michael kaufmann

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

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#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

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#3: Communicate Effectively

“The single biggest problem in communication is the illusion that it has taken place.” George Bernard Shaw

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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?

Dedicated to Doctors. Committed to Patients.

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

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#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

michael.kaufmann@oma.org

Plenary 4

Dr. Michael KaufmannOMA Physician Health Program