Today, we speak about communications: difficult conversations, feedback, conflict–you know all of the juicy, tough stuff.
Hayden Richards
Hayden runs a youtube channel called COMMS Lab with some of the best and most enjoyable medical communication videos that I have come across.
Here is his self-scribed bio:
Currently I work as an Emergency Physician in the amazing city of Geelong, Victoria. Although I enjoy the technical aspect of my job, my primary interest lies in developing the “soft skills” of communication, culture change and leadership, both in myself and others. I'm curious about how we can best utilise the insights from diverse domains and educational modalities to create a culture of transparency, collaboration and growth orientation in medicine. I see the ability to honestly self-reflect and engage in challenging conversation as the most potent means for advancement.
Today he joins us on the show to discuss communication in medicine…
I-Messages to Assert during Conflict
Similar to Non-Violent Communication, the I-Message usually comes in this form:
- When I heard/saw/experienced [state an objective account of events],
- I felt [insert a feeling],
- would you consider [Insert a specific request to the other person]
What you leave out are judgments, insults, and demands!
Do check out my lecture on On Deeper Reflection to hear more about my spin on this.
Insight vs. Leverage
First try to bring them to a true insight on their behavior. If that fails, then switch to a leverage framing. Leverage means getting them to understand that even if they don't quite agree with the insight, not changing will lead them to fail at their goals (what's in it for them–self interest)
Jenny Rudolph on Insight-based Communications
“When you think, ‘WTF?’ instead think, ‘What’s their frame?'” –Susan Eller
Cluster B Personality Communication Tactics
Rapidly deescalate their sense of threat.
SCARF Model for Social Threat
Created by David Rock. Involves five domains of human social experience: Status, Certainty, Autonomy, Relatedness and Fairness.
- Status is about relative importance to others.
- Certainty concerns being able to predict the future.
- Autonomy provides a sense of control over events.
- Relatedness is a sense of safety with others – of friend rather than foe.
- Fairness is a perception of fair exchanges between people.
These five domains activate either the ‘primary reward' or ‘primary threat' circuitry (and associated networks) of
the brain. For example, a perceived threat to one's status activates similar brain networks to a threat to one's life.
In the same way, a perceived increase in fairness activates the same reward circuitry as receiving a monetary
reward.
Just Posted: Hayden's video on SCARF
EMCrit Communication Dictums
- Local Rationality (Hayden calls this the Basic Assumption)
- Curiosity as the overarching stance
- I not You sentences
- Compliment in Public, Negative/Improvement in Private
- You can be right or you can get what you want
- “You don't have to be right, you just have to care” was Hayden's addition
The Crap Sandwich as a failed Paradigm – How to Give Negative Feedback
Get the Micro-Yes first: Would you like to hear my thoughts on that resuscitation?…
- Prepare
- Setting
- Agenda
- Data Gathering-advocacy/inquiry
- Agree on a Plan-especially if they can come up with a plan
- Review
Hayden has 3 videos on feedback:
- How to PREPARE for any Difficult Feedback Conversation
- Giving Difficult Feedback: How to START the Conversation (WITH EXAMPLES)
- How to Give Feedback That Actually Sticks
Positive Feedback
Be specific. Tell them exactly what made you have a positive emotion.
Great Communication Doesn't Have to Take a Lot of Time or Be an Addition
You can actually save time by integrating great communication in addition to the increased enjoyment of your job
Hayden's Book Recommendation
I will double down on this one–this book profoundly changed how I negotiate and have everyday conversations.
Hayden's Recs for His Videos (Where to Start)
Interests vs. Positions (the Orange Video)
How to Start a Difficult Conversation
Additional New Information
More on EMCrit
- COMM CHECK: More On Resuscitation Communication
- EMCrit #230 Resuscitation Communication
- NonViolent Communication
Additional Resources
Professor
Nassau University Medical Center
No conflicts of interest (coi).
- ODR 013 – Should, Must, & Won't - November 25, 2023
- EMCrit Shadowboxing Case 6 – A Respiratory Case along with Extra Commentary from Mae West - November 23, 2023
- EMCrit 362 – Jonathan Edlow, Lead Author of GRACE-3, on Dizziness - November 17, 2023
Fantastic segment, loved everything Hayden had to say. I was struck by one thing that was little in the scheme of the conversation and for me has popped in many areas lately, that is “separating observation from judgment.” Hayden used it in the classic Jenny Rudolph (my mentor) I saw, I think, I wonder way of observing, exposing your judgment, and being curious to allow the recipient to expose their frames to you and themselves. This is to highlight thinking about that in so many parts of your life, not just difficult conversations/feedback. I am currently reading “Designing your life”… Read more »
wonderful, Lon!!
I love this, Lon.
I’m huge fan of applying principles across different paradigms to see how they fit, and I feel like you’ve given us some great examples here. Also love your take on the rationale – stepping back to allow for more system 2 thinking. Nice.
Thanks for your kind words.
thank you very much!! cool and useful! 🙂
Thanks for the episode!
Is there a chance us folks from other continents can buy the “flameproof“ course (will it be available on demand)?
the REAL flameproof course will be completely online and we will be opening registration in the next week or so.
Hi Scott and Hayden. I enjoyed the episode, but feel your take missed out a really critical element of communication, which is to do with unconscious bias, particularly around gender and race. Strategies based on showing vulnerability may be perceived very differently when the speaker is a woman, or part of a stigmatised or (unconsciously!) stereotyped minority. I know that if I (a youngish woman) start a sentence with “I am confused…” as Hayden does, I’m likely to get an eye roll and a pat on the head from people who are being difficult or confrontational. I think it’s important… Read more »
Excellent segment!!