Let’s talk about difficult conversations.

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.
1/
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.”

2/
“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.”

3/
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.

4/
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”.

5/
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.

6/
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.

7/
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.

8/
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.

9/
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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More from @gbosslet

23 Oct
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.

1/
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.

2/
.@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.

3/
Read 18 tweets
23 Aug
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.

1/
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.

2/
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/
Read 19 tweets
8 May
Our Summer with Coronavirus

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.

1/
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.
3/
Read 22 tweets
29 Mar
I have been chewing on the @SCCM @aarc_tweets @ASALifeline @APSForg @AACNme @accpchest “Consensus statement on multiple patients per ventilator”, published jointly on March 26:
bit.ly/2UIdrai

I disagree with the sentiment of this statement.
Here is why.
1/
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.
3/
Read 14 tweets
27 Mar
THREAD
#MEDED and #PCCM ADVOCACY HELP NEEDED:
The U.S. Citizenship and Immigration Services announced on March 20 the suspension of premium processing for H1B visas.
@ATS_BSHSR
@accpchest
@acpinternist
@APCCMPD
@AmerMedicalAssn
THIS IS A MAJOR PROBLEM.
1/
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.
2/
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.
3/
Read 10 tweets
5 Aug 19
This weekend I posted a #thread about #PersonalStatements. It got a lot of attention- much of it good, some critical.

In the spirit of a #GrowthMindset I decided to lean in to the criticisms and try and improve it.

#Meded
#Medtwitter
#MedstudentTwitter
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).
Read 30 tweets

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