If there is one skill that we must all continue to grow and develop it is our communication skills. Communication drives the way we interact with the world and the way the world interacts and perceives us. Many a good person has ended up in conflict, misunderstood or hurt because of miscommunication. It is a skill that we should try to grow until the day we die.
I try to read or attend one communication resource each year as a minimum. I appreciate that can be difficult to fit in (though you really should), and to help that we’ve put together a podcast based on the workshop on communication we put together for SMACC in Dublin. Have a listen and read on.
The toughest communication skill is LISTENING. The greatest communicators are listeners and observers. Listening is the skill often most forgotten in communication and what most people crave. Nothing makes you feel more important and special than when someone really stops and listens, giving our full attention. Something very difficult to achieve in today’s society of smartphones. Before you have any important conversation with anyone in your life PUT AWAY PHONES AND SCREENS. This will communicate something very powerful in itself, without words.
Here are a few of the major tips from the Master Communication Course Dr Steve Philpot and I run at the SMACC pre-conference workshops each year.
WHO AM I?
If you want to excel at communication you will need a really painful awareness of yourself, who you are as a communicator, as a listener, and understand the primary reason you communicate. These are really difficult questions to ask and to answer.
Some people communicate to fill the silence, to play the clown, to hear the sound of their own voice, to feel alive or energised, for validation
Others communicate only when they have a message to share or receive, out of necessity, to get a task done or to avoid loneliness.
Do you know what drives your communication?
Do you have any idea how others perceive you as a communicator? Do they find you loud and overbearing? Painfully shy? Thoughtful? Dominating? Opinionated? Facilitative? A combination of all of the above?
When you communicate are you an:
- Extrovert or Introvert?
- Leader or Joiner?
- Serious or Clown?
- Cognitive or Emotive
- Toucher or No Contact
In a meeting or a ward round do you:
- Shout things out
- Thoughtfully reflect
- Have to make people laugh
- Feel compelled to sound the most intelligent
- Worry about embarrassing yourself
- Deliberately antagonise
- Dread interaction
If you can answer these questions for yourself it may reveal what your strengths and weaknesses are as a communicator and what you need to work on. As an extrovert I need to work on silence, allowing others the time and space to speak and offer suggestions, stop with ideas and work on finishing tasks, speak softly. I need to utilise my communication strengths and build on my many weaknesses. If you are unsure of how you communicate ask a loved one or trusted friend. You may be surprised how others experience you!
IMPORTANT ‘QUICK TIPS’ FOR COMMUNICATING:
There are two major ways to use signposting in communication. The first is to continually return to a point so that people are clear where the conversation is headed and that it remains on the same point. Using the metaphor of a map, signposting continually redirects and guides people as to where the conversation is going and what is important. In a family meeting where you are concerned for the wellbeing of a patient your signpost phrase may be “I am really worried about your father”. The second value of signposting in your communication is that it allows for smooth openings, transitions and closings.
e.g. “the reason I have asked you to meet this morning is because x”
“this is going to be a difficult conversation I am afraid”
e.g. “moving to a completely different agenda item”
“I would now like to talk about something a little more light-hearted”
e.g. “I have spoken enough, do you have any questions?”
2. ‘BUT’ OUT OF IT
When we use the word ‘but’ we essentially dismiss or diminish everything we said previously.
e.g. “You have been a great registrar but you have to learn to stop being so opinionated with the nurses”
“I love you but your snoring is driving me crazy”
Eliminating the word ‘but’ from your vocabulary is exceptionally difficult to do. We use the word ‘but’ to constantly try to negotiate difficult conversations and sandwich it between the good and the ugly. Using the word ‘and’ or simply using a full stop and staring a new sentence can dramatically alter the way our communication is received
“You have been a great registrar. You do have to learn not to be so opinionated with the nurses”
“I love you and your snoring is driving me crazy”
It changes the tone and the way both sentences are received. You may find if you say these examples out loud your whole tone will change in your voice, even your facial expression may change to adapt to what you are now saying…
3. IMPORTANCE OF THE FIRST AND LAST THINGS YOU SAY – The effects of RECENCY and PRIMACY
The human brain naturally orders and prioritises things all of the time. In communication the brain naturally orders and ranks messages according to urgency. The first item in a list is initially distinguished from previous activities as important (primacy effect) and is usually transferred to the long-term memory where it is ready to be accessed and recalled. The same is true for communication. The first message remains the most important one, and the filter for which all other communication is received. If your first message – spoken word, body language and/or facial expression is serious, the receiver of the communication braces themselves for serious news, filters all of that news through a serious lens. Items at the end of the list are also usually remembered because they remain in the short term memory (recency effect) ready for recall. This is also true of communication.
e.g. If you want to have a difficult conversation you may first:
- Signpost “ I am afraid we have to have a difficult conversation about your work performance”
- Primacy/First “ At the moment I am not sure you can pass the exam”
- Middle “Blah Blah”
- Recency/Last “ It would be my recommendation that you defer your exam as I am concerned you will not pass because you are not ready”
People who start difficult conversations with a beaming smile, a free coffee, small chat, set the tone that this is not a serious conversation and not something the person should worry about. This is the filter through which they will receive the information.
4. CHUNKS AND SILENCE
People find it easier to receive, digest information and to have the courage and space to respond and ask questions if information is received in small chunks surrounded by short pauses of silence.
Frequently doctors talk at their patients and junior staff giving a subliminal message that questions are not welcome or tolerated the goal is to listen and be quiet.
Breaking information into small chunks with small pauses invites a conversation, invites reflection and allows emotional response and reaction.
5. PLATINUM RULE – Connection and Attunement
If people feel respected, heard and understood, important communication actually works because rather than talking at someone conversation becomes a message out, message heard, message received and message responded. When you are ‘attuned’ in communication you have a better understanding of what the other person needs or wants. Attunement provides a sense of connection and understanding. Creating a connection with someone you are communicating with does not take prolonged time, it takes an energy and commitment to be present even if it is only for a few moments. Connection and attunement provide a safety net between you and others.
If you are not sure how to attune or communicate with someone because they are angry, a different gender, culture or age – ASK THEM!!!
e.g. “I have some difficult news and I am unsure if you would like to hear all the science or just the hard facts?”
“I am sorry that I have just met you and have to be having this difficult conversation. I am really aware that you are alone. Can we get someone to sit with you while we talk?”
6. OPTIMISM BIAS OR MIRACLES
When someone refuses to hear a challenging diagnosis or poor prognosis, this is part of their coping strategy. Denial can be a strong protective factor in allowing people to keep functioning. We should never have a goal to ‘break someone’. If you have ever really been desperate or concerned about a loved one you will know what it is like to pray or wish or long for a miracle. It doesn’t mean that the message has not been received at all. It may simply mean that the information you are presenting is too painful to absorb. We should always want a miracle for our patients or ourselves. Suffering is never pretty. However it does not mean that we have to ignore the science.
e.g. Attunement “I cannot imagine how hard this is for you. I am truly sorry…”
Miracle “We hope you get a miracle too, we really do. However I remain really concerned because of the MRI results and the fact that your husband isn’t conscious. I would love to be wrong. How can we support you while we wait to find out what will happen. If the worst happens and he does die is there anything that would be really important to you that we could do like bring in a spiritual leader or give you time alone together?”
None of us will ever be perfect communicators. Together we can build on our skills and create a workplace for patient and staff where people feel valued and heard no matter what our communication style.
- Crucial Conversations – Switzler, Grenny, Patterson and McMillan
- Communication – Core Interpersonal Skills for Health Professionals by Gyn O’Toole
- Difficult Conversations – Stone, Patton and Heen
- How to Break Bad News – Robert Buckman
- Handbook of Communication in Anaesthesia and Critical Care edited by Cyna, Andrew, Tan and Smith
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