Category: Reflections on Life, Being Human, and Medicine

Reflections on a variety of topics. My hope is to stir your thinking and perhaps even give you things to talk about in regards to what it means to be human, about life in general, and often times on 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 Reflections on Life, Being Human, and Medicine

Tilting at Windmills

We have all had this scenario.

We are at a restaurant and the entrée that you get is not what you had hoped for. Perhaps the condiments were wrong. Or perhaps it is not cooked to how you asked for it to be cooked. Something is wrong.

And this is where there is a great divide in the world. Half of us will grumble and eat it. “See if I ever come back to this restaurant again,” we say in the back of our minds. The other half will complain or call for the manager.  Those of us in the 1stgroup may be getting uncomfortable even thinking about what those of you in the 2ndgroup do in this scenario.

I have already hinted which group I am in. Which group are you in?  

I can tell you that I am group 1. And my wife Sarah is group 2.

Why am I a “group 1” person? I think it is because I don’t want to cause problems. One of the cardinal virtues growing up was kindness. It seems kinder to just accept less and not make troubles for others.

But which really is kinder? 

This has been a lesson that has taken me years to learn. I still tend to be a group “1-er” but I now realize the tremendous value in the group “2-ers.” I have come to realize that those of us in group 1 might look kind, but the group 2 people are often actually being more kind.  Let me explain.

Sarah believes in people.  She values them and expects them to be intelligent and capable human beings. If they did not cook her food properly it is not because they should be “written off.” They should be told so that they can make it right. Also, they should be told so that they do not do this again or keep doing it. She actually believes that they are capable of doing their job. She gives them the benefit of the doubt and assumes that they are intelligent and capable. She is kind enough to believe in them and push them to be better.

Several years ago, we were looking to shift to a smaller church. We went through the process of visiting a variety of churches throughout the area. One Sunday we visited a church we were really interested in. That morning it was so crowded that we had to split up. My wife and I each had 1 or two of our daughters next to us on opposite sides of the church. As we heard the Pastor’s message it didn’t match what I thought the passage of Scripture said. At the end of the service we got in our car and started driving home. We talked about the message together. 

The group “1-er” (= me) was happy to drive on. “I don’t know that I agreed with what he said. I don’t think we need to go to that church again.” 

The group “2-er” (Sarah) was bugged. She didn’t think what he taught made sense either. When she heard that I agreed we talked about what to do. Ultimately, I turned the car around. Back to the church we went. We found the pastor. And then we started asking questions. In the end the discussion was a good one. We were able to hear and better understand his perspective. We ultimately still disagreed with his interpretation but not without showing him an appropriate level of respect. 

You see, Sarah assumes that people have a brain and are capable. 

Sarah has a very strongly developed sense of justice. Nothing bugs her more than to see something that is just not right. She feels compelled to try to fix it. As a group “1-er” I am more inclined to be passive, just accept things the way they are and handle things on my own. But Sarah believes in others. She believes in me. She thinks that I can do more than sometimes I think I can. 

I call it “Tilting at Windmills.” 

This is of course a reference to Don Quixote. This I know is not quite the correct term or reference. Don Quixote is wrong. He assumes the windmills are giants and fights them. They are not. They are windmills. But what is important is that he insists on continuing the fight. He is not going to just abdicate the responsibility. He will fight against what he thinks is a real threat. He would fight against what he thinks is wrong. 

So, this is not a perfect reference. Sarah is by and large fighting against things that are truly wrong. But she does not easily give up fighting against injustice, even if she is not likely to win or change things. And that is why I call it, “Tilting at Windmills.”

She is the same way with people. She is not so quick to “right them off.” She expects them to be competent. When they are not she might push them to be what they ought to be. Even though it might seem like an unending and futile battle, she will engage in the effort. She will be a “2-er” and bring up the problem with them. She will give them a chance to do better.

It is a hard lesson. From the outside I may look to be more kind. If they let me down, I can be tempted to just sort of give up and do it myself. I take on the servant role and just do things for people. I do not really want to make them uncomfortable or to hold them accountable. On the surface that seems kind and understanding. 

But on a deeper level, Sarah is actually being more kind. She is valuing people. She refuses to give up on them. She often pushes them to be the person that they really can be. It does not always work. But it works a LOT more than I think it would. 

I continue to try to learn from this example. I should believe in people. If they at first fail to perform I should ask them why. I should push them to be better versions of themselves. I should swallow hard and walk into confronting them not because I want to be mean, but because I value them so much that I want them to be better. It is not easy to do this. It takes some courage. But it can be important and really valuable.

I still would rather just eat the burger medium rare rather than medium (I like medium). But the years have brought to me a growing appreciation and respect for those of you who are group “2-ers.” 

Thank you for believing in people. 

Thank you for believing in me.