Category: Medicine

Posts that are specifically tailored around the practice of medicine.

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Being human Medicine Reflections on Life, Being Human, and Medicine

Listening

“You seem upset that we did surgery on the wrong side of your body.”

Reflective listening. They taught us about this in medical school. It was in our history and physical exam course. We were specifically taught how to handle an upset patient. The technique was to reflect back what they were saying to you. You were to do this even if you couldn’t provide an answer to what they were saying.

“You seem upset that your surgery was delayed.”

“You seem upset that your son is not doing well.”

 “You seem upset that you had the wrong leg amputated.”

It seemed ridiculous to me. We had to practice it on each other.  They gave us all sorts of goofy scenarios to emphasize the technique like that. We all thought it was a bit ridiculous, but we followed the protocol and learned it. 

Oddly – it works. 

Even with someone who is very very upset, reflecting back their concern can calm them and help the dialogue to go forward.  It has been an invaluable tool through the years. In retrospect that was probably one of the most valuable classes that I had in medical school.

Why?

We need to listen to others. On the other side of it, all of us need to know that we have been heard.

I confess that I am not perfect at this. It is so easy to talk to get my points out rather than actually listening to what other people are saying. And when I do this the conversation can go in circles. Each of us keeps repeating the same thing hoping to be heard. The conversation can get louder and louder and more and more jumbled. 

If I would stop and just intentionally acknowledge what you are saying it would go a long way to improving our communication.  I am frankly pleased that I have a little bit of a reputation for using some of these phrases.  “What I hear you saying is…”

I have found reflective listening to be very effective in working with patients. I have found it to be even more important in meeting settings. 

In an ideal world, every person at the meeting has a purpose for being there. This means that they bring some special training or purpose or value to the meeting. Every person deserves to be listened to. More than that – they really deserve to be heard. If we as a group do not hear them, we have robbed ourselves of the perspective and value that they might bring to the conversation. And often the most junior person might just bring the fresh perspective that helps the rest of us see through the cloud of confusion to what is really going on or what really needs to happen.

That is reflective listening. But there is another lesson that sticks in my mind.

We had a controversial issue during my training as a flight surgeon in the United States Navy. Eventually it came to a special board of flight surgeons (SBFS) to make a decision. This was where the data was presented to all the flight surgeons present in the area and they could then all vote on what was appropriate. The idea is that in the setting of unclear issues, we fall back to expert opinion, and the more experts you can have, the better the decision.

In this case however, the commanding officer interjected a comment. It had wisdom in it. He said of one person presenting, “This doctor is my expert in this area. I either need to trust him and listen to him or fire him.”

That was a fascinating example of empowerment. Suddenly the specialist was being heard. More than that, the specialist felt the burden and duty of his position. He was being asked to have a real impact on the decision making for the entire group. There was an immense weight put upon him. It was an appropriate weight however. He was indeed the expert. His opinion in the matter should really matter. And he should feel and shoulder that responsibility. He shifted from just telling his opinion and “washing his hands” to helping us all struggle with the decision. When he spoke, it was with a much different “gravitas” than it would have been had the commanding officer not empowered him in such a way.

Of course, not everyone is correct. Even specialists can be wrong sometimes. And this does not mean that the rest of us can abdicate our judgement or our conscience. But if we have someone who is supposed to be bringing a special view on something, we had better really listen to them, or we had better “fire” them.

I would call this, “empowered listening.” We really ought to do this more often.If we fail in this people can keep their opinions at a superficial and frankly not very helpful level. But if we truly empower them, then they are pushed to a much greater depth. What they say suddenly has more intensity and meaning. 

I do think there is one even deeper level however.“Fools find no pleasure in understanding but delight in airing their own opinions.” “The heart of the discerning acquires knowledge, for the ears of the wise seek it out.”[1]

This is a lesson that I learned from my college roommate John. He may not even know that he taught me this.[2]I was the one that always wanted to talk. We would come away from talking with someone else and I would discover that John had learned more than me. He had been listening more deeply to the person we had been with. He taught me by example some very valuable lessons. I will call these lessons collectively, “Treasured listening.”

  1. Go into each conversation hopingto be surprised.If someone says something that does not fit, you might just have discovered an area where you might actually learn. That is a golden and precious opportunity. Do not lose it.Push it forward. Reflect back what they say if need be. Ask more questions. Like pursuing a nugget of gold under the water, go after it. Grab a handful of the sand if need be and sort through it hoping to find the precious within it.
  2. Assume that everyone brings a little different perspective. Value that difference and celebrate it. Push yourself to learn from it. That is another opportunity to grow and be changed. No one likes a movie in which you can predict the entire plot and ending. Look for how people think differently. Try to put on their perspective as you might try on their jacket or their gloves. See what it feels like. We seem to all assume that others think like us. They do not. Even though they might be similar in their thinking, there are always subtle differences. Look for them. Celebrate them. Try them on. In so doing you can really learn. I tried this with John’s Dad one day. He told of his profound disappointment in not being medically qualified to fight in WWII. This has stuck with me. It made me realize how wildly different the times were then. Everyone really wanted to go and fight. They were ready to be put into harm’s way. That conversation taught me that tomorrow we all might see things completely different than today. September 11, 2001 was a classic example. In an instant many of us changed how we thought. Tomorrow might bring an event into our lives that will change our thinking again. We can learn today from other’s experiences if we are just wise enough to truly look for it, celebrate it, and listen to it.
  3. Value other people.It amazes me the number of times that I go into a conversation and all I really care about is what I am going to say. I walk away empty from those conversations. Everyone has value in the eyes of God. They were created in His image and as such I should value them. I am a fool if I do not push myself to give everyone value. I squander the opportunity of knowing them.If I do this, I walk away emptier. But if I truly value them, I can grow and have a rich experience of them. It does not matter how young or old, rich or poor, educated or uneducated. People all have value. I remember one older patient. He was slow of speech. I wanted to rush in and rush out. I wanted to assume he had little to contribute. It was only because he reminded me of a family friend that I slowed down. I sat down. I listened. And I was richly rewarded. He was in there. He was not only in there, but he carried the wisdom of his age. He was mostly alone because most of us where moving just too fast to notice. But for the wise person who would sit down and slow down and listen, there were precious jewels of wisdom. 

Reflective listening:Bounce back what you hear people saying so that they can know that you heard them. This is powerful.

Empowered listening:Let people, or even make people, take responsibility for their position and training.

Treasured listening: People are a treasure. You can learn and grow each other from every conversation if you are willing to work at it. Look for surprises. Find the difference in their perspective. Value them. If you do this, you will be richly rewarded.

[1]Proverbs 18:2, 18:15 (NIV)

[2]Thank you John!

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Being human Medicine Reflections on Life, Being Human, and Medicine

Ta-da!

It doesn’t matter who or when this was. But he was brilliant. He had incredible drive and vision. He would dream, plan and then execute. But it didn’t come off the way he wanted. Why not?

It was because he did it as a “Ta-da!”  

It was an inappropriate “Ta-da.”

What do I mean by that?

We think that we can perform like showmen in a circus. We dream, plan, and prepare the show. We practice so that we can perform flawlessly. We plan and get the supplies and decorations and everything in place. We do it ourselves, in secret, so that to the audience it is a wonderful surprise. You wouldn’t want to take away the mystery of the surprise by showing them the tedium that went into the planning. It should come off in presentation suddenly. And when it does, they will be in awe. You jump out with your arms held wide and yell, “Ta-da!” They will stand and applaud at the wonderful thing that you did in front of them.

At least that is how it is supposed to work.

And if we were working for the circus, for people who were coming to be entertained, it would be the right way to do things.

But in business, in the workplace, and often in life, that is not how things work.

It made me sad to see him jump out with his arms held wide. The loud “Ta-da!” was met with an awkward silence, or even worse, with anger and disapproval.  There were people who were impressed and clapped. But they were not the people around him who worked with him. 

And it is not just him. I too have done the same thing. For someone who is young, passionate and driven it is not an easy lesson to know and embrace.

What is wrong? Those who are experienced in the working world and in management immediately understand. Success is not about just achieving results. Results are important but there is much more. Success is about having “us” achieve results. Success is about a team that grows and develops so that the results are reproduceable and sustainable. It is not about one dazzling performance. It is about excellent sustainable operations. And for that, the process is as important as the end result.

When he yelled, “Ta-da!”, those around him suddenly felt hot, disappointed, and left out. They could have done things. They could have contributed. But instead he didn’t involve them. They were excluded. They were a part of the team. But he left them out. He made them miss out. They couldn’t celebrate the success because it was only his success. It was not their success. It was even worse than that. It was an opportunity or a success that he stole from them.

Him: I am going to do something great for the department. This will be so good for everyone.

Them: He never involves us in the important things. He runs away from us and works in isolation. He is not a part of the team. He is all about only himself. 

What is the lesson? Be very careful if what you are planning is a “Ta-da!”  

When you have an idea or a vision – think about the team. Who will care about what you want to do? Who can and should contribute? How can you have them go on the journey with you? 

It is not as easy. In fact, it is a lot harder to push yourself to have others be a part of things with you. We all have hated the “group projects” in school. We know the challenges. But it is better. In the end, your success will be magnified by a multiple of how many people you have involved.

Step 1:Vision – This you can do. This is when you get the idea. You may see the need or the opportunity. 

Step 2:Change management: Communicate the need (even declaring a crisis) to get others on board. That is the start. They have to see and feel the problem. Then you can move on. Get them motivated and enthused about your vision. If you are really good at this – get them to think that the vision is coming from them rather than you – or ideally – that this is a vision that came out of the group. Please do not think you have lost something if others don’t recognize that the idea started with you. The victory is so much better bringing the group with you that it is worth sacrificing this little bit of “credit.”

Step 3:Determine the team. Who should be involved? What roles should they have?

Step 4:Get people working and keep them working. Even if you have to do most of it yourself, look for ways that they can be contributing. Instead of going to a meeting with a polished plan, go with an open agenda with a presentation of the problems and guide them to help develop the plan. If you are really skillful, you will be able to guide them to develop the plan that you have thought of in advance but it will be so much better with their contributions. 

Step 5:Deliver. A lot of things never go forward because they need a person or persons to push them to completion. But in the process keep going back to the team and pull them into contributing their aspect of the project.

Step 6:Celebrate. Not a “Ta-da!” But instead a group celebration that is really worth it and meaningful.

My mind can race forward at times. I can dream up things. I run forward with them. I can type fast and it is easy for me to go from problem to resolution to plan in a single bound. It is oddly easier for me to come in with a 4-page document with problem, background, research, and solutions than it is to slow down and masterfully guide a process. But it is the wrong thing to do. 

I hand them my 4-page document. It surprises me when people get stuck on the 1stparagraph. It shouldn’t. I have had time to sit alone and work through it all already. This is their 1stexposure to it. They need to understand the problem, and then walk through a process of how to solve the problem. If I give them the solution immediately, they are not ready for it.  

The 4-page document actually ends up achieving much less than I would have achieved if I had only brought the 1stparagraph.

How about you? Do you understand that victories that you achieve alone are generally empty and meaningless? Do you know that the process, building the team and sustainability are much richer victories? Are you able to be a “master?” Can you be mature enough to intentionally move more slowly, bringing people with you as you go? Even if you may be so clever as to be 4-5 steps ahead of everyone else, can you bury that for a while for the rich blessings that come from doing it with everyone else?

I tried to explain to him how he could easily alienate others.

He didn’t hear me.

The “Ta-da’s” didn’t work.