Communication Is Tough, so Make Sure You Have Onions

Christina M. Sorenson, OD


March 26, 2018

Fresh off a new cycle of communication courses, with new outlooks and deeper insights—yup, my patients will be the best informed, and they will understand everything we discuss. I am ready to clearly communicate with anyone and everyone.

So, a few people were staying with me. One is "Mother Earth incarnate"; she cooks everything from scratch with ingredients she grows herself. When she asks if we would like her to make some chicken soup, we all heartily agree.

OK, let's be real here. I don't cook. In fact, the only thing I do in my kitchen is dust. But when Mother Earth asked if I have flour, I opened a few cupboards and actually found flour! Then she requested a rolling pin. A rolling pin? Hmm, I was very certain I didn't have a rolling pin, but a bottle of vodka was similar in size. I offered it up as a rolling pin surrogate. Her frown and rejection were scathing. We substituted rice for homemade noodles and moved on.

"Do you have onions?" Mother Earth asks.

Absolutely not; I do not have onions. Mother Earth is incredulous. "How can you not have onions? Everyone has onions."

"I don't, but the grocery store has onions. I'll go get some," I offer. She mulls this over and states, "No, we can try to make the soup without onions."

"Are you sure?" I ask.

"Yes, I'm sure, but how come you don't have onions?" she replies.

"I don't have onions, sorry," I reply.

"OK, well, let's get started," she states. A few moments later, she says, "This is when I would be chopping up the onions to go in the soup."

I sigh and say, "I'll go get some onions, and it will only take a few minutes."

"No, we can make the soup without onions. But who doesn't have onions in their kitchen?" she laments.

"I'm very sorry, Mother Earth, but I don't cook often, and I don't like onions, so I don't have any onions," I state resolutely. "But," I continue, "I know the way to the grocery store, and I even know where to find the onions in the produce section. I will go get onions."

"No, that's OK, we don't have to have onions for the soup." She trails off and whispers under her breath, "I've never made soup without onions. I hope it will be as flavorful."

Now, I don't know this woman well, and the chances of me seeing her again in the next few years are slim, so I put on my big girl panties and confront her. "Mother Earth, you are being very passive-aggressive with me. I am so sorry I don't have onions, as I have stated. But playing the martyr-cook and muttering under your breath is not a good communication style. You don't want to send such a mixed message. I am certain that your grown children and their wives get confused, and maybe even frustrated, when you ask for something and then state that you don't need it."

Mother Earth turns to look at me and says, "No, they never complain about that because they all have onions!"

Communication is tough.

Even with all of the pitfalls, there are a few universal skills we should remind ourselves to use and to make a natural part of our ongoing communication, especially with our patients.

Initially, we should always observe body language. Effective eye contact, leaning forward, and head nodding all indicate active listening.

Make use of open-ended questions. Most questions that call for a yes or no answer will typically stilt useful conversation. An open-ended question will call on the patient to reflect and report on their concerns.

Speak plainly, on the order of Randall Munroe's book, Thing Explainer: Complicated Stuff in Simple Words.[1] If your conversation cannot be understood by a student in grammar school, you might be considered too highbrow by patients.

Make use of a consistent summary technique at the completion of each patient visit. I use my version of the "Ask Me 3," developed by Institute for Healthcare Improvement/National Patient Safety Foundation.[2] While it was designed for use by patients, I turn it around and provide a summary in the following format:

  1. What is the patient's main problem?

  2. What does the patient need to do?

  3. Why is it important for the patient to do this?

Always directly discuss an adverse event, complication, delay, or challenge in the patient's care. Forthright empathetic communication maintains the patient-doctor relationship.

Avoid bias. Easily said; not easily done. We bring bias to everything; it is intrinsic to our survival. In healthcare, our biases may alter our treatment of a patient and, unfortunately, our outcomes.

Yeah, communication is tough.

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