Consult-Liaison Education Informal-curriculum Medicine

Difficult Interactions (II).

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.