The sounds – and shame – of silence

“Much unhappiness has come into the world because of bewilderment and things left unsaid.”
– Fyodor Dostoyevsky

We all worry about things we say – have we hurt someone’s feelings? Spoken too harshly? Been too sarcastic? I would argue that we do just as much damage by the things we leave unsaid. Think about it – when we are angry, hurt, or just confused and elect not to say anything, we usually make the situation worse. We respond coldly to the other person, attempt to “get even” or make assumptions that alter all future interactions with that person. If we’re honest with ourselves, we know that when we don’t speak up, we act out.

I’m happy to report that there is something positive we can do when we find ourselves in these situations.

We can speak up.

I can almost hear the panic in your voice – but how do I do that? Or the anger and frustration – it will never work!

It is true that our initial impulse might be to attack those who do things we don’t like. As Patterson, et al describe in Crucial Confrontations, the usual path that our reaction takes looks like this:
We see/hear something…Create a story about what’s going on…Feel an emotion…Act
Unfortunately, our stories are usually flawed, our emotion deprives us of sound reasoning ability and our actions reflect it. So first, be clear about the story you’re telling yourself and, as Patterson and colleagues suggest, stop and ask yourself, “Why would a reasonable, rational, decent person do this?” What other explanations are possible?
If there was ever an antidote to judgment, it is curiosity.

At the outset of the discussion, a sense of both mutual respect and mutual purpose must be established. Their absence can sabotage even the best of intentions and skills. Mutual respect is frequently conveyed (or disproved) with our tone of voice, facial expressions, or simply by asking the person if this might be a good time to talk. When mutual respect is missing, try using the communication skill of contrasting – say what you don’t mean, followed by what you do mean (see post 10/8/11). And if the other person feels that your intentions are at odds with theirs, it becomes important to state why and how this discussion will help them as well as you.

Armed and empowered with an open mind and supported by a foundation of mutual respect and purpose, approach the person who has disappointed you and describe the difference between what you expected and what happened. Stick with the facts and avoid descriptive words or an emotional tone of voice. “I expected you to do your job well and you didn’t” is not helpful. A more useful description of the gap between expectations and occurrences might be, “I expect that you will have the charts/X-rays/reports ready when we see each patient and yesterday, many of them weren’t available when I needed them.”

After describing this gap, tell the story that you created about what happened. “I noticed that you were making personal phone calls while patients were waiting, so it seems that your personal life is getting in the way of your doing your job. This is negatively affecting our ability to see patients on time, to have the information we need for them, and makes us seem disorganized and incompetent.” End with a simple question such as, “how do you see this situation?”

By opening your mind to other explanations, establishing safety with mutual respect and mutual purpose, then clearly stating the gap between expected and observed behavior and following with a genuine, curious question, you will be able to fill those dangerous voids of silence with powerful, effective, relationship-building communication.
Try it – it’s a lot easier than you think.

About Helane Fronek

Over the past 28 years I have had a fascinating and fulfilling career in medicine, initially practicing as a general internist and then as a procedural specialist, caring for patients with vein disorders. As Assistant Clinical Professor of Medicine at UC- San Diego School of Medicine, I’m thrilled to be teaching medical students crucial communication skills along with many other aspects involved in the practice of medicine.
This entry was posted in building relationship with patients, effective communication in healthcare, honesty in medical care, physician coaching, physician communication, Uncategorized and tagged . Bookmark the permalink.

2 Responses to The sounds – and shame – of silence

  1. morrisonvein says:

    Reblogged this on Morrisonvein's Blog and commented:
    Great post by a highly-respected Doctor friend of ours, Helane Fronek

  2. Corey B says:

    Good reading this ppost

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