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Book Blog: “It was as Plain as Day” Post Reading Supercommunicators

Ryan Pong, MD, FASA | Member AIAMC Board of Directors AIAMC

Interpersonal and Communication Skills (ICS). Most readers of this book blog know exactly what ICS refers to. Every rotation we have finished, and each program completed has our directors signing off on our proficiency in communication. I’d like to think that our supervisors, attendings and program directors are right in signing off on this competency. Personally, I’d like to think that I am an effective communicator-both listening and responding to form relationships that allow me to deliver the best possible care as a physician.

Conundrum

What has perplexed me is how, on the one hand, I could have a busy day, performing preoperative interviews and anesthetizing patients leaving the hospital feeling a sense of pride and accomplishment in the care I delivered. However, within minutes of getting home, I could get so deep into a miscommunication (even missed communication) event with those that I love most-my twin teenage boys and my wife. This book helped me understand this seeming paradox, and in retrospect it was plain as day.

Supercommunicators: How to Unlock the Secret Language of Connection by Charles Duhigg emerged from a long search as the book to be gifted by our GME leadership team to our GME leaders following a retreat. The retreat was built to further effective communication in our Sponsoring Institution’s GME community. As we searched, we found a TedTalk by Duhigg from his book, Supercommunicators. Both highlight the story of Dr. Ehdaie, a urologist who cares for men with prostate cancer. This urologist was amazed at the rate at which his patients were choosing to have a prostatectomy, an invasive and sometimes morbidity inducing surgery in an effort to treat a cancer that would ultimately not cause any problems for the majority of his patients. Perplexed, he wondered why. That led him to discover his methods of communication were not serving his patients in the manner he had intended. Examining and changing the way he communicated led to a 30% reduction in surgical intervention through joint decision making with his patients.

The Science Behind Effective Communication – 3 Types of Conversations

Duhigg, through many interesting examples spanning from the familiar of medicine to the CIA’s recruitment of spies to the legal world and in the inner workings of a jury, develops the science behind effective communication. He offers science-based methods for readers to incorporate into their everyday lives. It begins with enhancing one’s ability to identify which of the three conversation types are occurring: 1) practical, 2) emotional, or 3) social. After recognizing the type of conversations each party is having, Duhigg argues that we must strive to have the conversation type match at the same moment. This allows us to maximize the effectiveness of the connection and communication.

Example 1. Practical Conversation: What’s this really about?

I am an anesthesiologist and enjoy my time with patients–short intense conversations. These include eliciting a thorough medical history and then formulating and sharing a sound anesthetic plan in a manner that the patient can understand. Within this quick conversation, I must simultaneously assure my patients that they can trust their vulnerable state to me while they are having surgery. What was I missing that my teenage boys and spouse aren’t always wanting to engage in these practical conversations?

Example 2. Emotional Conversation: How do we feel?

In my role as a husband and partner in a household and with parenting, what allows success at work is not at all what allows success at home. Coming home from work I’m primed by my day to engage in practical conversations – to fix things. Yet my wife is ready to share the details of her work, whether it be contract negotiations or the conundrum of planning the next steps in a project – not a solution. This is a set up for missed communication.

Understanding where she is in her processing, what she needs from me is key. Being able to realize that she doesn’t need the practical pragmatic direction of “Here’s how to fix it.” Rather what she needs from me is to ask deep questions to figure out what conversation type she is needing “why did that interaction make you so happy?” Matching my responses to her needs leads to our ability to communicate and learn more about each other.

Example 3. Social Conversation: Who are we?

As the father of twin teenage boys, I’ve learned that sometimes they don’t want the advice and practical comments of their GenX father. Sometimes, they don’t want the emotional discourse about how events in their day made them feel. Recognizing that they are moving through a time of identity formation and that they need to engage in conversations to help them figure out their beliefs and stances is key. They are trying to figure out how to be independent in this strange time where they have little ability to acquire their needs of life, independent from their parents (housing, food, transportation), but want to maximize their independence. Understanding this conversation type and the needs it serves has allowed me to better communicate with them, where they are.

Some overlays on the conversations…

The three types of conversations are dynamic. Sensing and responding to the changing type of conversation type is key. What may start as a practical conversation can morph into an emotional conversation. This can be vice versa as well. Sometimes with patients, the emotional conversation (“I am so anxious right now, I can’t stand the thought of surgery”) needs to be explored before the practical conversation of history taking and anesthetic planning can occur. When we don’t sense that, we are not delivering the best and effective patient care that we can.

I also appreciated and have tried asking deep questions, not asking about the facts, but about the feelings behind situations, dilemmas and choices. Duhigg offers tangible examples of how to tell what sort of conversation you are engaged in and thus can respond most effectively.

Finally, if the book seems overwhelming - as if I could never remember all of the science and nuance of techniques - Duhigg reassures us that these skills, like any other, can be practiced and learned. This brings me back to Carol Dweck’s Growth Mindset. After all, if we expect that our students and residents can learn and show development in milestones, including those in ICS, through knowledge acquisition and practice of skills – we all can.

About Ryan Pong, MD, FA SA:  is a practicing neuroanesthesiologist, Vice President and Chief Academic Officer+ DIO and Medical Director of GME at Virgina Mason Franciscan Health – a Member of CommonSpirit. Experienced in Kaizen and the Virginia Mason Production system having been trained at Virginia Mason Medical Center and in Japan! Examiner for the American Board of Anesthesiology.