Transcript Clip 1 & 2: Why is your Barista a Better Communicator Than Your Doctor?

From: Power Up Your Teaching of Communication Skills with Techniques for Business and Performing Arts – Richard Snyder

It’s 1988, 2:00 a.m. in the morning.  I am wearing hospital greens and my waist is weighted down with a variety of beepers.  I have a name tag.  Not surprisingly, it says Richard Snyder MD, Resident in Anesthesiology.  My mother would be so proud.  I am at the threshold of the patient waiting room for the ICU of this hospital.  10 minutes before I had been at a CODE the ICU.  The patient could not be resuscitated.  And then my senior resident and attending were then called to another emergency. I was given the job of telling the patient’s family that what had just happened.  I step into the waiting room.  I can’t believe how many people are in here.  There is a human being on every piece of furniture.  Most are asleep, but when I walk in, their eyes open and they all turn to me.  One of them gets up and walks towards me.  It’s a woman.  She’s older than me.  She has with black and grey hair (move to her spot) “I am her sister.”  All I can remember about what to do in this situation was to not use medical jargon.  So I said, “Your sister just died.”  The woman literally collapsed unconscious in front of me. Needless to say, not one of my finer moments as a doctor.

By a show of hands.  How many people feel really confident about how they would have handled this situation?  (raise hand)  Show of hands.

(If hand ups)

Now, by the number of fingers on your hands, hold up the number of years you think it took you to get good at this.  If you don’t feel good about it now, hold up how many years you think it would take to get good. Looks like 10-20 years.

So here’s the question:  Does it need to take that long?

(If no hands)

So here’s a question:

Does it need to take that long?
Can this be taught or does it just come from years of trial and error?

I’m Richard Snyder.  I was a medical student and a resident in Anesthesiology here.  Dr. Gaba was one of my attendings at the VA.  Steve Howard and I were in the same residency class.  Thank you so much to Dr. Gaba and Sandi Feaster for inviting me to be here.  It’s good to be back.  For the last 23 years, I have been in private practice in Seattle.  I have been solo provider doing my own cases, a supervisor of nurse anesthetists and residents, and a department Chief.  I have seen, time and time again how you can be perfect in the science of healthcare and still have a bad outcome because of a communication failure.  As you know, I’m not the only one who has made this observation.  The ACGME has made communication and interpersonal skills one of the 6 milestone competencies.

So communication is important.So why it is, when we try to teach communication, the reaction of most students is … Tina Fey Eye roll Slide

It’s like my daughter being asked to take out the garbage.  (Girl Eye roll slide )

Why the eye roll?  (to slide)

Why the eye roll?  (to self)

(To audience) I’ll give you three reasons for the eye roll

Eyeroll Reason #1 Cognitive Overload Slide Cognitive Overload.  Here’s two summaries Click to reveal summaries of communication tasks from well regarded curricula.  If you give the student every one of these communication goals, it ends up being like your worst ski lesson.

Look down the Hill
Keep your hands in front of you
Your elbows at right angles
Your body in a letter C
Weight the outside ski
Bend your knees
Relax Your shoulders
Tighten up that core.

As you can imagine, you end up with a frustrated student who doesn’t get any better.

Eyeroll Reason #2 Habit Change Slide
Habit Change vs. Something New.

Learning something new is fun!  Changing a habit is not.  It’s hard.  Communication is a habit.  It’s a lifetime of ways of talking to people.  Nobody likes to change something they’ve been doing for a long time.

Eyeroll Reason #3: (slowly and like educational film) It’s Personal Slide
It’s Personal.  Communication is intensely personal.  It’s who you are.  You’ve been successfully talking for your entire life.  Being asked to change how you talk is tantamount to being told that there’s something wrong with you.  It is threatening and provokes defenses.

Given Cochraine Slide cognitive overload, habit change and defense of self it’s no wonder that communication classes often don’t work.

This from  Cochrane Review on the subject.  “Training for communication skills has not produced uniformly positive results.”  It’s an understatement.  The fact is that there is curricula that is good to have been widely adapted

So, maybe the eye roll is justified.
Maybe the only way to master this stuff is by trial and error over many years.

That’s how I did it.

Click and Fade Cochraine Slide

But in my 20th year of private practice I learned that trial and error is not the only way.  I got the crazy idea to celebrate my 50th birthday by performing a one man show.  I had never done anything like that.  The potential for epic humiliation was vast.

So I signed up for Acting Classes.  It was there that I learned a secret. Acting Schools know how to teach people to be great communicators

I guess this shouldn’t have surprised me.

Book of Mormon Slide

Professional Actors are the Olympic Athletes of Communication. Wouldn’t it be great if we could connect to patients and each other at this level of mastery?  Well, we can if we train for it. These people took classes to get this good.  Even Robin Williams, one of the greatest talents of our generation, took classes.  He was a student at the Julliard School of Drama.  As a doctor, I don’t need to be Robin Williams.  I can however, benefit from the Acting exercises.  It’s like going to the gym.  I’m not going to be Michael Phelps.  Just look at me.  But I do benefit from going to the gym.

There is another place that teaches people to be great communicators… the business sector…

Starbucks Slide

Do Starbucks Employees have more emotional intelligence than your physician?  .Ouch !  That’s not fair, but ya…. sometimes they do.  Why?  Because they have great trainings.

Click to Fade Starbucks

There are so many techniques here that we can use.  Today I want to share three of them.  I picked them because they are easy to use, they address the eye roll issues and they work.

Engaging openings, impactful closings and medical improv. The first two are adjuncts for any learning session.  The third, medical improv, is a specific Performance Based Curricula available to medical educators.