CHC Think Tank Guide: Communicating Balance and Providing Feedback
By Billy Table, PhD
Who is the Think Tank?
The Think Tank is a multi-disciplinary health communication collective with experience and subject-matter expertise to consult on real world communication issues in practice. Every month, we select submissions from health professional stakeholders and explore their patient-clinician and inter-professional challenges. Through Think Tank questionnaires and discussion deep dives, our collective of scholars and health professionals offer practical recommendations, share educational materials, and craft messages that stakeholders can implement in practice immediately. Bringing innovative ideas to practice at an accelerated pace, the Think Tank aims to unpack complex conversations and distill effective and structurally competent applications of “what you could say” and “what you could do.”
Communicating Balance and Providing Feedback
This month, we tackled the topic of communicating balance and providing feedback or dissenting ideas. The following post captures the recommendations that the Think Tank shared via questionnaires and our in-person deep dive discussion in July.
The stakeholder was Dr. David Ring, who describes the following scenario:
“In trying to come up with a set of principles to inform improvements in surgical care through incentives and research, Dr. Ring suggested this principle: Surgical treatments always start in a deficit of potential harms compared to potential benefits. To better understand this, imagine having your gallbladder removed when it was absolutely fine. The downsides of the scars, discomfort, inconvenience, and recovery time are immediately apparent. You need to have a notable benefit to make it worthwhile. This concept was met with resistance. Many colleagues view surgery as something that is by definition helpful, restorative, and problem solving.”
From this scenario, we posed the following two questions to the Think Tank:
- How can surgeons better communicate that surgery has inherent harms that out to be balanced by a high likelihood of potential benefits without leading patients to believe that surgery is not an option?
- What are some effective strategies for bringing up a perspective that challenges the viewpoint of a colleague in a non-threatening way that fosters dialogue?
Communicating Balance by Managing Expectations
Members of the Think Tank discussed how both patients and providers have varying goals when they're discussing surgical options, and even among surgeons discussing treatments, there can be conflicting goals. They asked, "Are they trying to persuade a patient/colleague? Trying to open up the topic for more discussion? Present both sides of a scenario fairly? All or none of those? It was suggested that managing expectations can be achieved by clarifying goals and addressing cognitive biases.
Two strategies for this involve convergence of interests and awareness of one's vocabulary. What this means is to start the conversation at a point of agreement. Additionally, one should be aware of the different meanings their words can have. One Think Thank member surfaced the distinction between hurting and harming (e.g.. stabbing is harming someone and removing a tumor is hurting but not harming). Being at a place where there is mutual understanding of this distinction allows for open dialogue.
Challenging Viewpoints and Providing Feedback
The Think Tank tackled the second question in this scenario about challenging viewpoints and providing feedback. Some healthcare practitioners at the meeting described how it can be difficult to speak up in their fields when there are viewpoints that are so widely shared and unquestioned. One member suggested, "I have learned that approaching these types of situations with 'a persona of curiosity' can be productive. An example: "I see your point about X. I was also curious about an idea I've heard that X may negatively impact Y. Could you tell me your thoughts on what you've heard about that?"...But the idea is just to present a challenge to someone's idea as a curiosity more than a direct challenge."
Other's discussed that acknowledging the other's perspective in your response can let them know you hear and understand what they're saying. Another member said that if possible, one should, "Use "yes, and" rather than "yes, but" in conversation (recognizing that your colleague conveys truth which you can add on to rather than challenge)." Additionally, we discussed ways that the listener (whether they are a colleague or patient) might be more receptive to your feedback or challenging viewpoint. One member said that for example, "persuading a colleague might be more effective with statistics and evidence from research, whereas persuading a patient may require a vivid narrative about another patient they can relate to."
- Have you experienced a difficult conversation in healthcare practice that you want the Think Tank to explore? Tell us about it here!
- To join the Think Tank email list and receive invitations to our meetings, email Remington Johnson with "Think Tank Add" in the subject line.