Caring Enough to Tell the Truth

I’ve been reflecting on a situation someone close to me recently faced in her work as a consultant.

She was brought into a high-stakes situation by her boss, who had asked her to help a close friend. The friend believed that other people involved in an important transition were the problem. Her assignment, at least initially, was to assess the situation and help get everyone else aligned.

But after conducting a thorough evaluation, she reached a very different conclusion: the others were not the primary problem. Her boss’s close friend, the person she had been brought in to help, was.

That left her with an unenviable task. She had to tell a powerful person, who expected her findings to validate his perspective, that the evidence pointed instead to his own difficulty with transparency, fairness, and relinquishing control.

That led us to a conversation about tough empathy.

Leadership scholars Rob Goffee and Gareth Jones described tough empathy as giving people what they need rather than simply what they want. I think of it as the ability to hold two truths at once:

I understand why this is difficult for you.

And I still need to tell you what I see.

Tough empathy is not brutal honesty nor kindness diluted into vagueness. It is truth delivered in a way that preserves a person’s dignity without protecting them from reality. It essentially is radical candor as described by Kim Scott.

During my faculty development fellowship, Dr. Nancy Stevens taught us a framework that Dr. Olivia Rae Wright has continued to develop and teach: the distinction between performance that is above or below the line.

Above the line, residents benefit from an individualized learning plan. They retain meaningful choice in identifying their goals and determining how to pursue them. Below the line, or nearing it, there is risk to patient care or professional standards, and it becomes the program’s responsibility to intervene. If early efforts do not help the resident course-correct, formal remediation becomes necessary.

The distinction matters because it challenges something we well-intentioned faculty sometimes do: we understand why a resident is struggling and inadvertently allow that understanding to excuse performance that in reality is unacceptable.

During that same time, one of my advisees was facing significant personal challenges outside of work. We felt deeply for what he was going through. Without quite realizing it, we had allowed our empathy for his circumstances to become an excuse for early patterns of unacceptable performance.

Because of what I had learned from Nancy, when I was working with him on the prenatal unit and seeing important gaps in his review of the labs and even MFM recommendations, I knew I had to do something. 

Her framework helped me recognize that his performance was just below the line. Empathy did not remove my responsibility to address it.

I sat down with him and acknowledged what he was experiencing. I also told him plainly that his current performance posed a risk to patient care. We reviewed the support available to him, including the possibility of taking FMLA leave. I told him that we genuinely cared about him, his circumstances, and the physician we believed he could become.

(This was before I trained as a coach, so I’m fairly certain it involved considerably more telling and minimal asking.)

He rose to the occasion. We maintained a strong relationship despite the hard conversation. He knew I wanted the best for him. We still keep in touch years later.

Over the following 18 months, I needed to have similar direct conversations with two other residents. I never became comfortable with them. But I became more willing to initiate them and better able to trust that clarity and care did not have to be opposites.

Not every difficult conversation produces the outcome we hope for. But withholding necessary feedback does not protect a learner. It deprives them of the opportunity to understand where they stand and respond while there may still be time to change course. And it isn’t very caring to allow them to be on the wrong trajectory.

As educators, we can understand why a resident is struggling without lowering a standard they must ultimately meet. As leaders, we can recognize that a colleague is overwhelmed while still addressing behavior affecting the team. As clinicians, we can honor a patient’s fear or frustration without recommending a treatment unlikely to help.

Empathy helps us understand what someone is experiencing and helps them see that we care. The “tough” part asks us not to let that understanding obscure what they need from us.

So even better than, How can I say this kindly? 

How can I tell the truth clearly, show them I care, preserve their dignity, and remain present long enough to help them work with what they have heard?

Reflection:

Who do you care enough about to be radically candid?

What do you need to remind yourself of to take action?