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Name: Difficult Conversations: How to Discuss What Matters Most (10th Anniversary Edition)

Author(s): Douglas Stone, Bruce Patton, Sheila Heen

Medium: #books

Published: November 1, 2010 (ebook)

ISBN: 978-1-101-49676-3 (ebook)

GENERAL THOUGHTS

This book was recommended to me by a friend. I appreciate how the authors outline their system (the three conversations) and then elaborate with relevant examples and scenarios. It took some time to work through as I would pause to imagine how their suggestions would have helped me to navigate previous difficult conversations.

This book is relevant to my work as I encounter all types of difficult conversations, whether with my patients, colleagues, or staff. The skills in this book help me to act in the professional manner that I hope to maintain when discussions become heated.


BIG IDEA


Each difficult conversation is really three conversations: 1. The "What Happened?" Conversation. 2. The Feelings Conversation. 3. The Identity Conversation.

QUOTES

We don’t see ourselves as the problem because, in fact, we aren’t. What we are saying does make sense. What’s often hard to see is that what the other person is saying also makes sense.

This approach is a foundational part of how I enter into conversations. Especially if something doesn't make sense to me, I should seek to understand the logic or rationale behind someone else's thinking. That doesn't mean that I agree with their assumptions, but as least I can follow how they arrived to a decision.

Much of the first mistake can be traced to one basic error: we make an attribution about another person’s intentions based on the impact of their actions on us.

This skill of differentiating between intention and impact is ongoing work.

The problem with focusing only on clarifying our intentions is that we end up missing significant pieces of what the other person is trying to say. When they say, “Why were you trying to hurt me?” they are really communicating two separate messages: first, “I know what you intended,” and, second, “I got hurt.” When we are the person accused, we focus only on the first message and ignore the second. Why? Because we feel the need to defend ourselves.

This explanation for intention and impact gives some insight on how to escape the familiar arguments that can happen. We might never be talking about the same thing. Good intentions don't minimize the negative impact, so it doesn't help to go on and on about one's intentions as the primary defense. Acknowledge the hurt, and then let the rest follow.


Contribution asks a related but different set of questions. The first question is “How did we each contribute to bringing about the current situation?” Or put another way: “What did we each do or not do to get ourselves into this mess?” The second question is “Having identified the contribution system, how can we change it? What can we do about it as we go forward?” In short, contribution is useful when our goal is to understand what actually happened so that we can improve how we work together in the future.

This concept of contribution has been a great addition to my thinking. It's a responsible, non-accusatory path towards discussing conflicts and problems without assigning blame in a way that triggers defensiveness.

There are probably as many identities as there are people. But three identity issues seem particularly common, and often underlie what concerns us most during difficult conversations: Am I competent? Am I a good person? Am I worthy of love?

When I receive a strong emotional reaction to something I've said, I try to reflect if what I had said infringes on a person's identity. Great insight.

The question is what to do instead. Below, we lay out two powerful guidelines for starting the conversation off in the right direction: (1) begin the conversation from the “Third Story,” and (2) offer an invitation to explore the issues jointly.

The "Third Story" is what I would call the objective unfolding of events. Equipping myself with non-inflammatory language to create an agreed-upon narrative helps to set the stage for discussions to follow.

Stepping out of your story doesn’t mean giving up your point of view. Your purpose in opening the conversation is to invite the other person into a joint exploration. In the course of that exploration you’ll spend time in each side’s perspective, and then come back to adjust your own views based on what you’ve learned and what you’ve shared.

An earlier insight in the book is how our feelings about a situation can change with new information. It helps remind to hold loosely to my perceptions or interpretations.

“I Wonder If It Would Make Sense . . . ?” The simple advice about making requests is this: Don’t make it a demand. Instead, invite an exploration of whether a raise is fair, whether it makes sense. That’s not being unassertive, that’s being in better touch with reality.

Great wording to introduce ideas as requests.

Usually the reason someone repeats himself or herself in a conversation is because they have no indication that you’ve actually taken in what they’ve said. If you notice that the other person is saying the same thing over and over again, take it as a signal that you need to paraphrase more. Once they feel heard, they are significantly more likely to listen to you. They will no longer be absorbed by their internal voice, and can focus on what you have to say.

I appreciate this insight because it helps me to recognize times when I need to pause and reflect on how well I'm listening. The other person may be repeating because it may appear like their point did not land with me.

Difficult conversations require a certain amount of compromise and mutual accommodation to the other’s needs. If you find problem-solving difficult and anxiety producing, it may be because you are focused on persuading them.

This is a good thought as an act of self-reflection. What are my intentions? Do I need to maintain my position, or am I allowing space for the other person to inform my thinking?

Let’s distinguish between two kinds of power: control and influence. Control is the unilateral ability to make something happen. Influence is the ability to affect someone else’s thinking.

And ultimately in life, what can we control? Influence is relational and contributes to the connectedness we have with one another.

DISCLOSURE: I did not receive any financial compensation for this blog post. I do not participate in affiliate programs. Any links are provided for convenience only.

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Family Medicine Summit is the flagship annual conference for the Alberta College of Family Physician (ACFP). 2020 was the second time I attended this conference, and I appreciate the quality of the keynote presenters. The sessions are highly relevant to family medicine, and the speakers are aware to tailor their talks to help primary care.

This year's conference was especially meaningful to attend as the attendees were highly motivated to discuss to major issues that were unfolding before Alberta physicians: the COVID-19 pandemic and the master agreement with the Alberta government regarding physician compensation.

I've assembled my main takeaways into several blog posts. While most of the sessions were strong, the ones that provided the highest impact on my practice are listed below:



DISCLOSURE: I did not receive any financial compensation for this blog post. Any links are provided for convenience only.

Title: Plagiocephaly and Torticollis

Presenter(s): Dr. Mia Lang

Date: March 8, 2020

PEARL: Postnatal Risk Factors for Abnormal Head Shape

  • Supine position

  • Torticollis, restricted head movement

  • Bottle feeding without repositioning

  • Little “tummy time”

  • Development delay

PEARL: Ddx plagiocephaly

  • Congenital muscular torticollis

  • Unilateral lambdoid synostosis

  • Unilateral coronal synostosis

PEARL: Prevention of positional plagiocephaly

  • Avoidance of favorite side

  • Bilateral stimuli

  • Adequate tummy time: 10-15 min TID

  • "How to make tummy time more enjoyable" handout

DISCLAIMER: This post contains my interpretation of the presentation. This post is not intended as medical advice. If you have medical concerns, contact a health care provider for assessment. If there are any copyright concerns, please contact me directly to remove the relevant material.

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