Communication and Civility: Caring for Oneself, Colleagues and Our Medical Community

1. Plenary 4
Dr. Michael Kaufmann
OMA Physician Health Program

2. 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

3. Men are from
Mars,
Women are from
Venus…
Doctors are from
Krypton

4. Dedicated to Doctors. Committed to Patients.

5. exhausted and burned out ANXIOUS
depressed
D 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
stressedat work workconditions
PHP callers are …

6. 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.

9. 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?

10. What are some definitions of civility?

11. 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.

12. 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.”

13. Dedicated to Doctors. Committed to Patients.
The Young George Washington’s
Rules of Civility & Decent Behaviour
in Company and Conversation

14. Dedicated to Doctors. Committed to Patients.
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

16. Dedicated to Doctors. Committed to Patients.

17. #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

18. Dedicated to Doctors. Committed to Patients.
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

19. Dedicated to Doctors. Committed to Patients.

20. 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

21. Dedicated to Doctors. Committed to Patients.
Awareness Gap

22. Dedicated to Doctors. Committed to Patients.
Enhancing self-awareness and reflection
• Keep a reflective journal
• Meditation
• Mentorship
• Group discussion
• Counseling
• Seek effective feedback
http://php.oma.org/Mindfulness.html

23. 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

25. Dedicated to Doctors. Committed to Patients.
Two kinds of silence:
• Good: Listening
• Not so good: Withholding important
feedback

26. Active Listening
• Plan listening
• Eye contact
• Receptive body language
• Take plenty of time
• Be curious
• Resist planning your own script

27. 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!

28. 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)

29. Can we communicate civilly with everyone?

30. Dedicated to Doctors. Committed to Patients.
ABC for tense moments:
• A for Aware
• B for Breathe
• C for Choose Civil Communication

31. Dedicated to Doctors. Committed to Patients.
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

32. Dedicated to Doctors. Committed to Patients.
#4: Take Good Care of Yourself

33. Dedicated to Doctors. Committed to Patients.
Human Function Curve

34. What happens if we can’t put the load down?
Burnout!

36. Dedicated to Doctors. Committed to Patients.
#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

38. Dedicated to Doctors. Committed to Patients.
Bystander
“A person who does not become
actively involved when someone else
requires help.”
Petruska Clarkson
The Bystander

39. Dedicated to Doctors. Committed to Patients.
• Ask
• Listen
• Encourage
• Follow-up
https://www.ruok.org.au/how-to-ask

40. Dedicated to Doctors. Committed to Patients.
Culture of Civility
Civility is contagious!

41. Dedicated to Doctors. Committed to Patients.
Physician
Health
Program
1-800-851-6606
php.oma.org
michael.kaufmann@oma.org

42. Plenary 4
Dr. Michael Kaufmann
OMA Physician Health Program