Tag Archives: communication

#AtoZChallenge: Yes, And!

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Some practices take a while to establish, and it’s worth.every.minute.

I first learned about “Yes, and” from my residency classmate, c.2001. She was taking an improv class in her spare time (a revelation in itself for me at the time—you can do that?).  One day after rounds, she came into the workroom eager to share this new learning.  I warily accepted her invitation to try it.  For those of you unfamiliar, the “Yes, and” exercise goes thusly, according to Wikipedia:

“Yes, and…” is a rule-of-thumb response in improvisational comedy that suggests a participant should accept what another participant has stated (“yes”) and then expand on that line of thinking (“and”).[1][2]

“Yes”

The “Yes” portion of the rule encourages the acceptance of the contributions added by others.[3] Participants in an improvisation are encouraged “to agree to the basic situation and set-up.” Thus, “By saying yes, we accept the reality created by our partners and begin the collaborative process.” [1]

“And ”

In addition to accepting the premise offer by others, a participant in an improvisation is expected to add new information into the narrative. Hence the phrase “Yes, And!”[1]

 

The goal is to open our minds, allow possibilities, expand our boundaries, and encourage creativity. I can still see her smile, the gleaming light of engagement and anticipation in her eyes.  I also remember my own hesitation and self-consciousness.  What do you mean, pimple on my forehead?  Is it really about to burst?  I need a mirror!  I was distracted, trepidatious, reserved—less than an engaging partner.  Sadly, I think she left that interaction a bit deflated.  So sorry, Carol!

In August of 2003, I read an interview with Tina Fey.  [Hey, isn’t that AMAZING, that I can Google “tina fey interview 2003 yes and” and it pops right up??]  In it, she recalls, “A couple of times I’ve been called on to do things—jobs or whatever—where I’ve felt, ‘Maybe I’m not quite ready. Maybe it’s a little early for this to happen to me.’ But the rules are so ingrained. ‘Say yes, and you’ll figure it out afterward’ has helped me to be more adventurous. It has definitely helped me be less afraid.” For whatever reason, perhaps primed by Carol’s invitation to try improv, this spoke to me, and I resolved to say Yes more often.  The very next day, I was invited to attend a luncheon at my church at the last minute, when another attendee had cancelled.  Normally I would have said no, thanks, and gone home.  I would not have wanted to overstep usual social boundaries, assume a position higher than my own (the luncheon was to honor benefactors).  AND, as I had nothing else going on that day, I thought of Tina Fey’s advice, and said yes.  I learned about all the people who give their time, talent, and treasure to help our faith community thrive.  I was humbled and grateful to be included.  Years later, I would give the keynote address at that annual event.

In 2005 I started working with my life coach, Christine. The “Yes, and” idea resurfaced again, this time as a practice in mindfulness.  Rather than saying, “I want to be in Colorado, but I am stuck in Chicago,” I redirected to say instead, “I want to be in Colorado, AND I am stuck in Chicago.”  The first was a straight-up complaint—a whine.  Changing the one word made all the difference, propelling me beyond the ‘stuck’ness.  After the ‘and’ statement, I intuitively accepted the current situation as it was, and a logical, sequential question arose: “So, what do I want to do now?”  In the following year, I moved (somewhat) past my resentment, feeling anchored in Chicago for the rest of my professional life, and embraced the opportunities a life here could offer.  The but-to-and modification played an important role in this attitude shift.  I was even able to apply it to my patient interactions, holding space for their stuck-ness and inviting them into new possibilities.

Fast forward to 2009, my first time at the Harvard Coaching Conference.  I had the enormous fortune to attend a presentation by Rosamund Stone Zander and Benjamin Zander, based on their book, The Art of Possibility.  I had my picture taken with Mr. Zander, and soon became of disciple of the book’s teachings, including the practice of substituting ‘and’ for ‘but’ in daily vernacular.  ‘But’ implies limitation and scarcity.  ‘And,’ conversely, opens our minds to movement and possibility.  I would say that by this time, my Yes, And practice was almost second nature.

And, it was February of 2013 when everything truly gelled. I was offered the privilege of leading a group of internists in the Chicago area, in an innovative educational initiative—weekly board review webinars for practicing physicians.  The format was new to all of us, so we took an improv workshop to hone presentation skills and build the team.  My partner, Sean, and I engaged in iterative exercises to demonstrate the power of ‘No,’ ‘Yes, but,’ and finally, ‘Yes, and.’  You can try it yourself.  Get a partner, and whatever you say, your partner says, ‘No.’  Do that a few minutes, then switch to ‘Yes, but,’ then finally, ‘Yes, and.’  The first two responses have essentially the same effect—shutting down the conversation, tempting the initiator to disengage in exasperation.

When we got to ‘Yes, and,’ I could feel my anticipation rising. Where would this go, what positively outlandish ideas could we possibly come up with?  I understood Carol’s excitement at sharing an imminent journey of imagination and creativity.  Between Sean and me, we devised a plan to hitchhike to California through the Badlands and Yellowstone.  We would stop on the Golden Gate bridge after our car broke down and help tourists take pictures.  Then we would steal one of their cars and joy ride down to Jay Leno’s house, or some professional athlete’s house, by way of Candlestick Park, I can’t remember for sure.  We would somehow convince the celebrity to drive with us, in his car, back to Chicago, taking selfies along the way, and make a presentation to our colleagues about the importance of primary care…  Or something like that!  I patted myself on the back; I am a Yes, And pro.

Our webinar series is now well into its second two-year cycle, and the Yes, And approach has guided us well through changes in communication, marketing, staffing, and expansion.

I’m reminded of a strategy that that Dr. Phil McGraw’s team implements when they brainstorm content for his show: “We love every idea for fifteen minutes.” That is the essence of Yes, And!  Take any idea, love it, embrace it, flesh it out, water it, pour Miracle Grow on it, throw it around, bounce it off the walls, crack it open, dissect it, sit on it, taste it!  You never know what will come of it until you let loose your imagination—YES, AND it!

Yes, And can be applied in every conversation, every relationship, every decision. Yes.  And?…

#AtoZChallenge: Withhold Judgment

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My brain is so tired. All month I have racked it trying to figure out what to write next, how to render it most authentically, and finally get it out looking close enough to how I intended.  On top of that, I have also engaged in multiple exchanges on Facebook around gender identity, public restroom use, vaccine rationale, and presidential politics.  It really has been shang nao jin, as we say in Chinese—literally wounding the mind.  I realize these are all activities that I choose, and none of them have significant bearing on the world at large.  And, I would do it all again.  My mental exhaustion is the hurt-so-good kind, like the muscle soreness after a particularly strenuous workout, when I know I have pushed myself to my limit and maybe extended it a little.  The writing and conversations are ways that I engage with my world and practice what I preach—open-mindedness, curiosity, and cultivating connection.

After all of this exploration, conversation, debate, research, and observation, once again I conclude that one of the most important practices for inner peace is to Withhold Judgment. Not all judgment, and not indefinitely, but much and for a while.  Here are some illustrations from the past week:

I shared this post on my Facebook page on Saturday.  I agree with the author’s sentiments, basically that discrimination is wrong and we should open our minds and bathrooms to all people.  I also thought her writing was cogent and forceful.  One of my friends pointed out her name calling, as she labeled supporters of the North Carolina HB2 legislation, and people who boycott Target as a result, as hateful.  He then asserted that the left “can’t argue a point without calling people who disagree with them hateful,” or at least they choose not to. At once I see both sides generalizing in ways that preclude any possibility of meaningful mutual understanding.

After this I became more sensitive to name calling in articles I read. Even ones with relevant data and useful information can be tainted, as I found here, in which the writer calls bigots the same people that the previous author called hateful.  Why must we stereotype and label like this?  Is it just to get published, for attention?  Can we not convey our message just as effectively without all this vitriol?

Finally I read and shared this article, in which the author does not call anyone names directly, but writes a brilliant and searing piece of satire that also inflames and incites.  I suppose that is the point of satire, after all?  It was the comments on this last article that really drove home to me the perilous state of assumptions and judgment that drive many of our interactions these days.  If you support this law, you’re hateful.  If you oppose it, you’re irresponsible.  Perform one act that is, superficially, inconsistent with your professed beliefs, you are forever a hypocrite.  Commit one lapse in judgment and you are instantly unworthy of respect, now or in the future.  Snap judgments can degenerate our encounters to a series of sound bites of rhetoric and aggression.  They seriously inhibit, if not completely destroy, our connections, and they consign us to echo chambers of isolation.

The doctor who rushes me through my 15 minute appointment for a sinus infection, after making me wait 30 minutes already, is uncaring and just wants to make more money. Actually, she just spent the last 45 minutes telling her patient of 10 years that he has metastatic cancer and answering his questions, and she is anxious to get to her son’s school play tonight, his first lead role.

The woman who yells at the receptionist and makes a scene with the nurse is just another angry, entitled patient. Actually, her son was killed by a drunk driver last year, she lost her job and her home, and her mother is dying.

Fellow blogger and talented artist Jodi posted this beautiful piece today, including these words:

Skip the religion and politics,

head straight to the compassion.

everything else is a distraction.

— talib kweli

It really spoke to me, because compassion lives at the core of human connection. If we can remember compassion for one another more often, no matter our circumstances and state of mind otherwise, we can probably also remember to Withhold Judgment and listen for the rest of the other person’s story.  Listening more, yelling less, moving slower to the keyboard, showing up in person, asking more questions for understanding—these are the practices of Withholding Judgment.  Please, let us make the effort; it may save us all.

#AtoZChallenge: VAGINA! No Fear of Words, Please.

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Sexuality can be hard to talk about.  I think this is true for adults far more than for children.  Children are naturally curious and nonjudgmental.  They just want to know, what is that, what’s it for, why are yours different from mine, and why does he have one of those and I don’t?  It’s we adults who squirm and dodge, deflect and bolt.  From a very early age, children learn that it’s not okay to talk about certain things because it makes the grown-ups uncomfortable.  I want to change that.

My kids have known formal names of body parts forever—breast, vagina, penis, femur.  They also know what the parts do, how they ‘go together,’ etc.  Anytime they ask a question, I try to answer as honestly as possible, in an age-appropriate way.  For instance, I have had to clarify that babies do not come out of a woman’s ‘butt.’  First I had to clarify the general use and meaning of ‘butt.’  Then I explained that men have two holes down there, and women have three, and the baby comes out of the middle one, between where pee and poop come out.  Maybe it’s because my husband and I are both doctors and science nerds—we say these words all day long and never think twice.  I think also it’s because I’m a terrible liar, and everybody can tell.  It’s just not worth telling one story now, only to recant and revise later.  Moreover, even if they don’t challenge the fib I’m telling today, their intuition that I’m not being fully forthright undermines my trustworthiness.

There are important parallels here for physicians and patients, too.  In medical school we learned how to take a sexual history.  I think most of us handled it fine, but there was some blushing and gnashing of teeth at times.  Again the key is repetition and getting comfortable with saying the words without embarrassment or judgment.  “Are you sexually active?  With men, women, or both?  How many partners do you have now?  How many in your whole life?  Ever have anal sex?  Receptive, insertive, or both?  Do you use condoms?  Every time?”  It also applies to other aspects of the social history.  “Do you or have you ever used recreational drugs, such as marijuana, cocaine, heroin?  Acid, mushrooms, PCP, MDMA?  Anything else?”  The underlying implication is, ‘tell me anything, I really want to know, and I will only judge the risks to your health, not you as a person.’  Once I get to the end of these lists, patients can see and feel that I am comfortable talking about anything related to sex, drugs, and whatever else, and I make no assumptions.  They are much more likely, then, to tell me honestly about their behaviors and experiences.  I can then make a more accurate assessment of their health risks, and give more relevant advice.  As a bonus, we often establish a deeper connection, because that sense of safety now likely extends to other things they may want to disclose.  This is often when stories about sexual assault and relationship abuse surface.

I want my children and my patients ask me about sex, drugs, cancer, death, Alzheimer’s, depression, anxiety, and all kinds of other things.  All of these topics can render us deaf, dumb, and blind so often, just by virtue of the acute discomfort they induce.  But if we as parents and physicians cannot tolerate them, despite our responsibility in these relationships, how can we expect our children and patients to navigate them successfully?  Yes, there is a plethora of information on the internet.  Much of it is actually accurate and helpful, and I Google as much as anyone.  But when it comes to such personal and emotional topics as these, people need more context and interaction than a screen can provide.  Google does not know your unique situation.  It cannot help you sort through your emotions, your family dynamics, or the implications of your decisions today on your future and the future of your loved ones.  We all need a human connection to do that—a safe, trusting, and loving connection.

When parents and physicians share freely our knowledge and expertise, in words that children and patients can understand and apply to their own experiences, we empower them to make decisions in accordance with their core values and highest goals.  We partner with them in service of their own self-determination.  Our role is supportive, guiding, ancillary.  We help demystify the process.

My goal is to help my children and patients be responsible, autonomous individuals who exercise good judgment for their own health and that of those they love.  Since words are my primary mode of communication, I cannot afford to be afraid to use any of them.

 

Of note:  My family and I recently discovered the book, It’s Perfectly Normal, by Robie H. Harris and Michael Emberley, and I (sing-song voice) loooove it!!  We own the 20th anniversary edition, updated to include information on sexuality for this digital, online, social media age.  This book appeals to me because it totally demystifies the body and sexuality, and does so with objectivity, openness, inclusion, and good humor.  We highly recommend it!