A Commitment to Communication

sI knew why Core Educational Objective: Interpersonal Communication

Objective: Use effective listening, observational, and communication techniques in all professional interactions.

Interpersonal communication is a skill that I refined over the course of medical school. Before medical school, I approached communication as a craft that primarily develops through live practice, which steadily builds experience over the course of a lifetime. Consequently, I was fair at communication. I could effectively communicate my thoughts to my audience, but I lacked the minor techniques that elevate communication from good to great. I did not always frame my message in a way that my audience would best receive it and I am confident that I overlooked subtle signs, whether verbal or nonverbal, that my partner was trying to communicate. A certain wording of a phrase or a small change in posture can be covert, but they reveal the true thoughts of a conversational companion. Unfortunately, I was prone to miss them.

A breakthrough in my development as a communicator came with health coaching. It really allowed me to focus on my patient and it forced me to listen to them. The patient-centered approach of health coaching was helpful. The patient led the conversation and I did not have to devote as much mental energy to formulate my responses. I was reacting to them and their desires, instead of steering them with my own ideas. I was forced to intently focus on them. It became clear that an affirmative answer after a slight hesitation is most likely a dissenting answer. I could easily receive verification of my communicative sleuthing by asking the patient to rate their confidence in the goal on a scale from 1-10, a score that was required to be obtained regardless of my intentions to build confidence in my skill development.

While I was pleased to work on my interpersonal communication, it was more rewarding to help my patient achieve his goals. I listened to what he wishe he could improve on and then helped him transform those thoughts into concrete goals that he realistically thought he could achieve with a plan that he devised. His goal was to lose weight and it was apparent that he preferred only minor changes to his diet. However, he was more passionate about increasing exercise, so that was the main route that he took on his weight loss journey. Over the course of our weeks together, he increased the miles he jogged each week and had his training culminate into a 5k race at Disney World. At the end of our sessions together, he achieved his goal weight and enjoyed the process to get there.

Figure 1: My health coaching allowed my patient to complete the Walt Disney 5k Race.

Another step in my maturation as a communicator came during third year. I started reading eBooks on social skills on my phone before going to bed. I realized that I have read books on chemistry and cardiology to learn about those subjects for school, so there is no reason communication should be different. Consequently, I read about leadership taught in the Navy Seals through Extreme Ownership by Jocko Willink and social intelligence from the classic How to Win Friends and Influence People by Dale Carnegie. However, the most enlightening was Never Split the Difference by Chris Voss, a book that I learned about from a fellow in the Neuro Critical Care Unit. It was written by the former head of FBI hostage negotiations, who detailed examples of negotiating in his career and more everyday examples. It soon became apparent that basic principles of negotiations like labeling emotions and utilizing empathy were the same things that were taught in LG and employed in health coaching. What made the book transformative to me was that it explained why these principles were effective, rather than simply stating to use these them like I learned in the classroom. In some ways, a medical interview is similar to a negotiation in that both parties are trying to extract information from their counterpart, some of which can be crucial yet hid below the surface that requires skill to uncover.

 

Figure 2: An excerpt from Never Split the Difference detailing the use of empathy.

I developed a thorough understanding of communication from all my extracurricular reading and I was able to use these skills on my rotations. For example, I had a patient in the ED who had significant frostbite, yet was quiet in the initial stages of the interview. I learned that she had been locked in the walk-in freezer at her restaurant for an hour. Instead of asking about physical symptoms, I instead told her that she must have been terrified as that was a nightmare scenario that I thought about when I worked at a restaurant. I knew from my experiences that she most likely had no phone service in there and she probably was frantically trying to call for help. Verbalizing this empathy broke the ice in the interview and suddenly details started flowing more rapidly from her, which saved me precious time in the fast-paced environment of the ED. Also, I was able to better spot when patients were not fully committed to the plan of care. For instance, during my Mini-I, a young patient with a Crohn’s flare needed a colonoscopy, but developed emesis while consuming the prep and had not finished it by the time I saw her the morning of the procedure. I was able to listen to her concerns and explain the risks/benefits of obtaining the colonoscopy at this point in time rather than at a later time. She told me that she would finish the prep, but I could sense that she was not fully committed as she did not take more than a half sip after she agreed to the plan. From my health coaching experience, I realized that she was in the precontemplative stage and was not truly ready for a change at this moment. As a result, I was able to proactively communicate with GI that the prep would realistically not be done in time and arrangements were made to reschedule. The patient indeed was unable to complete the bowel preparation that morning, but she did so for her colonoscopy the next day. This evolution in my interpersonal communication was reflected in my evaluations from my Mini-I.

Figure 3: My Mini-I evaluation on my interpersonal communication.

A goal going forward is to continue to improve my interpersonal communication. During intern year, I want to verbalize empathetic statements at least once a day. That will help me better connect with my patients and allow me to better understand their viewpoint. To help achieve this goal, I want to further refine my social intelligence by reading new books and reviewing the old ones, just as I would review a chemistry book for school.

 

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