The One and the Many

How do you change your words or message depending on your audience?

Weeks ago I read an article sharply criticizing public health messaging throughout the pandemic, and took a hard look at my own communication over the past year.  A year ago I wrote a series of posts on COVID, which were generally well received.  I have consistently taken a very conservative approach to mitigation, admonishing people to avoid gatherings and travel, mask up, and be patient.  In my public messaging, I have not directly addressed the mental, emotional, economic, and social costs of all of these measures. 

But what about in my private conversations?  How are they/am I different?

I thought of two groups with whom I interact:  Those whom I know personally, who trust me, and who think similarly to me, and those whom I don’t know, who may not trust me, and who think/believe differently from how I do.  Okay so six groups, not two—and they can overlap—I have patients who trust me and think very differently—but I think my messaging generally takes one of two approaches depending on my audience.  And in the end, I think it comes down to trust.

The One

When speaking to one person whom I know, or someone who agrees with me, two assumptions are at play: 1) they trust me, and 2) I trust that they trust me.  It sounds semantic, but I think it matters.

In this situation, I’m probably much more willing to admit uncertainty, and to ‘negotiate’ my position because I trust that my counterpart understands and respects my concerns.  So I’m willing to show vulnerability in my expertise because I trust that they know I will incorporate new information and update my recommendations.  I also trust them to know that it’s not because I’m stupid or gullible or on some kind of power trip—we’re all just learning and trying to balance everything that matters in a rock vs hard place situation.  When engaging in mutually trusting conversation, even in disagreement, openness, curiosity, and ambivalence can be taken as humility and seeking truth rather than weakness and lack of conviction, and both parties may be more likely to walk away with broader, more nuanced perspectives.  And best of all, the relationship can be strengthened, allowing for continued engagement, learning, and growth.

The Many

Posting to the blog or on Facebook, I think I run a much higher risk of being misunderstood.  I am responsible for providing clear and concise context for any expression or opinion.  My audience is diverse, and depending on any reader’s mood or context themselves, my words may be interpreted very differently one day or one moment to the next—and I have no control over that.  Do they trust me?  Can I trust them to assume my humility and good intentions?  Unclear.

In this space, depending on my mood, perhaps, I may feel defensive, and/or a deep desire to prove myself right.  I may be much less willing to admit to gaps in my knowledge or flaws in my reasoning, for fear that my expertise will be wholly discounted if one aspect of my interpretations or recommendations is imperfect.  If I assume my audience does not trust me, then I’m less likely to trust them to receive my intended message, to take my advice, and achieve my primary goals.  I get preachy, narrowing my perspective and failing to see more than my own point of view.  I ask fewer questions—that is always a red flag.  I make more assumptions, defensiveness increases, and my mind closes further.  It’s an emotional hijack of sorts, resulting in further disconnect and polarization.  Yikes.

Or maybe, just because I don’t know how my message will be perceived, I qualify and hedge, and lob ideas much more passively, inadvertently conveying that I don’t really believe what I’m saying, that I’m actually not trustworthy, just wishy-washy. 

So what should I do?

I think one solution is mindful attunement and differentiation.  As a communicator in relationship of any kind, but especially when I’m the expert, it is my responsibility to manage this dynamic polarity intentionally.  Face to face, I can make sure the other person feels seen and heard, by asking more questions, paraphrasing, reflecting their values and goals back to them.  When writing for an audience I cannot see or hear, I can respectfully acknowledge opposing opinions and their validity, before presenting my own arguments.  Above all, I can hold a larger space for everyone’s values, concerns, and objectives.  I see you.  Please see me.  What do we both care about?  What trade-offs are we willing and not willing to make to achieve our shared goals?

Results from my Think Again quiz, March, 2021

Adam Grant’s new book, Think Again, will be my personal and professional bible for a while, I think.  Its central tenets are intellectual humility and cognitive flexibility.  I may speak and write like a preacher about things that matter deeply to me.  But I will strive to think more like a scientist, seeking truth and connection above winning arguments and/or proving other people wrong.

In the end, as I practice myself, I will observe and apply these principles in other arenas.  Can we keep attunement and differentiation in mind when we hear leaders and politicians speak?  When a constituency is diverse, and an issue complex, can/should we expect a public figure/expression to convey nuance in generalized statements?  I say yes, absolutely.  I think we should hold leaders, as ourselves, to a much higher standard for acknowledging complexity and uncertainty.  Oversimplified sound bites divide and incite, and we should all reject them, strongly.  We can address complexity and uncertainty without inciting mass panic if our statements also clearly convey conviction to core values, and what we are for more than what we are against. 

We can all/each elevate the quality of both private and public discourse if we help one another feel connected throughout.  That means earning trust, and there is no substitute for the work it takes to do this.

No Wonder I’m Burned Out!

Once again, I ask my friends:  How are you? 

I am not great!!  Neck, back and head pain, insomnia, low mood, and the worst case of stress eating in a couple years—GRRRRRRRR!  *deep breath*  …So, like a good primary care doctor (she says with tongue in cheek), I evaluate and treat myself.

I ask patients to rate the stress and meaning of their work and then compare:  Is work overall more stressful than meaningful, or the other way around?  It helps me assess the sustainability of their work life, and gives me insight into their values and priorities.  In recent years when I’ve asked myself, the answer is consistent: moderate stress, HIGH meaning.  Today it’s high stress, less high meaning.  For the first time in a long while, work is not necessarily more meaningful than stressful.  Yikes.

Stress:  It’s COVID. 

Meaning:  I ask patients how they derive personal fulfillment and meaning from work.   I recently asked myself again.  It’s twofold:   Relationships and Efficacy.

Relationships: I am your primary care doctor. Sometimes I’m your therapist, your cheerleader, your drill sergeant, and your accountability buddy. I have always loved this, even on the hardest days. But this year, I am also a resolute public health advocate. Sometimes that rubs you the wrong way, because I tell you things you don’t like. I recommend against flying. Don’t eat at restaurants. Don’t gather with your family for the holidays. Don’t go to church. Stay home for 14 days after an exposure. I interrogate your COVID precaution practices. Then I dissect and judge them (not you), thank you on behalf of humanity, and admonish you to persist, longer and longer, for all our sakes. It kinda puts a damper on our relationship.

Efficacy:  I. Help. People.  It’s my calling!  Hemorrhoids?  No problem.  Back pain?  I’ got this (yer back, that is).  Viral gastro?  Migraine? Core instability, palpitations, paresthesia, GERD, thyroid nodule—even  depression and anxiety—I can make a good plan for all of these things.  I can walk you through it, reassure you, and help you feel better, even when I can’t fix the problem. 

Not so with COVID.  How did you get it, when you were so careful?  If the test is negative there’s still a 20-30% chance you’re infected if the scenario is high risk, but I can’t say for sure.  If you’re sick, how long will it last?  Will it get worse before it gets better?  How much worse?  Will you have lasting symptoms or long term health problems?  How long does immunity from illness or vaccine last?  I cannot lie:  I. Don’t. Know.  I will stay with you through it, but I can’t even satisfy your most basic questions, while you sit alone at home coughing, short of breath, unable to see or touch your loved ones, sipping ginger ale because you throw up anything else.  I can’t help.  And it kills me.

On top of that, I’m not doing any good as a public health champion, either!  Have I changed any of your behaviors?  Have I made even an iota of difference in my community to stop the spread?  All signs say NO.  I’m failing left and right.  No wonder I’m eating so much.

Burnout

Burnout is widely understood to have three key components: 1. Emotional Exhaustion, 2. Cynicism/Depersonalization, and 3. Reduced Personal Efficacy. Studies of physicians generally show that while we often score high on the first two, we do better with the third. I think not anymore. Burnout affected about half of all physicians in all specialties a few years ago, but had improved due to widespread research, awareness, and advocacy for systemic change led by professional societies such as the American College of Physicians and the American Academy of Family Practice. But think about 2020: Whatever emotional exhaustion my emergency medicine and critical care colleagues felt before, caring for the sickest of the sick, likely pales in comparison to the horrors of this pandemic. When their health systems ignored their pleas for PPE and then laid them off, making remaining docs work that much harder, and when they saw people partying and spreading virus all over the place, could you blame them for getting cynical? And though we’ve learned so much and fatality rates are lower now than in March, imagine going to work every day to watch patient after patient suffer and die alone, despite your and your team’s best efforts. We can no longer count on efficacy to save our morale.

Re-ignition

So how do we hold it together? Well DUH, it’s about connection! I had not felt this bad in a long time, but I’m better now, thanks to my peeps. They’re everywhere, and we hold each other up. Texting a meme here, venting (a lot) over there, and generally being present for one another, sharing, even embracing, the deep suck of the morass. Because this too shall pass… Like a kidney stone, as they say.

The only way out is through.  The best way through is together. 

I haven’t thought, said, or written that in a while.  It’s not that I forgot.  I got overwhelmed.  Happens to the best of us. 

Pandemic Lesson #1: Flexibility

NaBloPoMo 2020 – Today’s Lesson

What have you had to be flexible about this year?  What has this taught you?

It’s not that we cannot make plans anymore.  It’s that we must be willing and able to change them, quickly and effectively, if we want to actually get anything done.  Move all primary care and primary/secondary education online?  Done.  Stop flying?  Okay.  Come back to work and school?  Sure.  Wait no, outbreak, go home again, please?  Fine.  Postpone big vacation 3…6 months… indefinitely…  *sigh*…we can deal.

Many of my patients are actually thriving in the new work from home normal.  Without the constant travel, jetlag, business dinners (the quadruple threat to acid reflux:  late, fatty, large, and full of alcohol), and long commutes, they sleep more and better, spend more time with family, exercise more, and eat healthier.  If all goes well, my executive health job may be obsolete in the next decade, hallelujah! 

Not everybody’s doing well, of course.  60% of the workforce still shows up in person; risk, stress, and burnout are very real, and escalating.  The people who are well are those with choice.  They are the privileged ones.

Most of us still don’t know how the new work life balance will look in the coming years, but we hope to retain and expand the flexibility that has given us some sense of agency and control.  Check out this episode of Hidden Brain to hear a Stanford work from home researcher on implications of this augmented world for all of us. 

What flexibility do you wish for in 2021?

Agency and control in the midst of a global pandemic—how ironic!  Pandemic lesson #2 may be Paradox and Polarities… The last 2020 NaBlo…  Wait for it…