Confidence, Body Positioning, and Taking It One Step at a Time

I like to think that interpersonal communication is one of my strong suits. I have always felt comfortable holding conversations even with complete strangers, and I am very conscious of other’s comfort with my presence. I often try to pick out signs of discomfort in conversations and work to alleviate those through my own actions or words. Part of that I think is my own tendency towards empathy, but I also think that I have a natural inclination as a “people-pleaser”, and although there are downsides to that trait, it definitely helps during interpersonal relationships.

The area where I struggle most with communication is in situations where I lack confidence. For instance, in the vitals room, I had never before performed these skills on an actual patient, and so my confidence just walking in the door was already low. That showed in my relationship with my patient a bit, where I moved a bit slower and seemed a little unnerved at times as I tried to steady myself and get the encounter done properly. It was difficult for me to carry on a robust conversation while also trying to navigate what was for me a set of common skills in an uncommon environment. I think a solution to this would have been running through the skills in realtime with a practice patient before hand and learning how to navigate both interpersonal communication and clinical skills at the same time. In contrast, I thought my encounter with the man with ankle pain was more smooth and I was more of a comforting presence. I’ve had experience in the patient HOPI before, and so that part of the encounter – gathering clinical information – could take a relative backseat in my mind and I could really focus my attention on making the patient feel comfortable while I was gathering that information.

One thing that I constantly strive to work on in these interpersonal settings is my body posture and positioning. I shadowed a general surgeon a few years ago, and the biggest piece of advice he had for me during patient encounters was to be on their level physically and to look relaxed. Thus, in these OSCEs, I really work to get relaxed in the chair, to face the patient, and to ensure that the setting doesn’t seem too “clinical” or straight-laced for the patient, who may be unwilling to divulge sensitive info if it seems like more of a professional relationship than a personal encounter. I want to continue working on this physical manifestation of comfort, and I think another area of improvement is in the tone of my voice as I respond to comments. Increasing empathy can stem from the way responses are worded or vocal pitch is changed, and even though it seems minor, I can even notice the difference when talking to someone who is responding in monotone and someone who is conveying emotion through tone.

In order to accomplish some of these goals and improve more, I think I just need to have more frequent patient encounters. I plan on asking for more opportunities in LP to interface with patients directly. In addition, a lot of these interpersonal skills can be applied in everyday, non-clinical conversations and relationships, and so being more aware of myself and my responses in those settings can allow me to refine that part of my clinical skill.

The communication from classmates about my performance in groups is always a little difficult to interpret. Some responses are just the generic “has great opinions but should speak up more” whereas others really delve into how I operate within the group and what they like and don’t like about that. Sometimes people get preoccupied with providing some all-encompassing critique or encouragement that seeks to define my entire role within the group, and it ends up appearing as bland or generic feedback. The best evaluations have been the one that pick out one specific component of my behavior or interpersonal relationships and expands on it to talk about why it’s good or could be improved. For example, one student said that “Kevin does a really good job utilizing the internet to help us during the last part of TBL. He won’t just stop at one source, but will confirm findings on multiple different sites”. That person has clearly keyed in on one part of my behavior (hunting down multiple sources for confirmation) and gave me encouragement to continue that in upcoming group settings. I appreciate that specificity as it helps me understand how to be specific with my feedback for my classmates as well. Everyone in our class is very skilled at relationship-building and communication – we would not have made it through medical school interviews if not. What separates a great physician from a good physician is the ability to pick up on the nuances of how you and your colleagues interact with patients and work to improve them incrementally. I appreciate that kind of feedback from my classmates as it will help me hone my skills in the years to come.