Want greater skill? Try a moment of planning!

Yesterday was our daughter’s last day at home before she flew across the country to return to college. My mind was buzzing with the growing list of things that I didn’t want to forget to remind her about. So I did what any overly-anxious mother would do – I walked into her bedroom and announced that we had a lot to do today and began to recite my list. As you might imagine, this was met with a less than warm and enthusiastic response.

Fortunately, our daughter is able to clearly articulate what she wants and what she doesn’t want. So she explained, “If you had come into my room and said, ‘Good morning! We have a lot to do today. How do you want to organize the day?’ things would have gone a lot better.”

She was absolutely right. It reminded me of a situation that occurred during my Internal Medicine residency. I was in charge of the ICU when a very sick man was admitted with a diagnosis of ARDS, a condition with a mortality rate of 70%. After assessing him and writing orders, I proceeded to bombard the terrified family with a list of statistics about the potential risks and survival rates of this virulent condition. They were as shell-shocked and shut down as our daughter was after I unloaded my to-do list on her yesterday.

As we rush through our day, trying to keep our head above water while managing so many aspects of so many facets of our lives, we can easily get stuck in our heads and think only of unloading the information we want to transfer – before we forget or get pulled into another interaction. Unfortunately, if the intent of our communication is that the other person receives and understands this information, we may as well be talking to ourselves.

A more skillful way for me to impart the to-do list that I found so important would have been to greet my daughter first, acknowledge what must have been HER feelings, state my intention, and then ask for permission to proceed. It might have sounded like this:
Good morning! I imagine that you have lots of feelings and ideas about this last day at home. There are some things that I think we need to accomplish today and I’m wondering if this is a good time to talk about them.

The family of my patient would have been better served if I had introduced myself and then said:
You must be quite worried about your husband/father. We’re going to do whatever we can to make sure that he recovers fully. I have some information to give you about his condition, but first, do you have any questions that you would like me to answer?

Communication involves a set of skills that we all can learn. For some of us, we must first unlearn some habits, such as our tendency to allow anxiety or other emotions to drive inefficient ways of imparting our message. One moment spent clarifying my intention and considering how I might best approach our daughter might have made the difference between a testy interaction and one that reflected the love and concern I was feeling. The importance of our communications, and the lasting feelings that they generate, are certainly worth a moment of planning to make sure they are as skillful as we can possibly make them.

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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, control freak, effective communication in healthcare, first impressions, physician coaching, physician communication, physician work life balance and tagged , . Bookmark the permalink.

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