Month: July 2013

(Note: If you found the previous posts in this series “woo woo”, you might find this one nearly intolerable.)

A final reason to stop talking in the midst of a difficult clinical interaction is so you can accept what the other person is doing.

When you accept someone else’s behavior, this does not mean that you necessarily agree with it. It doesn’t mean that you condone it, support it, or want it to happen more. It just means you accept what is happening.

We cannot control the behaviors of others. We can influence them, but we cannot control them. If we do not accept what is actually happening, we have no chance of influencing what happens next.

I worked in a residence where two men would occasionally pee in the elevator. They weren’t incontinent, there was no Foley catheter and bag that malfunctioned… they just periodically voided their bladders in that small space.

Willfully ignoring the yellow puddle in the elevator won’t resolve the problem. The odor would fill the elevator and other people would inadvertently step into the urine.

Wistfully wishing that they had voided their bladders elsewhere won’t resolve the problem, either. “Why didn’t they use the bathroom? If they really had to go, they could have at least peed into the plant next to the elevator. Should they wear adult diapers?” Trying to solve the problem before having a clear definition of the problem often only leads to frustration. You cannot define a problem until you accept that it is a problem.

It’s also common to realize that, when you’re silent and accepting what the other person is doing, the difficult interaction often softens. It is hard to argue with or resist someone when he is accepting what you are doing and saying in that moment.[1. It takes two to fight, two to tango, blah blah blah….] Furthermore, you are also practicing and modeling a useful skill. The other person might realize that he could use that skill at that moment, too.

To review: One reason why it is useful to stop talking during difficult interactions is so you can acknowledge the emotions you are experiencing. Another reason is to recognize and adjust the language you are using to describe the situation to yourself. A third reason is to accept what is actually happening so you can plan and take next steps. It seems like all of this would take a long time and result in awkward silences, but that doesn’t happen. For many people, staying silent isn’t a habit. It takes practice.

Another reason to stop talking in the midst of a difficult clinical interaction[1. I focus on clinical interactions here, but this arguably applies to any difficult interaction we have with our fellow human beings.] is to recognize what you are thinking and adjust the language accordingly. The words we use to describe events, even if only in our heads, will influence both our emotions and behaviors.

Here is an example. Who would you rather work with?

Person 1: This is a 28 year-old woman who is manipulative and immature. She will do anything to get attention; she’s so dramatic. She never takes responsibility for what she does and everyone else has to clean up the messes that she makes.

Person 2: This is a 28 year-old woman who struggles to deal with emotions she feels like she can’t control. She has difficulties with relationships, but she’s doing the best that she can with the skills she has to get her needs met. If she knew how to work with people more effectively, she would. She might also have fears that if she tried harder, she might fail. No one likes to feel shame.

These descriptions could be of the same person. However, your reactions to each description might be noticeably different.

Some may argue that this is an exercise in semantics or, worse, indulgence in delusion. “But, Dr. Yang, she really is manipulative….”[2. Like I noted here, we manipulate each other all the time. I’m arguably manipulating you right now with these words. We often use the word “manipulative” when the manipulation isn’t skillful. People would do something different if they could in that moment.]

It’s our job to be more flexible than our patients. That’s why we get paid to do what we do. Yes, you could argue that these are just word games. However, would you rather be helpful or would you rather be “right”?

If describing patient behaviors in neutral, if not generous, language will help you maintain your professionalism and deliver quality care, then give strong consideration to what words you choose.

Please note that you can still use neutral language even when you feel angry or frustrated:

She’s screaming and trying to bang her head against the wall right now because that’s the best that she knows how to cope with the situation. I’m getting really annoyed with this… and if she could do something different right now, she would.

What is happening and how you feel are both “true”.[3. Using neutral language in your head during difficult interactions can have the added benefits of making you slow down and reducing the intensity of your emotions.] Remember, you feel what you feel. Own it.

To review: One reason why it is useful to stop talking during difficult interactions is so you can acknowledge the emotions you are experiencing. Another reason is to recognize and adjust the language you are using to describe the situation to yourself.

One more reason to follow before we all resume talking.