Mindful communication, part 2: Speaking clearly

Last week we discussed the art of listening well, which is a huge part of clear, effective communication.

A good rule to start is even before you utter a word, do 2 things: 1. Check-in with yourself briefly. What’s the real intent behind your communication? – Are you happy with it? 2. Check your stress level.

We want to come with a clean mindset when we communicate all the time, but in higher stakes communication with patients, staff, colleagues, consultants, attendings, residents, medical students, spouses, partners, children, etc., we really want to ensure we are clear with not only what but why we want to communicate.

To really have the most effective communication, after you’ve cleaned up your mindset and set your intention, pay attention to the best setting and timing. If it’s not the best time or setting, ask yourself, does this have to be communicated right now, or can I convey this in a more ideal time/setting?  For example, telling your MA while she’s on hold with a pharmacy with a confusing task may not be the best time and setting to tell her she forgot to take your patient with diabetes shoes off.

That leads us to discuss the manner. Your tone, facial expressions, and body language make a huge impact. Make sure they are in line with your intention to leave less room for misinterpretation.

Finally comes the actual content – the words you choose.  Again, being intentional goes a long way to clear, effective communication.

A quick word about communicating under stress – As busy family physicians, we often find ourselves in escalating situations such as a shoulder dystocia, a decompensating patient, or a chaotic clinic. Under extreme stress, our prefrontal cortex is dulled, the number of inputs we can receive drops, we aren’t thinking as clearly about things outside the immediate stressor, and our amygdala is amped up, making impulses harder to control.  Developing a pattern of awareness, “I’m about to communicate under extreme stress,” will serve you well. Then you can take a deep breath and aim for clear, calm, factual words.

So, let’s break down the MA and shoe example. What’s the intent? Is it to give clear feedback from a maximizing teamwork space? That sounds good. Or is it to express your frustration with her? If so, you may want to take a few breaths and examine your intent more closely.  Can you find a private setting in which she doesn’t feel publicly shamed? How about a time when she’s not at max stress level herself?  How do you want to sound, stand, express yourself? Sitting is nice and disarming if she’s sitting. Kind facial expressions with relaxed posture make you as an authority figure seem more relatable. Now for the words. Remember your intent – do you want her to feel supported and still have some balanced feedback? Remind her (and yourself) that she is great at putting patients at ease, and following through with your inbox correctly lets her know you see the good as well.  For wording about the shoes, just take a moment to choose the best words for the situation. “You forgot to take Mrs. Smith’s shoes off again,” may not be how you want to communicate.  Find your own style. Something like, “Hey Marie, is now a good time for me to offer some feedback?...” “Great, I love when I get to work with you because you are so good with my inbox task completions accurately, and you are so very good at putting patients at ease. I’m wondering how we can make it easier for you to remember to have patients following up for diabetes to take their shoes off.” “Thank you for coming up with a good solution; I’ll also try to remind you in huddle as well. It takes the whole team.” 

We can all grow in our communication abilities – both listening and speaking. 

Have a joy-filled week.  -Tonya

As a reminder to any resident or early-career physician that has been through one of my courses, you are eligible for the Joy FM Community.  Learn more here.