIVER (COMMANDER)

• PROS
• Best in crisis
• Focused
• Multitasker

• CONS
• Can be autocratic
• Serious
• Blunt, abrupt

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ANALYZER (TECHNICAL)

• PROS
• Detailed, accurate
• Critical thinkers
• Independent

• CONS
• Obsessive
• Indecisive
• Slow, methodical

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RELATOR (AMIABLE)

• PROS
• Good listener
• Team player
• Nurturer

• CONS
• Indecisive
• Over sensitive
• Over involved

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ADAPTING YOUR STYLE

• To Initiators Its a great day, etc. I need
  your help
• To Drivers - send email. I need your 1 or 2
  sentence feedback on
• To Analyzers I need your help analyzing some
  data
• To Relators - Id like to talk to you.

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GIVING DIFFICULT FEEDBACK CONSTRUCTIVELY

• Eliminate constructive criticism
• Eliminate but, however
• Brainstorm with others
• Script it out and practice
• Determine the level of risk

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3 FORMULAS

• 2 and 2 give 2 specific positives and 2
  specific improvements
• F State Facts
• I - State Impact
• R - Give Respect
• R Make Request
• U - Understand others point of view 1st
• S - State your Situation
• A - Alternative Action

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RECEIVING DIFFICULT FEEDBACK

1. Learn to receive criticism. Look for any truth.
2. Stay calm. Take a break if necessary.
3. Admit you are wrong if you are
4. Proactively work on shortcomings/weaknesses.
5. Give everyone the benefit of the doubt.
6. Be a good listener!

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CASE SCENARIOS
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CASE 1

• A faculty member constantly interrupts you
  during the monthly staff meeting.
• What would you say?

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CASE 2

• One of your most clinically skilled faculty
  members keeps patients waiting to be seen for at
  least an hour past the scheduled appointment
  time. Many patients are threatening to find
  another doctor.
• How would you give him/her this feedback?

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CASE 3

• You appointed a faculty member Project Director
  over an important research project as a reward
  for her hard work. However, she has performed
  poorly and does not have good leadership skills.
  You have decided to remove her from the position.
• How do you approach her?

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Resources

1. Difficult Conversations, by Douglas Stone, et al
2. Crucial Conversations, by Kerry Patterson, et al
3. Dealing With Different, Diverse, and Difficult
   People, -audio series, by Barbara Braunstein