What to Do When a Junior is Badmouthing Your Colleagues

When that chimp part of us, that lizard brain, or however you want to call it, is active, and we get that emotional response of, “I can’t believe that’s happening. That’s so inappropriate. That’s wrong.” Doctors and healthcare professionals often have a very strong sense of justice — a very strong sense of what’s right and wrong. If you’re to have an emotional state where you feel anger towards someone else, or frustration, it’s almost a knee-jerk response to say, “Report.” Because that instantly absolves you of ownership of the emotional state. You’re basically saying, “Well, you’re not like me; you’re different. You’re a bad mouther.” Or “You’re a bad mouther who needs to be punished or sorted out or fixed.” So therefore, that external agency can do that.

Rachel Morris: Ever been in a situation where someone’s acting in a really inappropriate way, and you’re not sure whether to call it out or not? Maybe you’re not sure exactly how to have the conversation or even if it’s your place to have it. Maybe you’re worried that if you do, you’ll just become the next person on the list, or your relationship will be doomed forever.

In this episode, Dr. Ed Pooley, communication skills expert with a background in general practice and I discuss one of those tough calls, where we probably know what we ought to do in a certain situation, but doing it just seems too hard. We chat about the importance of listening to understand — not just to be heard, and how to approach this in a way which leaves the relationship intact, if not stronger. I’m sure that if you were doing something which caused difficulties your colleagues, you’d like someone to call you out on it.

So tune into this episode, if you want to be able to do the same for others. Listen to find out what so many of us get wrong when trying to confront tricky situations. A simple model which will help you understand the things which are guaranteed to trigger other people, and why our first knee jerk reaction could make things ten times worse.

Welcome to You Are Not A Frog, the podcast for doctors and busy professionals in healthcare and other high stress jobs — if you want to beat burnout, and work happier. I’m Dr. Rachel Morris, a former GP, now working as a coach, speaker and specialist in resilience at work. Like frogs in a pan of slowly boiling water, many of us have found that exhaustion and stress are slowly becoming the norm. But you are not a frog. You don’t have to choose between burning out or getting out.

In this podcast, I’ll be talking to friends, colleagues, and experts — all who have an interesting take on this, and inviting you to make a deliberate choice about how you will live and work. We talk a lot in the podcast about the zone of power and other coaching productivity and resilience tools and principles, which I found made a huge difference to me personally, and also the teams which I worked with. I put all these principles and tools together to form the Shapes Toolkit. This is a complete package of resilience, productivity, tools and training for doctors, healthcare teams, and other busy leaders.

We’ve been delivering Shapes Toolkit courses all over the country in the form of keynote talks, webinars, workshops, online memberships and courses, and full or half day live programs. We’ve been working with GP training hubs, new-to-GP fellowship programs, return-to-practice programs, trainers, groups, health and wellbeing projects, and many more organisations. We’re now taking bookings for summer and autumn 2022 and have a few slots left for spring 2022. So if your team are feeling overwhelmed with work, one crisis away from not coping, and want to take control of their workload, feel calm and work happier, do get in touch to find out how we can help.

So it’s great to have with me back on the podcast today, a friend of the podcast, Dr. Ed Pooley Welcome back Ed!

Dr Ed Pooley: Morning, Rachel. How are you today?

Rachel: I’m very well, thank you. It’s a nice sunny day, which just is lifting my spirits. So anyway, we’re back today, and Ed is a communication skills trainer with a background in general practice. It’s wonderful to have him back. We have a series of podcasts: Ed and Rachel’s Tough Calls because there’s lots of stuff that comes at us, whether we’re practising as doctors or in other health care areas, or even in another high stress profession. The stuff that comes at us that we just don’t really know how to handle — or maybe we do know how to handle them, but we don’t really want to, or it just feels really difficult and really awkward. I think that’s really one of your special, isn’t it? In digging down into how we can have those tough conversations that we really don’t want to have.

Ed: Absolutely. We all face those situations where we know what to do, or we don’t know what to do. When we know what to do, it’s often difficult or challenging. Having a set of skills that you can fall back on or practice in that situation gives you a much better outcome going forward. If you’re in that situation…

Rachel: I was reading a book recently by a chap called Donald Miller, who I talk about quite a lot. I really love his work. Now, he’s given some sort of business advice, and he was talking about that fact — he once was having some coaching, and his coach said to him, “Donald, stop choosing to be confused.” I thought that’s interesting. They said the reason was, he was discussing a difficult issue with an employee or someone in his organisation, and the narrative was, “I don’t really don’t know what to do. I’m really stuck with this. I’m really confused.” The coach said to him, “You’re not stuck at all; you’re not confused. You know exactly what you need to do. The problem is you don’t want to do it, and it just feels too awkward.” So do you think it’s mainly that we do know what we need to do, it’s just how to do it that we get stuck with?

Ed: Absolutely. We have a tendency to pick a more socially acceptable way of framing things when we feel that we can’t do something. So, if we’re not sure how we’re going to approach something, it’s going to be okay. We might say we’re confused. If we’re wanting to avoid conversations, we often say we’re tired or, “Not today, we’ll do it tomorrow.” Those kinds of approaches, because they’re more socially acceptable. I think the key is that you have to separate what you need to do from the emotion of what you need to do. If you do that — for example, in Donald Miller’s case, he knows what to do, but the emotion is causing the stress. That’s leading to the confusion because he’s trying to balance what he knows he needs to do with an emotional state he doesn’t want to feel. That’s where the confusion comes in.

Rachel: That’s so true. Because so many of these difficult conversations are only difficult because we’re so worried about upsetting the person. We feel stressed and anxious about it. Actually, we do really know what we need to do. Let’s dive into a dilemma this week. This one, I actually spotted on social media. It was posted as a dilemma, and I thought it was really interesting, particularly some people’s reactions to it.

So essentially, the dilemma went like this: “I lead a team, and one of my juniors has been bad mouthing many of the seniors and undermining them. What should I do?”

Now, on the face of it, it seems pretty obvious what you should do. But I was really fascinated to read a lot of the replies, because one of the first things that was written underneath this post was, “Report them! Report them! Completely unacceptable.” I thought, “Hang on a sec. If you think back to your own training, did you ever criticise your seniors behind their back ever? Perhaps you probably did. Did you ever moan about things? How would you feel if you got reported immediately, without anyone speaking to you?” So I was quite shocked and surprised because actually the people that were saying this were quite well-educated and quite well-meaning people. So, I thought I would bring this to you to sort of unpick. I mean, am I right that it’s pretty obvious what to do here? Or is it not particularly obvious what to do here?

Ed: My gut feeling is — as I suppose many of the listeners might be, is tell them to stop. It’s not an appropriate thing to do. It creates team disharmony. We’ve spoken about this concept of team disharmony and the type of workplace that you want to work in before, haven’t we? The answer is very simple: You tell them to stop. But, we fear conflict. We fear someone saying, “Well, I’m not both bad mouthing the colleagues.” Or, there’s that gaslighting type of response, and it becomes much more complicated. There is a simple strand of what you need to do that becomes overly complicated.

I think when that chimp part of us, that lizard brain, or however you want to call it, is active, and we get that emotional response of, “I can’t believe that’s happening. That’s so inappropriate. That’s wrong.” Doctors and healthcare professionals often have a very strong sense of justice — a very strong sense of what’s right and wrong. If you’re to have an emotional state where you feel anger towards someone else, or frustration, it’s almost a knee-jerk response to say, “Report.” Because that instantly absolves you of ownership of the emotional state. You’re basically saying, “Well, you’re not like me; you’re different. You’re a bad mouther.” Or “You’re a bad mouther who needs to be punished or sorted out or fixed.” So therefore, that external agency can do that.

I think that happens quite a lot. We see on social media all the time where there are errors, there are problems, people make mistakes. Then very quickly, it becomes a very much as in almost like a tribal type of approach. For example, if you take people who say things on social media 5,10,15 years ago, when social media was in its infancy, and people were not as guarded, as they perhaps are now, they may have said something inappropriate. The question we really need to ask ourselves is, “What do we do in that situation?” Do we quickly jump to, “You’re an awful person because of something you said 15, 20 years ago?” Or actually, “You’re a normal person who has an ability to change how they are and change their perceptions over time.” Because surely, that’s what we want. We want someone to be able to grow and develop as a person, don’t we? But that sits uncomfortably with us, because we think, “Well, I never did anything like that.” Well, you probably did, but social media wasn’t there at the time to capture all of those transgressions you did, which would have allowed you time to grow and develop as a person, which actually benefits society as a whole.

Rachel: I got to look back at social media, and I’m constantly so pleased that I grew up in a time where you can stick things on Facebook; you couldn’t mention things on Twitter; things weren’t recorded. You didn’t go out for the night and have it plastered all over social media the day after. I think it’s really, really these days. Yeah. It becomes very, very black and white, doesn’t it, when it’s on social media? If you look at this dilemma, if someone’s bad mouthing their seniors, well, it’s obvious, tell them to stop. That’s a bad thing to do. But, then as you get into the nuances of it, well, maybe some of the seniors are a bit crap. Maybe they’re not pulling their weight, or maybe it’s a really difficult place to work, and that junior is not seeing what the senior does. Maybe the junior is really frustrated with the processes that are going on. Maybe they’ve been treated unfairly — all those sorts of things.

You suddenly go from a very black and white thing, based on social media, to a really, really, really nuanced dilemma. I think the issue is when we start to see the nuances as excuses and reasons not to then address it. Because whenever we do training on difficult conversations and conflict, you always say, “Why haven’t you addressed it? Think of a difficult conversation; you should have had enough. Tell us why you haven’t had it.” “Well, not quite sure if I was the right person, or maybe I’ve done something wrong, too. Therefore, have I got the authority to address it? Am I right?” What if, what if, what if?” and all these different things start to make you confused about, “Should you address the issue?” Well, yes, you need to address the issue, but then we come up with all these excuses. Are they valid excuses, do you think? Or are they just our brain’s way of trying to get out of something we don’t want to do?

Ed: I think it’s our brain’s way of trying to feel okay. If we’re in a situation where we need to give someone some feedback, or we need to tell someone that something they did is not an appropriate way of doing it, we start to worry about the righteousness of that call, the okayness of that. I think for me, in this dilemma, someone bad mouthing their seniors creating team disharmony — clearly something has led to that behaviour pattern. What is going on for that person that has led to that pattern of behaviour? That’s question one. Question two is, is that an appropriate way of voicing discontent or upset? That’s an easy, “No,” isn’t it? So, what we can do by separating out the cause and the effect is to give our brains a little bit of a break, and say, well, “Let’s just focus on the effect.” The cause may be valid, but the effect is not. So, how do we have a conversation with that person so that we can validate the cause and find out if there is a problem and deal with it in a better way?

I might approach that person and say, “What’s going on? I noticed that you’re not happy with some of the things that your seniors are doing. You’ve made a couple of comments that would suggest to me that there’s an issue going on here. What I’d like to do is to find out your perspective.” Taught me three things. So hopefully that’s given you have a relatively non confrontational way of having that conversational opener. Then, the person may say, “Oh, it’s nothing.” But then you’ve drawn attention to the behaviour and it may stop. Or they may say, “There is a massive problem. I can’t stand the way that so and so belittles me, so my response to that is to bad mouth, to be passive-aggressive, to be all of those non overt ways of being hostile or aggressive, which people do.

Rachel: That makes a lot of sense, because there’s always a reason for somebody’s behaviour, isn’t there? People don’t behave in a vacuum; they behave based on the memories of what’s gone before, based on what’s triggered them, based on past experiences, based on what they expect, and mostly based on what their unmet needs are. So when someone’s bad mouthing someone else, there’s some need from that person that is not met. Either that’s a need to be treated properly themselves, or maybe there’s a need to try to make themselves look good in front of other people and be accepted and recognised. Maybe they’re worried about their own performance, so they’re sort of trying to deflect, I think the problem is, so often when we think of these conversations that we’ve got to have, it’s us versus them — us giving them difficult feedback. But what you’ve just said, actually, all difficult conversations start off with huge amounts of listening.

Ed: Absolutely. You can’t have a conversation where you are not interested in the other person’s perspective and where they’re coming from, “What is the information that they have, that I may not have? Can I learn something by getting that information?” Because if you’re not getting that information, or that perspective, and using it to form how you respond, you’re only really doing half a job, or you’re ordering. That’s not a conversation; that’s an order. So ,by taking those extra steps and finding out information, that has two effects. One, it calms your chimp brain down from panicking, because it gives you something tangible to address. And B, it gives you the opportunity to have a much better conversation. Because you’re getting information that you can use to have that better conversation.

Rachel: Yeah. I think we do struggle with collecting that information. I know that I’ve always worried that if I go and have that conversation, it might then seem including. Because what I wouldn’t want to do is go and have a conversation and then it sound like I’m slagging off my colleagues or whatever. So, how do you have that listening, exploratory conversation without colluding unnecessarily agreeing, but in an empathetic way, so their inner chimp isn’t triggered? So they feel that you — I was just gonna say on their side. That’s sort of, I guess, on the same branch, rather than on their side.

Ed: Yeah, so I might start that conversation by saying, “I’ve noticed that you made a comment about Person X. What was happening for you when you said that?” Again, that’s an entirely neutral way of saying things you’re not saying, and I agree. Or what you’re saying is justified at that point; all you’re doing is data gathering. Then, when you’ve captured the data, you can then say, “Do you think that was the appropriate way to go about voicing that concern you had? Because from my perspective, I don’t think it was. So what I would like to do is to give you a chance to say the thing that you’re concerned about in the most appropriate way, and for me to use that information, in order to make this situation feel better for everyone.” If there is a genuine problem that you uncover, then it’s your responsibility to then decide what to do with that going forward. Again, we need to get away from this right or wrong. What was the seed of disharmony or discontent that triggered that behaviour in the person and then caused the response? We don’t really want to start from a position of assuming everyone has malicious intent, because the majority of people don’t.

Rachel: Yeah, I think that is so important. That thing about what you’re assuming their intent is, and that, I think, is when people get really, really triggered. I’ve talked about this before, I think on the podcast, and probably with you as well — this thing about being over the net. I heard it from Carol Rubin, David Bradford, who’s written a book called, Connect, from a very brilliant course that they run, I think, at Stanford University, which is all about interpersonal dynamics. The students know it as the touchy, feely course, but it’s really, really popular in their business school.

They talk about the fact that any problems in interpersonal dynamics, it’s generally when you’re assuming, you know what is in the other person’s head. That is basically completely over the net. So, I’m just thinking that if you had made some derogatory comments about some stuff, and I came up to you thinking, “You were just doing it, because you thought they are better than everybody else.” Then I’m going to say, “Ed, come on. That wasn’t nice.” Either assuming, implying that you were trying to be mean or nasty, or whatever. That automatically triggers people, when they feel that they are misunderstood.

I’d love to talk about the SCARF model in a second, because I think that’s really helped me with really recognising what sorts of things are gonna trigger people. I’m assuming that you meant to be horrible — that you’re doing it for some sort of personal gain, rather than assuming good intent. So, maybe assuming that you were doing maybe to try and change things that were frustrating you or assuming that you do have good intent, it just came out the wrong way. That is going to really, really change how I then approach you about that.

Because I think, we hate being misunderstood, don’t we? We get very offended. I remember, as a junior doctor, I was being accused of being sort of autocratic and aggressive. I really didn’t mean to be that; I just didn’t know how else to act when people didn’t do what they needed to do. But, they assumed I was trying to be bossy, I was trying to be horrible. Actually, the reality was, I was lost. I was at my wit’s end, and I was really worried that the job wasn’t getting done and worried about the patients. Now, if they’d have expressed that to me and said, “Maybe you could ask in a different way,” that would have been much, much more palatable to just assuming I was trying to be difficult. But it’s very, very difficult to assume good intent, when we are feeling sort of backed into the corner ourselves when our inner chimp’s around, isn’t it?

Ed: It is. I think that example that you gave is a brilliant example, because — I don’t want to put words in your mouth, but I’m guessing that in that junior doctor state, there’s pressure, there’s fear, there’s the need to communicate quickly and effectively. So, if you’re coming from that mindset and that perspective, you may have seen people who you looked to, thinking, “Well, they look really confident. What do they do? They’re very clear and they tell people what to do.”

So you model that behaviour, but actually, that’s driven from a place of fear. So you’re not — again, in that situation, you weren’t being malicious, and you weren’t trying to upset anyone. You were just trying to do what you thought was the appropriate way of acting. But instead of giving you feedback and saying, “Are you okay? Are you struggling with any part of this job? Is there something we can do to help? How can we make this feel better?” People were saying, “Oh, you’re autocratic. You’re bossy. You’re all of these labels that we attach.”

I think, one way of assuming good intent is to imagine what you would do if the person doing the thing that’s upsetting you is your child. If you see a child — your child hit another child, what do you do? You know that’s wrong; you tell them it’s wrong; you assume they didn’t do it maliciously, and you respond in a way that allows them to shape and change their behaviour for the better. Because they are doing something, and something has triggered that behaviour. What you’ve done is taken a step back. You know the behaviour is wrong; you’re going to tell them it’s wrong. But you’re operating from a position of trying to understand what’s going on for that person.

Rachel: That makes a lot of sense. I think, assuming someone is your family member and treating them as such is really, really helpful. Because then what’s happening is you’re going — the relationship is there, right? Because we’re the same family, you can’t get rid of me. I absolutely have your best interests at heart. So, I’m going to be absolutely honest here. Also, when you’re talking to your child, you would never — well, in probably in retrospect, you would never have that conversation while they’re still really aggravated, and in the corner wanting to hit people and really angry. You’d need to wait until that comes down, and then, they themselves don’t really go, “Oh yeah, that wasn’t the right thing to do.” and you’re like, “Probably better ways of doing that.” And it’s all much better. Do you think that we always know when people are in their calm state? Or can some people be quite triggered and quite anxious, have their chimp out state without us knowing?

Ed: Oh, that’s a difficult one. I think, if you’ve taken training and you understand about psychology and body language, you can see predictors of people being in their chimp state. They have facial coloration in their cheeks; their muscle tension is higher; their pupils are dilated; they’re in that state of heightened autonomic function. If you don’t know what you’re looking for, which is the majority of people because it’s not something that particularly interests them, then it is quite difficult. So you have to be switched on to the language people use. Is the person using neutral language? Are they using aggressive language? Are they using defensive language? If it’s anything other than neutral, there’s probably an emotional state that is attached to that. What’s interesting is to try the experiment of trying to detect the emotional state.

What I did a few years ago, I used to be into martial arts quite a lot. I remember doing a training course where the idea was to prepare yourself for somebody attacking you when you weren’t expecting it. In the same way that doctors do CPR training, if you drill that behaviour, you learn how to recognise your own autonomic response in the face of threat. What was really interesting was this guy was dressed up in this full padded suit, and he was deliberately trying to wind me up and irritate me, so that I could feel the adrenaline and then know what to do with it. What I did was — the thing that defused the situation completely was, I said, “What’s your name?” and he went, “What?”, because he was so expecting me to be aggressive or confrontational that the thought of me trying to connect with him, totally disempowered him.

He was like, “My name’s Jeff.” I was like, “Well, my name is Ed. How you doing today?” What? This isn’t how it’s supposed to go! I think, if you start from a position of trying to connect with others first, then try and understand them, then feedback, that gives you a good pattern of things that you can do. If you if you try to connect with someone, that’s almost never a bad thing. Because it allows you to, like you say, sit beside them on that tree and understand what’s going on. People would recognise that from interactions with patients where there’s been difficulty, or interactions with clients, if they work in the legal profession where there’s been dispute or upset. Connection first, information and feedback second is a really good approach.

Rachel: That’s really good advice. So I think we are probably all walking around a bit like Inspector Clues or Waiting for Cato. Especially, I think as a junior doctor, there’s a lot of criticism coming at you from everywhere. You’re never on the right board at the right time. There’s 20 people who want you at once; you’re being too slow, forget to do this, the patients are waiting, so you’ve got it coming from all sides. So you’re gonna be very, very easily triggered into that stress zone — into your chimp zone. I think, as a senior member of staff, you really need to be the one to make that connection, to be really, really aware of the fact that you might trigger someone, and I think we don’t quite recognise enough of the things that might trigger somebody.

The SCARF Model has helped me really a lot with this. I mean, you can obviously go back to the neuroscience and go — okay, the really basic stuff that triggers you is physical threat, coming towards you, about to be run over by bus. The group threat will trigger you, because if you were thrown out of a cave — when we lived in caves — if the group didn’t like you, you were kicked out of the tribe; you would die of exposure, be eaten by a bear etc, etc. So, we don’t want to upset people. That is an existential instinct. Then, there’s that hierarchical one as well; the alpha male, challenging you. But, David Rock came out with a fantastic model called the SCARF Model, which we use a lot when we talk about change, and what sort of things trigger people. I keep coming back to this because there’s an awful lot of these SCARF factors are at play in almost everything we do in medicine and these high stress jobs.

SCARF stands for Status, Certainty, Autonomy, Relatedness and Fairness. Now, status — we can think of status as, if you get challenged by the alpha male, then you’re not going to react well, but status is at play in all sorts of interactions, isn’t it? Whether you’re a doctor or another healthcare professional, or a patient, or a manager, there’s all this sort of difficult interplay, and we were talking — I think it was on a webinar with someone quite recently about the fact that someone’s a doctor or has a particular position can actually trigger other people into the corner. As they notice that hierarchy — even if you don’t, just think the very fact that you are a senior person talking to a junior person, there will always be that status involved even if you’re the nicest person in the world, and you don’t believe in hierarchy, and you don’t act like that. Would you agree with that?

Ed: Absolutely. I think, if you’re aware of all of the various hierarchies and differentials in society, that gives you more power and potential to navigate that structure. Because it’s there; we know it’s there. So, why do we pretend it isn’t? Let’s try and acknowledge it and work out how to either make the hierarchy fairer, or how to navigate it better.

Rachel: Jo Bircher, actually, was talking when she did the podcast about leadership, about the fact that if you are in a meeting, you are in a commission, then automatically people will stop talking if you’ve said something, because often they see a hierarchy that you might not see. So, it’s very difficult to get everybody’s opinions about things. If you’ve gone off and given yours, which we do — we offer opinions so quickly, don’t we? As doctors, it’s just what’s been drilled into us. So, that really made me think about, “Just remember that hierarchy.”

So that’s going to trigger people immediately. Even if you’re the nicest person in the world, just the fact that you are more senior, having a conversation with a junior about something that is quite tricky, is going to potentially trigger that person. You’ve got stuff around certainty, so if you don’t quite know what’s going to happen, if there are some unknowns, — and I think a lot of the time we shy away from giving difficult feedback, because we don’t know if we’re right or not. We don’t know if what we’re going to suggest is going to have a good outcome or not. So that, again, is very triggering for people — that whole piece around certainty. You can certainly see that playing out and change autonomy. Now, how do you see autonomy playing out in these sort of difficult conversations that we have to have?

Ed: I think that’s about control. Do I have control to change my environment or the position I’m in? For example, in this dilemma, we’re looking at a junior colleague, who is bad mouthing seniors. Is the only way that they feel they can change a situation — be it in a really dysfunctional way — by bad mouthing? Or is there a mechanism by which they can experience more control? We talked about this on a previous podcast about control and breaking down the bits that are in our control and the bits that are in others’ control, and how we might use that information to improve a system. Because we know, particularly in healthcare, that giving people autonomy to report problems or feedback appropriately saves lives. It has a huge impact on the ability of the healthcare structure to function more effectively. Because it’s so big, that if you didn’t use all of your healthcare staff as almost like feedback sensors to know where things are and whether things are moving and working appropriately, you’re losing vital information.

Rachel: That’s really interesting. So I wasn’t even thinking about it from that point of view — that we need to give people control over how they feedback, etc. I was also thinking about it from the conversations’ point of view. I think earlier you said, “I would tell them that it wasn’t appropriate.” And that, “Do you think that was appropriate?” and, “I’d like you to do this in the future.” I was wondering whether that might actually trigger someone’s autonomy. Like, “You can’t tell me what to do or how to act!” Actually, maybe framing things either as a request, “So would you be willing to do this?” Or, even better, get them to come up with a solution themselves.

Ed: Well, that’s the thing that would promote autonomy, isn’t it? I don’t want to jump the gun in the SCARF model, but fairness is also in there. So, is what you have done a fair way of doing it? The sort of do unto others type of mantra, I guess.

Rachel: Yeah. It’s interesting though, because nobody likes to be told what to do. When someone says, “You’ve got to do this,” you’re like, “So I’ll do it my way.” You find that with coaching, don’t you? You can see, really obviously, what needs to happen and you might even suggest it to a friend and they just go, “No, that’s not gonna work.” Then, three months later, they go, “Oh, I thought I’d do this, should I?” “I told you that three months ago!” Really, would have been — they have to come up with it themselves.

It’s much better for people to come up with the methods, the suggestions themselves, so that as much as you can facilitate that in the conversation, that will help with the autonomy thing. Then you’ve got a cost relatedness in relationships. What I quite like about the SCARF model is it’s not just about threat; it’s about what you’re drawn to as well. So, all the research about the amygdala is, yes, it pulls us away from the threat situations, but it also pulls us towards things and belonging; it will pull you towards to relatedness; it will pull you towards — it’ll pull you away from a threat to your relationship and towards building relationships, that if you could maybe phrase this in a way that, this is going to pull us towards good relationships within our department or within our team, and provide some reassurance that having this conversation isn’t going to affect our relationship, or give them some reassurance. How would you do that?

Ed: I think it’s easier if you start from a noncritical approach. So for example, you can say, “Well, why are you doing it that way? What is doing it that way achieving? Is that working for you?” Or, is there perhaps a different way that we could be doing this? Because my aim, as the person giving you this feedback, is actually to build up the team and make it work better. And that includes helping you within the team, feedback about things that you’ve noticed or a problem, but in an appropriate way.”

So again, nothing I’m saying here is very confrontational at all. But it is being very clear and very boundaried and very neutral, which hopefully shouldn’t be pushing their adrenaline amygdala response too hard. I think what’s really interesting if we look at particularly neurobiology is the relative impact of dopamine, serotonin, adrenaline, and oxytocin as those are the four key transmitters that modify most of our behaviour in terms of reward, pleasure-seeking threat and connection-seeking. It’s a fascinating, newer field of that sort of neurobiology of behaviour that I think having an awareness of is really useful.

Rachel: Yeah. So it’s really, really changed the way I’ve been thinking about these sorts of things. Just recognising when someone is triggered in the corner and the fact that that is really going to change their responses. Let’s just talk about fairness. Because fairness seems to be really universal thing. In every single culture that has been studied, fairness is the is the thing that really triggers people — if that is breached. I’m thinking in this sort of conversation, if I was that junior, I would on be on high alert for fairness, because I’d be thinking, “Well, how come we’re talking to me? Everybody’s moaning; this isn’t fair.” Or, “Well, they can act however they want to, and I’m the one getting a good old rollicking here.” So how does one avoid triggering that response to fairness?

Ed: I think get the information out early. Say, “Is this is this something that you’ve particularly noticed and are frustrated about? Or have you noticed that lots of people are frustrated about it? If so, and I don’t want you to name any names here.” This isn’t about seeking to punish people. This is seeking to find out, “Is what you are saying — does it have a basis in reality? Is it really what’s happening? Is this what everyone is doing? Or is it just something that you’re doing?” Because that’s a fair approach. You’re not singling someone out and saying they just happen to the person you’re talking to.

But what you’re gaining from them is the,”Is it just you who’s noticed this? Or are lots of people noticing it?” Because, again, when we’re in that amygdala response — and I’m aware that some of this may be triggering that amygdala response for them — we tend to think in black and white ways, because we need to for that for that response to be as quick and as effective as it is when we’re under threat. So they might say, “Everyone is saying it.” and you’re like, “Everyone? Is there anyone who isn’t saying it?” Don’t try and get them to explore that. In the same way that you might with a child who says, “Nobody likes me.” Really? “Is it nobody, or is it one particular person you’ve had an issue with?” This is generalisation of belief.

Rachel: Could you check in with them about the fairness thing? Say, “Is this feeling fair to you? Or do you think there’s anything here in what I’ve said that isn’t fair?” Is that a good suggestion? Or is that just gonna…

Ed: I think it is. The concern is that it’s almost a presupposing question, isn’t it? You can’t really say no to that. If someone is in a hierarchical position to you and saying, “Am I being fair?” You’re like, “Yes.” You know, you can’t. It kind of prevents you from saying the “No.” — there is a lot of pressure. So you might say something like, “How might this feel fair? How might this feel fairer?” rather than making a “is this or isn’t it?” Which again, is giving them an increasing sense of autonomy because you’re giving them the opportunity to feedback to you and model how to give feedback appropriately.

Rachel: What should you do if you notice that someone that really has been triggered, but you’ve got to have this conversation? I mean, we always teach, press the pause button; do it another time; give people a chance to get out of the corner — all those sorts of things. But sometimes, you do just have to have these conversations. What do you do in those situations? It is ever good just to push ahead or do you always just have to go, “Okay, I can see this as difficult,” because what if you’re in a position where it’s always gonna be difficult, and there’s gonna be no time when they’re not triggered?

Ed: I think you have to read it, depending on the feedback you’re getting. Sometimes, you just have to push forward. Sometimes, you just have to press pause. The more times you have these conversations, the better and more nuanced your ability to decide when is the most appropriate route to take. In the same way that I wouldn’t want anyone listening to think, “Do we really have to have some protracted conversation about a behaviour that’s frustrating and irritating and causing disharmony in the team for every transgression?” No, you don’t. But by having the skill set to manage it, if it becomes a more complicated conversation, is going to be helpful.

Rachel: What do you do about those people that every time you try to feedback, they burst into tears or get very angry? So very soon, it’s just learned that you just don’t say anything to upset that person.

Ed: I would pre-warn them. I would say, “We know when we’ve had this kind of conversation before that you found it upsetting, but it is something I’m going to need to say.” So I have to say it, and you just have to be very clear about that. Because sometimes, that sort of walking out, crying — those almost sort of unconscious processes and behaviours, are often there as a defence. They’re usually not, but sometimes they are a defence mechanism, which says, “Don’t carry on. Don’t continue.” Sometimes you have to change tack and approach it in a different way. Again, it’s about practising the conversation, to know how to manage it — to say what you have to say, in the kindest way possible, in a way that builds connection.

Rachel: Because there’s so much in all of that. We could talk about this for a long time, but we don’t have forever. So Ed, if you are answering that post on social media, what would be the summary of the steps you should take to deal with this issue?

Ed: Connect first; information second; content third. So, build a connection, find out all the information, and then work out a plan of what you need to do. With that process, you are trying to differentiate between what you need to do and the emotion associated with what you need to do. So that way, you’re being consistent. In the same way that if one of your friends were bad mouthing someone and someone told you about it, you’d have a very different response than if it was someone you intensely disliked that you found out was bad mouthing someone. That’s all down to the emotion of it, and your ability to let someone off the hook. For instance, if you know them better or might understand the situation, give other people that chance to build connection and gather information and understand how your own brain works when you’re having conversations that are challenging. It makes you a better communicator, and that’s never a bad thing.

Rachel: Totally. I mean, I remember, when we’re teaching about emotional intelligence, we’d always say that, as a leader, some of your successes are down to IQ, but actually not that much. As a leader, probably 80% of your success is down to emotional intelligence, and the way that you can do these sorts of things. So it’s a really, really important skill. I think, from what you’ve been saying, the things I’m taking away is firstly, approach assuming good intent from that person. Assume they weren’t trying to be malicious, but they’ve got some unmet needs that aren’t happening, and we need to try and uncover those. And treat them as a close friend or a relative, so you’ve got their best interests at heart.

I think, just be aware of all those triggers, all those things — perhaps in the SCARF model — that may be triggering them, that you may not have thought about, particularly hierarchy. When it comes to the senior to the junior, you might think you’re being as fair and as open and as empathetic as possible, but when you said — when you just stopped me just now and said, “Actually, that sounds like if you’re a senior saying it’s a junior. Is that fair?” I would have thought that was a really reasonable question to ask. But yes, someone else might says, “I can’t contradict her because she’s senior.” So keeping that autonomy, always throwing the ball back in their court, so they’re not feeling that you are using your hierarchy to get your way. I think that’s really important. Well, we’ve covered a lot there.

Ed: We have. It’s been a good dilemma. Let’s see what the audience throws next week or next time.

Rachel: Totally. So, if anybody else has got a dilemma they would like us to discuss around interpersonal relationships, difficult conversations — anything, really, just email us at hello@youarenotafrog.com, and we will try and tackle that.

Ed, thank you so much. If people wanted to hear more about your work, find out more about what you do, where should they find you?

Ed: So, every week I post on my Facebook group, which is Difficult Conversations in Medicine, and that is primarily open to healthcare professionals. If you want more information from me, or you want to look at getting me to look at how your organisation communicates, or something like that, drop me an email at edward@tenminutemedicine.com, and I’ll be happy to have a chat with you.

Rachel: That’s great. We will also put a download link in the corner handout there. So, if you’re interested in the corner response, in your amygdala response, just go there. You can get that. We also have a Facebook group called the Shapes Collective. So, if anyone wants to pop in there and discuss things, then please do. You can put some dilemmas in there as well, and we can pop in there and have a look.

So that’s great, Ed. We’ll see you next time.

Ed: Perfect. Thank you.

Rachel: Thanks, bye.

Thanks for listening. Don’t forget, we provide a self-coaching CPD workbook for every episode. You can sign up for it via the link in the show notes. And if this episode was helpful, then please share it with a friend. Get in touch with any comments or suggestions at hello@youarenotafrog.com. I love to hear from you. And finally, if you’re enjoying the podcast, please rate it and leave a review wherever you’re listening. It really helps. Bye for now.