JAMES G. ADAMS, MDJAMES G. ADAMS, MDPROFESSOR AND CHAIRPROFESSOR AND CHAIR

DEPT OF EMERGENCY MEDICINEDEPT OF EMERGENCY MEDICINENORTHWESTERN UNIVERSITYNORTHWESTERN UNIVERSITY

FEINBERG SCHOOL OF MEDICINEFEINBERG SCHOOL OF MEDICINENORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL

CHICAGO, ILLINOISCHICAGO, ILLINOIS

COMMUNICATION

What if you could…What if you could…

Ensure you have a fulfilling year Be respected Be effective Feel appreciated Minimize frustrations and irritations

Wait, there is a problem…Wait, there is a problem…

A lot of the work will not be fulfilling A lot of people will not be respectful We cannot always be effective We will not always be appreciated There will be a lot of frustrations and irritations

Who has begun to take on scheduling duties?

You are making the schedule…You are making the schedule…

One of the junior residents submits an extensive list of days requested off, more than can be accommodated

You ask which requests are the highest prioritiesYou make the schedule to the best of your

ability…

The resident sends this message:“I cannot believe you made me work on Friday April

24. I specifically requested this day off. I would appreciate it if this does not happen again.”

Hint 1Hint 1: Only if we recognize our : Only if we recognize our emotions we can control thememotions we can control them

Recognize your emotions and reactionsYou cannot control how you feel but you can

hold back your response. Take time to consider the situationDon’t gossip, but seek the insight of another

“He who the gods wish to destroy they first make angry.”

-Socrates

These lessons are broadly applicableThese lessons are broadly applicable

The hints, tips and lessons described here are broadly applicable, now and in the future. Intra-residency conflicts Inter-departmental conflicts Personal conflicts Communication challenges anywhere, anytime

We are emotional beings, we are not We are emotional beings, we are not rationalrational

Our primitive instinctive responses rule us What do you do when pushed? Fight or flight Centered in the amygdyla

We have a constant voice in our heads that create our reality, our perceptions We can re-frame Using medial prefrontal cortex

Hint 2: We can choose our actionHint 2: We can choose our action

Ask clarifying questions“I don’t understand…”“Are you ok?”“We are on different wavelengths here…”

Blend and Redirect I understand that this patient does not seem sick… I know you are frustrated with…

Get advice, know when to elevate the issue Make sure you have backup Stay shoulder to shoulder

Anticipate bad behavior and Anticipate bad behavior and prepareprepare

Get the ground rules straight I am here to take care of you, but…

Lower expectations Everyone will be treated unfairly Everybody will be cheated, lied to, and otherwise

mistreated

If we all work together to accommodate each other we can minimize these problems, but it is up to you, whether you are willing to give If we are not all flexible and generous, then we all will be

mistreated That has nothing to do with me, we all have to stay together

Hint 3: Set and lower expectationsHint 3: Set and lower expectations

Set rules, standards, Lower expectations

Ensure fairness. Fairness is not equality. Establish expectations of

variability Never reward bad behavior

Give the bad shift to the complainer Watch your back by keeping everyone in front

We are always striving, stretching, overextending, reaching for grass that is greener,

But before we get ourselves trapped, we better make sure that those who are behind us …Are really our friends

Hint 4: Listen, Gain insight, increase Hint 4: Listen, Gain insight, increase influenceinfluence

People are not against you, they are just for themselves Everyone is behaving absolutely rationally…

according to them

Figure out their needs and motivations and you can create a solution If you can quiet your own instinctive reactions

and judgments, you can understand the other person and then be highly effective at figuring out a solution

Active listening and building relationships increase your Active listening and building relationships increase your influence and powerinfluence and power

Build social capital Establish your reputation

Invite early contact Be generous Do small favors

Get in synch with your residency director and key faculty leaders

Then when conflict comes…Then when conflict comes…

A group from the ED went to a local bar after workIn the next booth was a hospitalist loudly bashing the

emergency department, specifically complaining about an admission that you were responsible for.

What do you do?

Supreme ConfidenceSupreme Confidence

• Positive language reinforces good behaviors and creates an effective and happy environment– The housekeeper

Saving lives– The technician

“You just saved this person’s life!”“Here is what I am looking for…”

– The nurseThe saint“How are you doing?”

– The doctorMy hero

Hint 5: Gain control through communicationHint 5: Gain control through communication

Do not just react Your words can help you gain control Your body language matters Your communication skills matter

Some of the most powerful doctors that I know are the quietest

Hint 6: The norm of human reciprocityHint 6: The norm of human reciprocity

Your route to control People react, respond and mirror the emotions of the

other. Kindness and compassion or Anger and frustration

When it is not going well, recognize it, distance yourself and reestablish a new norm. Practice!

Learning Learning

A brand new intern presented a case of a young woman with low abdominal pain and minor vaginal bleeding. Asked by the attending, “Well what do you think?” the intern said, “Well, I think she is ok and can probably go home and follow up.” The attending asked, “What does the pregnancy test show?” The intern said, “Uhh…” To which the attending replied…

What? What? Why do you hate her? What did she ever do to you? You are trying to kill her! Why don’t you just go get a gun and make it a clean kill!

Conflict-seeking behaviors

“The patient cannot come up without a central line”

“Who paged the attending!!!”

“Hey, there is somebody using room 23”

Etc, etc, etc

Domination does not yield long term successDomination does not yield long term success

Domination yields temporary satisfaction Domination prevents long term fulfillment,

relationships, happiness If you try to dominate you will always be

fighting. You will have so many battles that you will justify the need to fight.

Ensure you have a fulfilling year Be respected Be effective Feel appreciated Minimize frustrations and irritations

Hint 1: Only if we recognize our emotions Hint 1: Only if we recognize our emotions we can control themwe can control them

Hint 2: We can choose our actionHint 2: We can choose our actionHint 3: Set and lower expectationsHint 3: Set and lower expectationsHint 4: Listen, Gain insight, increase Hint 4: Listen, Gain insight, increase

influenceinfluenceHint 5: Gain control through Hint 5: Gain control through

communicationcommunicationHint 6: The norm of human reciprocityHint 6: The norm of human reciprocity