Spin Doctors

16 Dec 2015

By Kelley Bullard

The two most powerful words in any language are YES and NO.

When my daughter was two and a half, she earnestly asked one day from her car seat:

“Can I drive when I’m older? Can I drive… when I am four?”

Our eyes met in the rear view mirror. She was completely earnest and I struggled to contain my smile.

“Why of course you can drive when you are older sweetheart,” I replied.

“When I am four?” she asked again.

“We will negotiate when you are four, and you will definitely drive when you are older than two and a half!”

Luckily her teachers at preschool had used the word ‘negotiate’ and she knew it meant that she would get some part of what she wanted. When I looked in the mirror again, I saw her contented smile focused on the tattered ‘black kitty’ who accompanied her through her toddler years.

As a surgical educator and intensivist I see times when the way we communicate is more important than the information being conveyed. I watch residents in the early stages of their careers struggle with this lesson as they talk to families and interact with nurses. I have watched residents with great potential react while exhausted and get labeled as temperamental (or a worse descriptive  term, especially if the resident is a woman). I have seen residents not gain the confidence of patients or their families because they are unable to find their strong, confident voice. The tremendous role “tone and timing” play in this process cannot be overstated. In other words, in communicating, spin counts.

I reflected on the conversation with my daughter and catalogued the techniques I could use in future conversations. What approach in the conversation had worked? Can I apply it to future encounters with my toddler, my partner, the residents I train, my co-workers, patients and families?

First, I mirrored the feeling of my listener. This non-verbal skill requires two things: empathy and the ability to place yourself momentarily in a similar frame of mind. When Daniel Goleman  examined persons in ‘socially intelligent’ conversation, he noticed a cadence occurred. A non-verbal linking was seen where a person’s body language and tone invites the listener.1 This interpersonal rhythm creates a receptive framework within which a conversation can take place. Even if the content of the conversation is not one of complete agreement or good news, a ‘yes-framed’ conversation allows acknowledgement and creates an environment of understanding and learning.

Second, I remained positive. Even though I was conveying “NO, darling, you cannot drive when you are four,” I said it with a positive spin and an upbeat attitude. I focused on ‘YES’, instead of ‘NO’. I focused on the possibilities. By focusing on what is possible we reframe the conversation. It is this positive revision that allows the listener to think outside the box of scarcity. My hierarchical surgical training in a pre-eighty-hour work week residency did not prepare me for this philosophical approach. And, I have to admit, I was very skeptical when I began reading about the improvements in outcomes, and productivity seen with positive-based communication techniques (a.k.a. management skills). Over the past decade, psychologists have replicated that a positive approach yields increased performance, productivity and outcomes. Shawn Achor suggests that it is the happiness this positive approach produces that creates all the other endpoints2.

I am not proposing a simple-minded ‘Pollyanna’ attitude where one walks around ignoring the tragedies of life. As surgeons, we see many fates that are difficult to process emotionally. What I am proposing is that we focus on the real possibilities that exist, even in desperate situations. And yes, this requires an optimistic stance; difficult as this may be at times, it has a logical foundation, as Rosamund and Benjamin Zander explain in The Art of Possibility3:

“… the people who see the glass as “half-empty” are the ones wedded to a fiction, for ‘emptiness’ and ‘lack’ are abstractions of the mind, whereas ‘half-full’ is a measure of physical reality under discussion. The so-called optimist, then, is the only one attending to real things, the only one describing a substance that is actually in the glass.”

This approach not only makes sense, it is one that is successful in achieving the desired outcome. Having tried the alternate experiment of simply saying “no” to a two-year-old, I have found that the positive approach achieves better results.

In other words, the spin we use determines how well we communicate. Regardless of how far we go in our careers, there is wisdom to be gained in every interaction. My two-year-old taught me skills that have served me in my committee work, in program improvement efforts, and in managing the Surgical ICU in a busy urban trauma center. It is an acquired skill that requires practice and attention, and is worth the effort.

  • Goleman, Daniel, Social Intelligence: The New Science of Human Relationships, Random House Publishing Group, New York, 2006
  • Achor, Shawn, The Happiness Advantage: The Seven Principles of Positive Psychology that Fuel Success and Performance at Work, Crown Publishing, New York, 2010
  • Zander, Rosamund and Zander, Benjamin, The Art of Possibility, Penguin Books, New York, 2002

Dr. Bullard is an Associate Clinical Professor of Surgery at the University of California, San Francisco – East Bay Surgery program. She has a robust General Surgery and Acute Care Surgery practice that offers continuous opportunities for surgical education. She is specialty trained in Trauma / Critical Care and is the Director of the Surgical ICU at Highland General Hospital. She acts as a faculty mentor for the East Bay Women in Surgery group which supports women residents as they mature through their years of surgical training.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.


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