Communicating Balance and Providing Feedback
July 2020
This month, we tackled the topic of communicating balance and providing feedback or dissenting ideas. The following captures the recommendations the Think Tank shared via questionnaires and our in-person deep dive discussion in July.
The stakeholder was Dr. David Ring, who describes the following scenario:
"In trying to come up with a set of principles to inform improvements in surgical care through incentives and research, Dr. Ring suggested this principle: Surgical treatments always start in a deficit of potential harms compared to potential benefits. To better understand this, imagine having your gallbladder removed when it was absolutely fine. The downsides of the scars, discomfort, inconvenience, and recovery time are immediately apparent. You need to have a notable benefit to make it worthwhile. This concept was met with resistance. Many colleagues view surgery as something that is by definition helpful, restorative, and problem solving."
From this scenario, we posed two questions to the Think Tank:
- How can surgeons better communicate that surgery has inherent harms that ought to be balanced by a high likelihood of potential benefits without leading patients to believe that surgery is not an option?
- What are some effective strategies for bringing up a perspective that challenges the viewpoint of a colleague in a non-threatening way that fosters dialogue?
Communicating balance by managing expectations
Member of the Think Tank discussed how both patients and providers have varying goals when they're discussing surgical options, and even among surgeons discussing treatments, there can be conflicting goals. They asked, "Are they trying to persuade a patient/colleague? Trying to open up the topic for more discussion? Present both sides of a scenario fairly? All or none of those?" It was suggested that managing expectations can be achieved by clarifying goals and addressing cognitive biases.
Two strategies for this involve convergence of interests and awareness of one's vocabulary. What this means is to start the conversation at a point of agreement. Additionally, one should be aware of the different meanings their words can have. One Think Tank member surfaced the distinction between hurting and harming (e.g. stabbing is harming someone and removing a turmor is hurting but not harming). Being at a place where there is mutual understanding of this distinction allows for open dialogue.
Challenging viewpoints and providing feedback
The Think Tank tackled the second question in this scenario about challenging viewpoints and providing feedback. Some healthcare practitioners at the meeting described how it can be difficult to speak up in their fields when there are viewpoints that are so widely shared and unquestioned. One member suggested, "I have learned that approaching these types of situations with 'a persona of curiosity' can be productive. An example: "I see your point about X. I was also curious about an idea I've heard that X may negatively impact Y. Could you tell me your thoughts on what you've heard about that?"...but the idea is just to present a challenge to someone's idea as a curiosity more than a direct challenge."
Others discussed that acknowledging the others' perspective in your response can let them know you hear and understand what they're saying. Another member said that, if possible, one should, "Use "yes, and" rather than "yes, but" in conversation (recognizing that your colleague conveys truth which you can add on to rather than challenge." Additionally, we discussed ways that the listener (whether they are a colleague or patient) might be more receptive to your feedback or challenging viewpoint. One member said that for example, "persuading a colleague might be more effective with statistics and evidence from research, whereas persuading a patient may require a vivid narrative about another patient they can relate to."