29th June, 2021

How to Have Crucial Conversations with Dr Ed Pooley

With Rachel Morris

Dr Rachel Morris

Listen to this episode

On this episode

Dr Edward Pooley joins us again to teach us how to communicate well. He discusses the three strands of communication and explains how to be aware of them. We also share frameworks to help you navigate difficult conversations.

Episode transcript

Dr Rachel Morris: Have you ever had a crucial conversation with someone which felt a bit like a car crash? Is there something that you’d like to see changed at work or home, but to get shot down whenever you try to raise it? Do you wish that you were able to have calm, rational conversations without feeling like you might say something wrong at any point? If so, this episode is for you. I’m joined once again by Dr Ed Pooley, GP and expert in communication and time management. We talk about how and why seemingly innocuous conversations can suddenly take a turn for the worse. How to get your points across in a way that someone else can really hear, and the perils of ignoring the emotional elements of any issue or interaction. So listen, if you want to know why we sometimes get an unexpected reaction to a seemingly innocent statement. Listen if you want to know the three elements you need to think about in any crucial critical conversation. And listen if you want to know how using a simple framework and plan for a crucial conversation can save you a whole heap of time and trouble.

Welcome to You Are Not a Frog, life hacks for doctors and other busy professionals who want to beat burnout and work happier. I’m Dr Rachel Morris. I’m a GP turned coach, speaker and specialist in teaching resilience and I’m interested in how we can wake up and be excited about going to work no matter what. I’ve had 20 years of experience working in the NHS and I know what it’s like to feel overwhelmed, worried about making a mistake and one crisis away from not coping.

Even before the coronavirus crisis, we are facing unprecedented levels of burnout. We have been described as frogs in a pan of slowly boiling water, working harder and longer, and the heat has been turned up so slowly that we hardly noticed the extra long days becoming the norm. And I’ve got used to the low grade feelings of stress and exhaustion. Let’s face it, frogs generally only have two options: stay in the pan and be boiled alive, or jump out of the pan and leave. But you are not a frog, and that’s where this podcast comes in.

You have many more options than you think you do. It is possible to be master of your destiny, and to craft your work in life so that you can thrive even in the most difficult of circumstances. And if you’re happier at work, you will simply do a better job. In this podcast, I’ll be inviting you inside the minds of friends, colleagues and experts, all who have an interesting take on this so that together we can take back control and thrive, not just survive in our work and our lives and love what we do again.

For those of you listening to the podcast who need to get some continuous professional development hours under your belt, did you know that we create a CPD form for every episode so that you can use it for your documentation and in your appraisal. Now if you’re a doctor, and you’re a fan of inspiring CPD, and you’re sick of wasting a lot of time you don’t have on boring and irrelevant stuff, why not check out our Permission to Thrive membership.

This is a new venture, a joint venture between me and Caroline who is The Joyful Doctor. Every month, we’re going to be releasing a webinar fully focused on helping you thrive in work and in life. Every webinar is accompanied by an optional workbook with a reflective activity so that you can take control of your work and your life. You can increase your well-being, and you can design a life that you’re going to love. You’ve got to get those hours so why not make your CPD count to a CPD that’s good for you. So check out the link to find out more. Thanks for listening to my shameless plug. And back to the episode.

It’s fantastic to have with me on the podcast, well, back on the podcast, Dr Ed Pooley. Ed’s a GP and he’s an expert in communication skills and time management. He runs a rapidly growing Facebook group all around difficult conversations and communication. It’s fantastic to have him back because the episode we had before, time management in a system which sucks, has been incredibly popular. I think people have found it really helpful, I’d say. Thank you for coming back on.

Dr Ed Pooley: Thank you for having me. It’s a pleasure to join in again and carry on the conversation.

Rachel: Yeah, so we said we wanted to get you back on because we didn’t quite fix time management, did we? I mean, that might take another podcast, and then it will be sorted and will all be absolutely brilliant. One of the things we were talking about in the last podcast and just encourage anybody who hasn’t heard that episode to go back and listen, was about the fact that there are all these reasons why we struggle with managing our time, managing our workload in a very, very difficult system, and the podcast we were talking about the things that we can do ourselves to make a difference, what can we do because we are only in control of ourselves, of our own actions.

We touched on the fact that eventually, actually, you are going to have to tackle factors external to you, and look at the system in which you work. Now, in my experience of trying to do any of that, you very soon butt up against resistance, against people who can’t see the need for change, or resistance to change, or worried about a change. That’s where we get into the realms of difficult conversations, I think, particularly when people feel that you’re criticising the way they’ve always done it, and they start to get defensive. So in terms of having these conversations, Ed, let’s just start off by asking you, what are the main problems that people are encountering in trying to have these conversations, do you think?

Ed: I think a lot of it is exactly as you said. It’s almost as though we fear speaking to people about things that may make them feel criticised, or may make them feel on guard. I think for me, one of the eye opening things, in terms of my practice in communication skills and speaking to people about having difficult conversations, is that almost always they’re, they are about emotion, and they’re about identity. So I think it’s really helpful to separate out these three streams of communication that we have whenever a conversation is difficult.

We have the ‘what is said’, we have the emotional content, and we have what the meaning of that conversation has on a person’s identity. So for example, when we have difficult conversations, we almost, we were almost willing it to be almost like a sugar-coated grenade. We want it to be delivered in such a perfect way, in such an exactly perfect, spot-on choice of words to make our message as well received as possible, and the other person is going to go, ‘Oh, yes, I fully understand what you said, perfect, I’ll adapt’.

But we know that that never happens, and the reason that that never happens is because of the conversation you’re having and what it means for the other person in receiving that information and what it means in terms of how it makes them feel as a person. So as you say, one of the challenges we have when talking to somebody else about time management is that very often, we’re not talking to them to say, ‘Well done, your time management is excellent, what you’ve done has made my life so much easier’. We’re often talking to them because we’re cross or frustrated or something has gone wrong for us. We’re almost looking for, to deflect that sense of irritation. It can’t be ours, it’s got to be someone else.

We looked in the last podcast about things that we can individually do to optimise our own time management. If we feel that we’ve done that, we may then start looking at other factors within the system and pointing fingers. That’s where that first layer of the conversation comes in, the ‘what if’, and we often have this sort of blame game where I’m right, you’re wrong, which is the main thrust of what is said, You’re almost trying to prove that your perspective is correct. That’s often the first hurdle we go wrong at.

Rachel: Hmm, that’s really interesting. I’m just thinking about some conversations that I’ve had, that I was quite shocked about the outcome and where they went. Reflecting on what you’ve just said about ‘what is said’ and the emotional contents, the emotional impacts and the impact on people’s identity. When I’ve spotted things that can be improved, I have sometimes just gone up to the person who I think could improve them and told them exactly what I thought, and then been really surprised when I had a very negative or defensive reaction.

I remember having a long chat with someone and saying, ‘Well, I think in actually if we could do this, and we could do this, and actually this has been really difficult because of this’. About a month later, this person said to me, ‘Yes, Rachel, when you had your massive rant at me about how dreadful I was’, and I thought to myself, ‘That’s interesting,’ because I never saw it as having a massive rant at him about how dreadful he was. I was literally just saying what I’ve seen wasn’t working and what I thought would be better. But I hadn’t figured on the fact that he had taken everything I said as a direct and very personal criticism. I just thought I was giving some feedback on some things that could be better.

Ed: I think what’s really interesting about that is if you pull apart the word rant, what does that mean? Usually what it means is that one person is talking, and one person is receiving the communication. It’s normally one way, and the word rant is quite emotive, which tells me that the other person would have had some emotional buttons pushed. The way they’ve framed that to you is, they’ve used the word rant for a reason. But it’s interesting, actually, if you look at those things in hindsight, that your message may have been correct. You may have been absolutely on the money in terms of things that need to be fixed.

But what tends to work better is if there’s a degree of balancing in the communication, and one way that you could approach that— Well not you specifically because you’re an expert on how to talk to people.

Rachel: I’m a complete expert— not! Ask my husband.

Ed: One tip would be, if you’re going to have that kind of that kind of conversation, again, is to say, ‘Well, I noticed this, what did you notice? This was going on for me, what was going on for you?’ Instead of it being about blame, which is, ‘This is the way I’ve noticed things, and I want this to change’, is actually to say, ‘Well, I’ve noticed this, what have you noticed?’ You’re inviting the conversation to be more balanced, and you almost cannot then be accused of ranting, even if the majority of the conversation is you putting your idea or observations across.

Rachel: Yeah, that’s interesting, because actually, often in these conversations, it’s not the point that you’re making, and often the person you’re talking to will agree with the points that you’re making, when they will say ‘Actually, yeah, absolutely agree’. But it’s whether they feel accused, whether they feel that you are implying that it’s their fault that they should have done something about it, which I guess immediately triggers their amygdala, puts them into their sort of sympathetic response. That’s when you then close down, and you don’t listen, do you?

I’m just reflecting, the mistake I made was not even considering that my feedback was going to be triggering for that person. I hadn’t considered the context, the fact that this person had been working in this place a long time, therefore, some of the things I was telling them weren’t very, weren’t working very well, they had actually set up. So I hadn’t realised that it would be taken as a direct criticism of them, I just thought they’d be like, ‘Oh, okay’.

I think when we go into organisation, something, particularly of surgeries and practices, new people who come in and can see the changes that can be made, go in there with the best intentions in the world, but they haven’t considered often the history and how things have evolved, and then they give us feedback, which can then just feel like a complete criticism of everything that’s gone before. Have you noticed that, or am I completely off track here?

Ed: No, I have. What you end up with is that you’re effectively trampling over the work that other people have done rather than evolving it. So it’s often better to think about what has gone before and why has it gone before? Have we sort of become stuck in that comfort zone where it’s kind of working okay. There were occasional complaints about the time it takes for documents to get processed, or there’s an occasional episode where a Friday on-call or a Friday will go very badly wrong.

But what we need to be doing is almost insulating ourselves against future change, because the majority of systems become more complex over time, it’s this kind of the idea of organisational entropy. If a system is going to become more complicated over time, or there’s going to be more demand on a system, we have to prepare ourselves for that, rather than sitting where we are. It’s to say, what, what could happen?

It’s better to take the people that have developed the systems that are in place and say, ‘Well, look, let’s try this as an exercise. Let’s see what would happen if we crank up the demand by 10%, 20%, 30%? How is our system going to evolve to meet that challenge? Because I’ve noticed that there are some things now that for me, in my role within the system, don’t really help me do my job. I’m aware that there may be things that don’t help you do your job. So why don’t we sit down together and work out what we’re happy with and what we’re not happy with and how we can adapt this system that works well in some areas, but perhaps needs tweaking,’ and that then becomes a very non-threatening thing, because it’s not about what is going on now and what is wrong? It’s about what happens if, and so it’s a kind of almost a non-threatening way of adapting a system.

Rachel: Oh, I like that it’s all about depersonalising it and saying, I do remember a conversation I had with the team and they were saying ‘Well, we we need to do some future planning because we’re not quite sure if this GP is going to leave or not; it was the elephant in the room that they couldn’t ask this particular GP if they were going to leave. This GP had a very prominent role within the practice that I was able to say to them, it’s not about this person. What if any of you leave? What if one of you gets really sick? It’s not just that, and as soon as it wasn’t about that particular person, they could then have the conversation about it, because it was what happens if.

Ed: There’s Edward de Bono, who’s one of these people who thinks about things philosophically, has this specific word that he calls ‘po’. I don’t really buy into it, but he’s kind of, when he says ‘po’, he means ‘Let’s talk about the possibilities that we can imagine going forward’. Actually what we’re doing is by thinking about possibilities, we’re engaging the inner child, rather than the inner chimp when we’re talking about fears, and it’s all going wrong. What are we gonna do? Panic, panic, panic.

Rachel: Now, that’s really helpful. I had never thought about depersonalising stuff by using what if, what if. That’s really good, that’s a really good tip. So you need to depersonalise stuff, and if you do, are there any other problems that you see in the content, in the ‘what is said’ stuff?

Ed: I think one thing that can happen if you depersonalise it is, there is a risk that you leave the emotional content behind. So we very often feel a sense of pride when we talk about ‘Oh, we had a very sensible conversation, and we were totally left emotion out of it.’ I think, well, that’s okay. You got the message across. But did you get the meaning across? Because a depersonalised conversation risks losing people. They won’t get why then there is a need to change.

It’s almost like receiving a memo. ‘That’s great information. But why do I need to buy into that?’ Actually, by engaging the emotion and using statements like ‘I feel,’ or ‘How does that make you feel?’ or ‘Does anyone else feel quite excited about this possibility? Or am I gauging the mood wrong and actually depersonalising?’ But making sure that you’re not leaving emotion out of the picture, I think is a really authentic way of communicating with a team.

If you don’t have the emotional content, if anything goes wrong or you need to revisit that discussion, you can then say, ‘Well, actually, I know a bit about, I know a bit about how Ed feels about this. Ed was very excited to change this part of the system. So actually, if I criticise him, he might take that the wrong way. I wouldn’t want him to because actually, I’m just making a suggestion’. A bit like the example you gave at the very start.

I think people having an awareness about how you feel about things, what it means for you, and certainly when we talk about identity, if you’re the kind of person who likes to come up with ideas and implement them, and you and you get a degree of self worth from that, if your ideas aren’t listened to or implemented, you’re gonna feel very irritated and frustrated being in a system that doesn’t listen to you.

That’s different to a system where your ideas have been accepted and looked at and evaluated, and then kind of say, ‘Well, yeah, actually, there is some really good stuff in here, let’s run with it. We can’t run with all of it. Because actually, for X, Y, and Z reasons, that may not work for us. But how about if we try a little implementation of that, get some feedback, and if it works, well, what a great addition you’ve made to how this system works’.

Rachel: So you ignore emotion at your peril. But actually, it’s much better to be expressing as ‘I feel this’, rather than A) assuming how other someone else is going to feel, or B) forgetting to think about how they might have, how you might trigger them how you might trigger those feelings and reactions.

Ed: Yeah, and we certainly use that approach, these ‘I’ statements: ‘I feel’, ‘I believe’, when we’re talking about assertiveness training, because the same principle applies, that you are giving an authentic statement of how you feel. The other person is then not able to, in some ways, criticise you because it’s not ‘I think’, or ‘This is my idea’, and the person is ‘Well, that’s a silly idea’, right?

You’re acknowledging that there are various parts to a conversation. There’s the words, the emotional identity. I think having awareness of all three makes you a very, very powerful communicator and very powerful influencer. It feels much better when you’re the recipient or the communicator giving that message. You just feel heard and listened to in a different way.

It’s not without its challenges, because there are some people who really don’t like talking in emotional terms, or who might see it as a little bit wishy-washy, or a little bit, sort of, we’re not really dealing with the issues, we’re dealing with feelings, and feelings are important. But for the majority of people, actually, it’s important to have both content and feelings.

Rachel: I think we’re very bad at being able to express how we feel. I was listening to a podcast, one of the Rangan Chatterjee podcasts about how to develop really authentic relationships, a fantastic couple of people who run a course in Stanford about how to develop really good relationships in the workplace. They were saying that often when we say we ‘feel’, we’re actually talking about our thoughts. ‘I feel that you’re not listening to me’. That isn’t a feeling, that’s a thought. ‘I think that you’re not listening to me’, and I’m assuming your intention. I don’t actually know that. What I should be saying is, ‘I’m feeling upset, because you’re not making eye contact with me; and I’m more, I’m worried that you’re not listening to me’. That’s very different, and it takes a judgement out of it. But I think we often do confuse thoughts and feelings.

Ed: Yeah, we do all sorts of little games to get us out of saying how we really feel, or diluting our message. So I was reflecting back when you gave your first example of going into a situation and giving your feedback. Certainly what I used to do was to say, ‘It’s all gone terribly wrong here, hasn’t it?’ It’s all, and it was all sort of depersonalised. But it wasn’t owning it, it was also kind of being attacking as well, but in a way that wasn’t about me and you. It was about ‘Oh, let’s, this system is just all gone wrong, hasn’t it?’

Again, if you’re not communicating the message you need to communicate, that’s when things start to go wrong. So actually, it’s easier to make little adjustments to systems and to say, how you feel rather than save it all up. So if we look at, for instance, giving feedback, a very popular model of feedback is something called the CORBS model, and CORBS is an acronym which stands for clear, owned, regular, balanced and specific.

So if we’re going to give feedback, you know, you need to give a very clear statement about feedback. Don’t be wishy washy about it. You can say, ‘What have you noticed about what happened or what went wrong here? This is an observation that I’ve made’. One of the things people often get wrong with feedback is they say, ‘Oh, everyone’s noticed’, which tends to put people on edge really, really quickly. If you’re the person receiving feedback, you’re then looking around going well, this doesn’t feel very safe anymore. Everyone’s noticed this about me and giving regular feedback as well.

Not waiting for things to hit crunch point, and then jumping in, because you have to do something, giving little bits of regular feedback, positive and negative, which is the balanced part of it, is actually really helpful. I like to think about it in terms of how autopilots work, you know, they make little course corrections on a plane’s journey to keep it on track. They don’t micromanage, which is where you have a very, very set trajectory and any deviation is not tolerated, or even allowed.

You allow little deviations, and then you say, ‘Well, I’m still going in the right direction. I was still doing okay, yes, we are. Carry on,’ and the specific part comes from, if you’re going to give feedback, don’t make it about ‘Everything’s gone wrong’, or ‘You’re always doing this to me’ make it about something very specific. Because if we deal with that, then we can usually find a solution more quickly.

Rachel: Hmm, that’s, that’s really good advice. I remember going on a marriage course years ago, and they sort of said when you talk to each other, you are banned from saying ‘you’re always’ or ‘you never’.

Ed: Yeah, absolutely. Absolutely. Because it makes it not about a specific event, and if you’re making it, is what we call almost like an identity-level challenge. It’s the difference between saying to a child, you did something naughty versus you’re a naughty boy. If you receive the message all the time that you’re a naughty boy, that’s gonna have a very different psychological impact on you, than if what you do is naughty, which is almost by definition, modifiable.

Rachel: So what if you need to have an assertive conversation or a difficult conversation with someone about something that they have done? So actually, this is quite personal, maybe about their manner or about the way that they’ve treated you or someone that you’ve seen or something that they are doing regularly that’s causing real problems? So actually, it is quite difficult, easier to depersonalise stuff when talking about system. ‘I don’t like the way we file our results around here’. But when it’s, ‘I don’t know, the way that you seem to be leaving all the visits or not seeing those last two people or just you know, leaving and dumping all the work on me’, stuff like that.

Ed: I think the trick here is that you have to, if that was me in that situation, I wouldn’t use the word ‘feedback’, because ‘feedback’ tends to put people on high alert. I would say something like, ‘Can we have a conversation about the visits? Okay, so I’ve noticed that there are quite a few visits that seem to build up. No one likes to do visits, it’s kind of a frustrating thing that we have to deal with them and manage. But I’ve noticed that you don’t tend to do very many of them, and I just wondered why that was. Is that something that I have got wrong, or is that really going on? And if so, how do we rebalance that because we all really have to do our fair share of these visits.’

If you’re going to give feedback, they kind of, in sort of the Harvard communication courses, they talk about this as an identity wobble, where you are midway through giving feedback and then you kind of go, ‘Oh, that makes me feel really uncomfortable. I’m giving someone bad news or challenging information’, and then you end up softening it. For instance, if you’ve got to tell an employee that, actually, you’ve got to fire them, it’s better to continue the statement with what we call ‘and’ statements.

So you can say something like, ‘I’m really sorry, I know this is going to come as a big shock to you. But unfortunately, we have to let you go, we can’t keep your job open anymore, and the reason for that is because things aren’t financially viable. And we’re really upset to see you go. And one of the things that’s been really vital to us has been having you working with us for now. And what we’re going to do to make that an easier transition is we’re going to help you in X, Y and Z way to help you move forward, because we want to recognise the service that you’ve given’.

That’s very different from saying things like, actually, ‘We need to fire you, we need to let you go. But I’m not really sure whether that’s something that has to happen now. So I’ll go back and speak to someone and we’ll have a rethink and see if I can change the outcome’, which is where you get caught up in this—

You want to soften the blow because it’s a difficult thing to say, and so you almost hold out this sort of olive branch of hope that it may change, and you kind of hope in the meantime, that that person may get the message that actually it won’t. That isn’t a very authentic conversation, and it’s done because the message that we have to give is a difficult one.

It’s kind of like the relationship one, we need to break up, but we’ll stay friends. That kind of situation isn’t, doesn’t really tend to work out very well in the long run, and you just end up drifting apart. So why not just make a clean break and move forward with your life?

Rachel: Mmm. I just, I really don’t deal very well with conflict despite doing workshops around conflict. Because nobody likes it do they? When you just said that thing about visits, I got a bit of a challenge, Ed, because I was with you until you started talking about it’s not very fair.

Ed: Okay.

Rachel: And then I thought to myself, if that was me, at that point, my back would have gone up. Because I would have felt you were making a judgement on me saying you’re not being fair.

Ed: Yeah, I think that would, I think if I was in that, in that moment, having that conversation, part of it is responding to that. So if you can see someone’s heckles raising, you can say, ‘Well this is my observation, and actually, what I want to do is I want to get your input on this. To me, it doesn’t feel fair, how does it feel for you?’ So what you’re doing is you’re turning that from ‘I’m right, you’re wrong’ into more of a learning conversation.

I should have made that, I should have chose my words more carefully there about ‘This is my understanding, and this is my observation. What I’m interested in is what’s your observation on this? Is it that actually, you’re sitting, going through loads and loads of cough stuff and actually earning lots of money for the practice, rather than visits? Because if that’s an unseen thing, and I’m judging you on the one bit that I can see, maybe I’m not seeing the big picture.’

And actually, then that might lead to a conversation about, ‘Maybe you’re really worried about the financial elements of the practice, and you’re less worried about home visits. But actually, maybe we should all be worried about the financial elements so that we don’t have other conversations where you come to me and say, “Well, you’re not pulling your weight financially.”’ It opens up the conversation by turning it from an ‘I’m right, you’re wrong’ conversation into a learning conversation.

Rachel: I think that’s a really helpful distinction to make. I think for me that illustrates just how careful you have to be with the way that you phrase things and just one nuance of ‘It’s not fair’, or ‘To me, it doesn’t seem fair’. It’s really important to point that out. It doesn’t feel fair, because then the other person can see what the impact is on you. Also, what you’re doing is revealing the story in your head about what’s going on, and then the other person is able to correct it.

Like you said, if what they were doing at lunchtime was dealing with all the staff crisis and staff problems that no one had to deal with, then then fair dues, you probably go ‘Yeah, and I’ll go to your visits, you carry on doing that’. To be able to reveal what the impacts and what the story in your head is, so that the other person can then correct it, or challenge it, or come back with what the story in their head is. I think it’s really important.

Again, on the podcast host talking about listening to him, I’ll put the link in the show notes, this was really helpful. They were saying if you’re not disclosing this, these sorts of things, if you’re not disclosing what you’re really thinking, and how on earth are you ever gonna sort stuff out? Because people are not mind readers, are they?

Ed: That’s a really interesting thing, because we often get caught in the trap of thinking that people are, you know, the number of times that colleagues have spoken to me and they’ve said, ‘I really wish someone would pull their weight round here, I really wish they just get how busy it is’. You think, ‘Well, maybe they don’t know, because we’re all different, and actually, maybe this is what you’re noticing’. It’s a little bit like, I remember blinkers on, you kind of noticed the thing that you are focused on, but maybe you’re not seeing the big picture. Now, that doesn’t mean you shouldn’t state your perspective and contribute, because you’re all actually walking around with blinkers on, maybe you could all sit down together, share your view and actually build the picture that really exists rather than one that you’re just focusing on.

Rachel: Yeah, I think the key to that is, like you’ve just said, it’s the story in my head, this is how I feel, not necessarily what’s going on. But this is what I’m thinking and then everyone else gets to share what their stories are, rather than the ‘You’ve done this’ or ‘You haven’t done this’, is what I’m thinking. It’s a much, much more neutral way. It also acknowledges the fact that perhaps, just perhaps like I could be wrong.

Ed: Yeah, absolutely. Because there is that. Actually being able to put the stuff out there and acknowledge that you may have had a skewed perspective, or you may have been wrong, or not wrong, but you may have not seen the big picture, or you may have been completely incorrect, actually gets it out there and moves the conversation forward.

We’ve all been in situations, and this comes up a lot in romantic relationships where, you have an argument, and you say things, and then afterwards, you kind of have the almost the debrief where you’re like, ‘Well, I didn’t mean to say it like that, what I really meant was this’, and then the person goes, ‘Yes, I understand that’. It’s like, well, why didn’t you have that conversation in the beginning? And then all of the frustration and all the anger could have been avoided?

Rachel: Yeah. Oh, well, this is, again, I think I’ve said this in every podcast I do at the moment. Why didn’t we learn this at medical school?

Ed: I think, I’ve thought about this a lot. It’s certainly in terms of the work that I do in talking to medics and trying to improve communication of healthcare professionals with each other and their patients, is that we often assume we’re good communicators until we’re told otherwise.

It’s one of those things that you and I’ve certainly had this, where you just think, well, I’m okay with that. There’s nothing wrong with my communication. And part of that is that we are almost, particularly for medics, we’re fed this, this idea that we’re very good, we’re very clever, or that we’re perfectionist, and it becomes part of our identity. We think we’re good at everything, and actually, we’re not good at everything, and that’s okay.

You don’t have to be good at everything. You have to be good enough at one thing, which is medicine. If you wish to be good at other things, then you can learn the skills for that. But if you assume that you’re good enough already, you won’t look for the other options until either you’re made to or until something goes wrong. That’s the kind of thing we want to avoid.

Rachel: How important would you say is to learn how to have these difficult conversations?

Ed: I think it’s vital. I think we, the majority, certainly for the medical audience that’s listening. I know you get a lot of lawyers and solicitors that also listen. The bulk of our work is receiving information via communication and giving information via communication. The knowledge bit of our job is about how we process that information to make meaningful judgement from it. But everything that we do is based on how we communicate with each other, and a large part of what we do involves a lot of emotional topic discussion and very challenging situations. So why not do that to the best of our ability?

Rachel: So Ed, if somebody wanted to just start off with a small conversation, and they just wanted a really quick framework for having it, what would you suggest? You’ve already mentioned that one, which is the cause—


Rachel: CORBS framework. Are there any other quick tips or frameworks or models that are helpful?

Ed: So I think, I would recognise that there are three strands to all the communication that we have, which is the the words that are said, the emotional context and what it means about you as a person, both as the recipient and the provider of the information. I think that’s crucial. I think the second thing is that difficult conversations, as with everything, gets easier with practise. So if it’s something that you want to practise, start with something that is low stakes. Start saying how you feel when a situation is just starting to drift, rather than when it becomes very, very serious.

I think the third thing is, if you have a framework, frameworks make, give you a plan, and plans prevent chimping. They prevent that stress response, because you know what you have to do. I think I mentioned last time, we’ve both been in situations where we’re dealing with resuscitation events. Almost all of the training around resuscitation events is about the focus on the plan, we have a very clear plan of what do we do when we’re feeling incredibly stressed, and in that frame of mind, where we can’t really focus on lots of things.

It gets easier with practise. But the plan helps us and I think frameworks like CORBS, or other techniques for learning how to talk to people, when there are difficult conversations works really well.

Rachel: There’s a framework called BOCA, which I’ve come across, which has helped me actually, which is state the behaviour. So non judgemental feedback, say what the outcome of that behaviour was. So rather than ‘You yelled at that nurse in the practice meeting, you’re horrible, and you really upset her,’ it’s ‘I noticed you raise your voice, the outcome was that she stopped talking, there were tears in her eyes, the consequences were seized for consequences, she then didn’t contribute to the rest of the meeting’. I think a sense of actions that actually what to do, ‘It would be really great, maybe, if next time, you could just let her finish. Maybe it might be worth going to have a word with her’, or something like that. Again, it’s this non-judgemental stuff. What about nonviolent communication? Do you sort of use many techniques from that?

Ed: Yeah, I think it’s a phenomenal set of work. This is stuff that evolved in kind of the late 60s, early 70s, dealing with really, really big, profound issues around race, identity, sexuality, gender, and about how we have conversations where there is going to be a lot of difficulty where you’re dealing with people who are from vastly different views, and actually learning to share experience and learning how to understand where another person is coming from, and to try to see things from their perspective works really well, but it does require practise.

Rachel: I think what I like about nonviolent communication is that, this core principle that behind every communication, there is a need. What is the need that that person is trying to communicate here? What need do I have? What need can I, what requests can I make at the end of that?

I think that’s really helpful. Just, what that for me, though, is just the start. I think we need more specific conversations about conversations. Because out of all the podcasts I’ve recorded, these ones about conflict, about difficult conversation, that I think are some of the most popular, and also the most needed, because it does strike the fear of God into people. Nobody really enjoys it, I guess, unless you’re a psychopath and you enjoy upsetting people.

But it’s difficult. I think if you want to develop into an authentic leader, and a good leader, we really, really need to know how to do this. So are there any particular resources that you would point people towards?

Ed: So there’s really, there’s two books that I recommend for almost everyone when dealing with conflict. So the first one is called Getting to Yes, which is quite an old book. I forget the name of the first author, but the second author is William Ury, who’s—

Rachel: Fisher, I think is the first author.

Ed: The second one is William Ury’s second book, which is The Power of a Positive No, which is talking about what it means when we say no and actually, we’re saying yes to ourselves, we’re not avoiding, we’re not being aggressive. It gives you a set of techniques for dealing with things.

The third one, which I found really helpful certainly in terms of our medical work is a book called Never Split the Difference by Chris Voss, who’s a former FBI hostage negotiator. He talks about how do you have conversations where, you know, there are potentially lives on the line with people who really only want to talk about what they want and don’t want to hear what you’re saying, and how do you have that kind of conversation, some of the techniques he raises are absolutely brilliant in terms of how they can be applied to everyday life,

Rachel: I think there are possibly some practice meetings that almost get into this sort of—

Ed: I want a million pounds and a helicopter to get me out of here.

Rachel: I think the reality is, and the importance of all this is, conflict is everywhere. Either you talk about it, and you have those conversations, or it’s still there, but it’s just festering under the surface. That is never a healthy place for an organisation, is it?

Ed: No, we and we end up in almost this this cycle of organisational passive aggression, which doesn’t help anyone. It makes everyone feel on edge, things don’t get fixed because you’re too worried about upsetting some person in a part of your organisation, and then the whole system slowly grinds to a halt.

Rachel: Totally. So we need to know how to do this. So Ed, what would your three top tips be for starting to deal with conflict?

Ed: I think the things that I would say number one is when you start to recognise that there’s an issue, find a way of authentically communicating that and don’t leave it to sit until it becomes a bigger issue. The second thing I would focus on is what can I see about this issue? What are things that I may not be able to see? Have an awareness of the other perspectives that may be going on? Step three would be, have the conversation, just do it. Because even if it goes wrong, it’s in some ways better to start the conversation, and then fix it if you have to, than just simply let it fester.

Rachel: Thank you. That has always been my experience, actually. Always been my experience that I’m really worried about it, I think it’s going to go wrong. Even if it does, the relationship’s actually always better after that conversation.

Ed: Yeah, we kind of build up the fear in our heads, don’t we, when there are those frightening experiences or things that provoke an emotional response. I liken it to horror films: it’s always better to see the monster than it is to imagine the monster. When you when you watch horror films, it’s always more frightening when you can’t see what’s attacking you. Even if the outcome is exactly the same, it’s better to deal with what you can see.

Rachel: Great, thank you, really helpful tips there. So I’m definitely getting you back on this podcast, if that’s okay to talk about this more. I know that you run a Facebook group and you put loads and loads of other information out there. So how can people join that? How can people contact you if they want to?

Ed: So if you want to join the Facebook group is only open to health care professionals. But if you work in health, if you search for either ‘difficult conversations in medicine as a group’, or if you go to Ten Minute Medicine, which is a Facebook page, you’ll see links to it. If you want to have, if you want to reach out to me, we’ll have a chat about anything, it’s edward@tenminutemedicine.com.

Rachel: Brilliant, thank you very much. So we’ll put those links in the show notes. I’d encourage people to join that group if they can, and to read one of those books. This is something we can all get a lot better at. So thank you so much for being with us today.

Ed: Thank you.

Rachel: Thanks for listening. If you’ve enjoyed this episode, then please share it with your friends and colleagues. Please subscribe to my You are Not a Frog email list and subscribe to the podcast. And if you have enjoyed it then please leave me a rating wherever you listen to your podcasts. So keep well everyone. You’re doing a great job. You got this.