Resuscitate your difficult relationships

After presenting a talk on communication at a local hospital, I was approached by a wonderful, experienced Internist who asked about a situation that I don’t often encounter. He wondered what to do with patients who enter into contracts with their physician, only to break them. The scenario he described involved substance-abusing patients who agree to a set of circumstances – decreased usage, participation in rehab programs, etc. These patients often break the contracts and then become angry when the physician refuses to provide prescriptions for additional narcotics. Definitely a frustrating situation! The physician then begins another round of discussions about the reasons to stop using narcotics, and the dance starts all over again. While most of us may not treat patients with substance abuse, it struck me that this situation occurs in all of our lives in different forms. How often do we find ourselves having the same, failed conversations, over and over again, with the people in our lives?

The solution to this issue is to determine which conversation we need to have.

In their excellent book, Crucial Confrontations, Patterson and colleagues propose the mnemonic CPR – which seems to be a propos as the structure of this approach can breathe new life into our frustrated relationships.

When a person does something that we find bothersome or troubling, the initial conversation is about the content. We discuss the problem behavior and the impact it’s having. Hopefully, we find some common ground, effect a change in the person’s perspective and actions, or we gain an understanding of why the behavior is, actually, appropriate.

If we agreed that the person would change their behavior but it continues, another discussion about the behavior is irrelevant and frequently useless at best. Many times, it worsens the situation as we become increasingly irritated and the other person finds us annoying and controlling. So at this point, the conversation should focus on the pattern. We have already agreed that the behavior will change – yet it persists. We may reiterate the effects that the behavior is having and try to discover what is motivating the pattern, what obstacles lie in the path of change, and what process will allow the change to occur. Mostly, we state that the fact that they agreed to change but haven’t is making you doubt their ability to keep a promise.

We all have many experiences, however, in which the behavior continues despite these conversations. At this point, we are angry, hurt, and our opinion of the other person has sunk to new lows. The conversation then should be about the relationship. The person has promised to make a change but has broken their promise. We are no longer able to trust or believe them. The relationship has been compromised and, if this continues, it will be irreparably damaged. Frequently, when the other person sees that their actions have such far-reaching consequences and realizes that it’s no longer about the behavior but now affects their credibility and your trust of them, change becomes more desirable and motivation increases.

I’m a big fan of structures, as they help us in so many ways. By applying this structure to your communication challenges, you might find that the seemingly impossible situations in your life begin to move forward in positive and more satisfying ways.
It’s as easy as C – P – R!

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, physician coaching, physician communication, Uncategorized and tagged , . Bookmark the permalink.

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