Difficult conversations are those that we tend to avoid because they suck. They usually include disappointing someone we don't want to.
A thread on difficult conversations, #COVID19, and leadership.
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Difficult conversations abound in COVID time. Examples include:
“I know you want to go to that soccer tournament, but 400 teenagers and their parents in an indoor facility seems unwise.”
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“Thanks for inviting me to dinner at Billy Bob’s low-ceilinged, poorly ventilated tavern. I am going to pass because of the pandemic.”
“Thanks for inviting me to your wedding. I am going RSVP no given the global pandemic.”
“Mom, we have to talk about Thanksgiving.”
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These are conversations that no one wants to have. And nowadays, not having difficult conversations often means simply doing things we shouldn’t in the time of a plague. Hugging. Not wearing a mask. Attending a large gathering of humans indoors.
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And we feel pressure to do these things because they are what makes us human- interacting with others. The emotional toll and damage done by deciding not to attend a loved one’s wedding is awful; many choose to go rather than endure the social awkwardness of saying “no”.
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This happens with mask wearing, too. Unless you have the awkward and explicit conversation about the fact that you are going to wear a mask when near friends, doing so becomes just awkward. It just feels easier not to wear the mask given the social pressure.
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There are literally millions of these difficult conversation moments every day with this pandemic. But these millions of moments are easily replaced by a single, larger difficult conversation that leaders can have in setting temporary restrictions on gatherings.
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Those in charge can unburden us of difficult conversations by not allowing large gatherings of humans in places where behavior leads to spread (bars and restaurants). One difficult conversation replaces a million.
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That’s leadership. Those chosen to lead through difficult times do so by making hard decisions for all of us. It's the reason we wear seatbelts and I don’t have to spend an hour convincing my teenager to put it on. Because it is the law. That is not a difficult conversation.
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Without strong leadership this winter is only going to get harder. I plead with those in charge to have the difficult conversation for us so that we can make it the next 6-8 months to the point where a vaccine saves us from this hellscape.
fin/
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Earlier this year, @bossletMD and I tweeted about how we were planning on handling the summer.
Winter is upon us.
As a critical care doc and a pediatrician with 4 school aged kids, and a winter of uncertainty ahead, here is how our family is approaching the coming months.
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I offer this as a point of reference for those struggling with how to handle the coming cold, not as a strict recipe others should follow.
This is OUR way- I don’t pretend it is THE way.
Some will think we are overly cautious, and others will think we are being cavalier.
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.@BossletMD and I discussed the underlying facts that will guide our decisions. They include:
Fact 1:
If I or my immediate family members (wife and kids) contract COVID, the odds are far in our favor that we would be fine.
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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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. 3/
As a critical care doc with a pediatrician wife, 4 school aged kids, and a summer of uncertainty ahead, here is how our family is approaching the coming months.
Also, some GIFs.
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I offer this as a point of reference for those struggling with how to handle the dog days, not as a recipe that others should follow. This is OUR way- I don’t pretend that it is THE way. Some will think we are overly cautious, and others will think we are being cavalier. 2/
This plan operates under 4 assumptions.
(@BossletMD and I had to agree on the following, which was a discussion worth having)
Summer plan assumption 1:
If I or my immediate family members (wife and kids) contract COVID, the odds are FAR in our favor that we would be fine.
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I disagree with the sentiment of this statement.
Here is why.
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The following come from a self-described medical minimalist and a skeptic when it comes to new medical technologies. I am far more likely to tell people to “slow down” than to “check out this new toy”. You can ask @GrahamCarlos@ryanboente@erinmcrowley@tjelle13 2/
The statement is not published in a format that allows for comment, or this would be a letter to the editor.
I agree with much of the substance of the statement- they point out issues well worth considering that need worked out before splitting a vent is definitively safe.
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Premium processing is THE WAY that these trainees are able to have visas processed in a timeline that best prepares them to practice at their place of employment starting in July. Disallowing premium processing means a delay in their visa status, which delays credentialing.
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This is likely to lead to a 3-4 month delay in their being able to see patients at the conclusion of their training. This will effect 1200-1500 physicians who are completing residency here in the United States, most of which will be practicing in underserved areas.
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The content of the original #thread was true to my thoughts about the topic, but was written in a way that did not give proper context to the role of the PS in the process. It was also completely tone-deaf in that the voice I used was condescending and mean. And that is not me.
So I’m considering that thread what @ANNELAMOTT would call a #ShittyFirstDraft. The following draft incorporates feedback from the @Twitter#meded community into something I hope is a bit more useful (and a lot more friendly).