Inspired by @ETSshow and @ChrisLMosher, a #medtwitter #thread on “6 tactics to improve difficult conversations”
The following can apply to conversations with loved ones, colleagues, patients, teenagers, and pretty much any other human.
Warning: this one is kind of long.
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The following can apply to conversations with loved ones, colleagues, patients, teenagers, and pretty much any other human.
Warning: this one is kind of long.
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I do not suggest that I am the best communicator in difficult conversations. @BossletMD may tell you the opposite. But this is something I reflect on and work hard at to improve.
I credit @vitaltalk for helping me notice my incompetence in these areas almost a decade ago.
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I credit @vitaltalk for helping me notice my incompetence in these areas almost a decade ago.
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First, let’s establish that conflict is ubiquitous, usually unavoidable, and often is not pathologic.
Like a forest fire, it is often a catalyst for new growth.
So avoiding conflict at all costs is folly and a way to lead to let things fester.
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Like a forest fire, it is often a catalyst for new growth.
So avoiding conflict at all costs is folly and a way to lead to let things fester.
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Given this fact, one of the MOST IMPORTANT skills you can cultivate is the ability to have difficult conversations well.
I recommend picking up one of these three books, all of which are relatively quick and easy reads and can help solidify the stuff in this thread.
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I recommend picking up one of these three books, all of which are relatively quick and easy reads and can help solidify the stuff in this thread.
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So here are the 6 tactics I will discuss in the coming tweets:
1. Open with a question
2. High listen:talk ratio
3. Use permission statements to shift to providing thoughts
4. Make an unassailable observation
5. Avoid the “but”
6. Use “I worry” and “I wish”
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1. Open with a question
2. High listen:talk ratio
3. Use permission statements to shift to providing thoughts
4. Make an unassailable observation
5. Avoid the “but”
6. Use “I worry” and “I wish”
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Tactic 1- open with a question when a conversation may be contentious.
Tee up the question in your mind and don’t offer thoughts before you probe this question fully. This helps to lay bare assumptions and preferences of the other person.
THIS IS DIFFICULT.
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Tee up the question in your mind and don’t offer thoughts before you probe this question fully. This helps to lay bare assumptions and preferences of the other person.
THIS IS DIFFICULT.
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.@gradydoctor demonstrates the importance of opening with a question in this tweetorial on defending an intern from a contentious interaction with a surgical colleague (plus, rhymes).
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Sample questions:
Can you talk a little bit about why you think I should be the one to do the extra shift?
Can you talk about the interaction you and John just had?
I wanted to know a little more about what you were hoping I could help with on that committee.
Are you OK?
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Can you talk a little bit about why you think I should be the one to do the extra shift?
Can you talk about the interaction you and John just had?
I wanted to know a little more about what you were hoping I could help with on that committee.
Are you OK?
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Tactic 2 is similar- “Have a high listen: talk ratio”
You should aim to listen more than give information- THIS ALSO IS HARD.
LISTENING SLOWS PEOPLE DOWN and absorbs emotion.
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You should aim to listen more than give information- THIS ALSO IS HARD.
LISTENING SLOWS PEOPLE DOWN and absorbs emotion.
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Two words I find helpful in helping to listen are “say more”. They allow the other to move the conversation where they want, and signal I am willing to go there with them. It is a signal of empathy and often opens the other party to listening when it is your turn to speak.
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My wife and I used “say more” a lot when confronting our son about his google review of @BossletMD (his mom).
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Tactic 3 is the use of permission statements before offering observations.
This allows the other to prepare their amygdala for news that may be difficult. It is a simple thing that is often overlooked and underused.
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This allows the other to prepare their amygdala for news that may be difficult. It is a simple thing that is often overlooked and underused.
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Examples of permission statements:
“Is it OK if I give my impression of the situation?”
“Would you be willing to hear my thoughts about the meeting?”
“Is it OK if I talk about how shifts are distributed?”
“I’m upset about that interaction- can we chat about that?”
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“Is it OK if I give my impression of the situation?”
“Would you be willing to hear my thoughts about the meeting?”
“Is it OK if I talk about how shifts are distributed?”
“I’m upset about that interaction- can we chat about that?”
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Tactic 4- make an unassailable observation
These statements take the syntax
“When you did X, I noticed Y”, or
“When you did X, I felt Y”
These are unassailable because they are YOUR observations of what happened- the other person can’t argue with your observations.
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These statements take the syntax
“When you did X, I noticed Y”, or
“When you did X, I felt Y”
These are unassailable because they are YOUR observations of what happened- the other person can’t argue with your observations.
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Tactic 5- avoid the “but”
The word “but” negates everything that comes before. The other only hears what follows.
Think of how you interpret sentences that start with...
“I would love to do that, BUT…”
“I really like him, BUT…”
“I’m not racist, BUT…”
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The word “but” negates everything that comes before. The other only hears what follows.
Think of how you interpret sentences that start with...
“I would love to do that, BUT…”
“I really like him, BUT…”
“I’m not racist, BUT…”
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Simply replace “but” with “and”. It works in almost all situations.
This simple tactic works well.
The first big hurdle is to notice buts- as you get better at this, you will find yourself starting to trip over your sentences as you approach a but).
Try it!
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This simple tactic works well.
The first big hurdle is to notice buts- as you get better at this, you will find yourself starting to trip over your sentences as you approach a but).
Try it!
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Tactic 6- “I wish” and “I worry”
Replace “no” with “I wish” or “I worry”. This ensconces a “no” in empathic and emotive language that aligns you with the other.
(NOTE: Sometimes a simple “no” is needed- it takes practice to figure out when to use “I wish” and “I worry”)
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Replace “no” with “I wish” or “I worry”. This ensconces a “no” in empathic and emotive language that aligns you with the other.
(NOTE: Sometimes a simple “no” is needed- it takes practice to figure out when to use “I wish” and “I worry”)
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Focus on one of these tactics and use it in low-stakes conversations. Notice what happens to the emotional temperature. Small wins will help you to remember and use it more often. When one is mastered (or deemed unhelpful), grab another one and start to play with it.
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Getting better at difficult conversations is a skill that can be worked on and cultivated. These tactics can help- simply reflecting on conversations and noticing what went well and what seemed to cause hiccups is the first step to improvement.
#FocusedPractice
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#FocusedPractice
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