Plenary 4
Dr. Michael KaufmannOMA Physician Health Program
Communication and Civility:
Michael Kaufmann MD, FCFP, FASAM, ABAM diplomate
OMA Physician Health Program
Touchstone Symposium Feb. 23, 2016
Caring for oneself, colleagues and our medical community
Men are from Mars,
Women are from Venus…
Doctors are from Krypton
Dedicated to Doctors. Committed to Patients.
exhausted and burned out ANXIOUS depressedD i s i l l u s i o n e d discouraged
crossingboundaries isolated
financially $tressed stressed by marital or family problems caught conflicts angry
victims of harassment and violence considering suicide
experiencing a serious mental illness abusing or dependent on alcohol or drugs
stressed at work Disrupting work conditions
PHP callers are …
in
timalop
Dedicated to Doctors. Committed to Patients.
Learning objectives:
• Describe the concept and components of
physician civil behaviour.
• Understand how effective communication skills are
a fundamental component of civility in the culture
of medicine.
Impacts of incivility: (Leiter, M; Analyzing and Theorizing the Dynamics of the Workplace Incivility Crisis)
• Worker stress, distress, burnout, illness
• Decreased productivity, absenteeism, presenteeism
• Propagation of unwanted behaviour
• Decline in workplace morale
• Increased worker turnover and cost to the organization
• Cultural “Code of Incivility”
• Patient safety?
What are some definitions of civility?
Civility: (Spath and Dahnke; Institute for Civility in Government)
Civility is about more than just politeness, although politeness is a necessary first step. It is about disagreeing without disrespect, seeking common ground as a starting point for dialogue about differences, listening past one’s preconceptions, and teaching others to do the same. Civility is the hard work of staying present even with those with whom we have deep-rooted and fierce disagreements. Civility is claiming and caring for one’s identity, needs and beliefs without degrading someone else’s in the process.
Civility: (Davetian, B; Civility: A Cultural History)
“…the extent to which citizens of a given culture speak and act in ways that demonstrate a caring for the welfare of others as well as the welfare of the culture they share in common.”
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The Young George Washington’s Rules of Civility & Decent Behaviour
in Company and Conversation
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1. Every Action done in Company, ought to be with Some Sign of
Respect, to those that are Present.
14. Turn not your Back to others especially in Speaking, Jog not
the Table or Desk on which Another reads or writes, lean not
upon any one.
44. When a man does all he can though it
Succeeds not well blame not him that did it.
49. Use no Reproachfull Language against any one neither Curse
nor Revile
Dedicated to Doctors. Committed to Patients.
#1: Respect Others and Yourself
“Respect is like air. As long as it’s present, nobody thinks about it. But if you take it away, it’s all that people can think about.”
Crucial Conversations
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Respect
• For those we know and like
• For those we don’t know
• For those we don’t agree with
• For those who have hurt us?
• Self
Dedicated to Doctors. Committed to Patients.
Dedicated to Doctors. Committed to Patients.
#2: Be Aware
“We don’t see things as they are, we see things as we are.”
Anais Nin
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Awareness Gap
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Enhancing self-awareness and reflection
• Keep a reflective journal
• Meditation
• Mentorship
• Group discussion
• Counseling
• Seek effective feedback
http://php.oma.org/Mindfulness.html
Dedicated to Doctors. Committed to Patients.
#3: Communicate Effectively
“The single biggest problem in communication is the illusion that it has taken place.” George Bernard Shaw
Dedicated to Doctors. Committed to Patients.
Two kinds of silence:
• Good: Listening
• Not so good: Withholding important
feedback
Active Listening
• Plan listening
• Eye contact
• Receptive body language
• Take plenty of time
• Be curious
• Resist planning your own script
Dedicated to Doctors. Committed to Patients.
Some principles of constructive feedback • Positive intent, well planned,
• Seek to understand motivation, goals
• Focus on accepted facts and observations, not the person or
interpretations
• Clarify expectations and preferred outcomes
• Clarify consequences / contingencies
• Leave the other feeling intact and OK
• Don’t forget praise!
Civil Conversation Blockers:
• “You…” (finger wagging)
• “You always…” (exaggerated over-statement)
• “You never…” (exaggerated under-statement)
• “Don’t take this personally, but…” (it is personal)
• “With all due respect…” (it is not respectful)
• “If you don’t know, I shouldn’t have to tell you.” (mind reading)
Can we communicate civilly with everyone?
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ABC for tense moments:
• A for Aware
• B for Breathe
• C for Choose Civil Communication
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What to do in the heat of the moment?
• Clear, firm, unhurried speech
• Tone of support
• Monitor emotions
• Avoid profanity
• Never belittle anyone!
• Check with team members to be sure they understand
• Debrief when necessary
Dedicated to Doctors. Committed to Patients.
#4: Take Good Care of Yourself
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Human Function Curve
What happens if we can’t put the load down?
Burnout!
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#5 Be Responsible
“Never doubt that a small group of thoughtful, committed
citizens can change the world. Indeed, it is the only thing
that ever has.”
Margaret Mead
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Bystander
“A person who does not become actively involved when someone else requires help.”
Petruska Clarkson
The Bystander
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• Ask
• Listen
• Encourage
• Follow-up
https://www.ruok.org.au/how-to-ask
Dedicated to Doctors. Committed to Patients.
Culture of Civility
Civility is contagious!
Dedicated to Doctors. Committed to Patients.
Physician Health
Program
1-800-851-6606
php.oma.org
Plenary 4
Dr. Michael KaufmannOMA Physician Health Program
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