Archive for the ‘listening’ Category

Therapists Behaving Badly

Wednesday, November 24th, 2010

This one’s gonna be touchy. I’m not all that clear about putting this post up there. It could be nothin’ but net, could be a brick. I’m sure this is going to make some people unhappy on both sides of the couch but, I gotta say something & so, as Wellington said to his mistress when she threatened to make his letters to her public, “Publish and be damned,” though I probably already am. It’s a professional liability.

This is written in part for patients, in part for therapists, and in part to get it off my chest ’cause its been there for a while & it’s startin’ to feel like a 10-ton safe. Here goes and if it bends you out of shape, so be it.

I was in the elevator going up to my office a few weeks, maybe a month and-a-half ago with 3 other people. Two were therapists, one was, I think, a patient. One therapist asked the other about his next patient & the comment came back something along the line of “He’s a real borderline.” The other said something like “yikes,” and then followed with a comment about being told by some mentor that you shouldn’t have more than one on your caseload. The one who made the comment in the first place said something about that being right.  If you’re reading this and you recognize yourselves, I’m not picking on you. I’ve picked you as an example. If you’re offended you can take it up with me. Leave me a comment. Please. If you have an opinion about what I’m saying here, please, leave me a comment.

The whole time this exchange was proceding I was uncomfortable because I wanted to say something to this pair. The other guy in the elevator (remember him, the patient looking guy?) was looking decidedly uncomfortable and unhappy.  I wanted to tell this pair to pipe down, that there’s other people on the elevator. Mind you, they didn’t say anything that might identify the patient (other than that he’s a he.) The behavior broke no privacy or confidentiality rules, HIPAA was certainly not violated. So, what’s my beef?

That’s easy. It makes patients uneasy when they hear this. They already think we talk about them when they’re not present. They have wonderful imaginations and are very sure we talk about them. There’s no need to prove them right. It doesn’t make them happy and gives them a not great opinion of us because, they think, it tells them what we think of them.

We’re not even going to talk about the categorizing of a patient with an unflattering label. We all know what borderline means, and that includes patients. It means difficult, explosive, unmanageable, right? Too bad it didn’t mean that when it was first proposed, but that’s what it’s come to mean. But I digress….

My point here is this: I was fortunate. My first internship was, in part, at the James A. Peters Veterans Medical Center in the Bronx where there were signs on the two side walls of each elevator reminding the staff to not discuss patients in the elevators because staff, patients and patients’ families all share the same elevators. Good signs to post because people forget.

What I’m saying to therapists – pipe down! If you must talk about patients, and I’ll be generous and say that you’re “consulting” with a colleague, do it in your office or your colleagues office and do it with the door closed. Not in the hall. Not in the elevator. Not in the toilet. Let’s show them the respect they deserve.They come to us in pain and we’re not here to add to it by hearing us talk about patients (in the pejorative) in public. We’re not carnies and our patients aren’t Rubes. If you can’t pipe down, and you’re in a public place with me, expect that I’ll ask you to hold it for when you’re alone. I invite any other clinician to do the same when they hear another of us doing this.

By the same token I’m saying to patients that it’s OK to tell the therapists who are having this conversation in front of you that they should zip it. Tell them not to have this discussion in front of the kids. Tell them that you feel disrespected. Tell them that they’re treating you like you’re not there. They may get huffy. Let ’em.

6 Ways to Cure Foot-In-Mouth Disease

Wednesday, August 11th, 2010

Watching Family Feud years ago I saw one of the funniest examples of Foot-In-Mouth that I’ve ever seen in my life. Funny to me, funny to Dickie Dawson who was doubled over with laughter so bad he had to sit down on the stage and try to stop. It was the “lightning round.” He started to ask the mother of the family a question: “In what month…” At the word “month” she blurted out “March!” That got ol’ Dickie going. What was so funny about “March” says you? Because the full question was “In what month of pregnancy does a woman start to show?” It wasn’t the name of a month, it was a number he was looking for. Her answer was so out of whack with the question that he just couldn’t stop himself from laughing. Hard. She, of course, was somewhat mortified but got over it quickly. It’s a game show, after all.

Not so funny when Foot-In_Mouth happened to someone I know. He was having a conversation with a woman. It was going well right up to the end. She said she had to leave to go to work. He said he had the day off. She said “Enjoy your day off.” He said, “You too.” She said, somewhat less that elatedly (to say the least) “Thanks.” He felt flattened. No, he felt like he made a total jerk of himself. She’ll get over it, probably did in about 2 seconds, but it stayed with him all day. What did he do wrong?

How to avoid Foot-In-Mouth Disease:

1. Listen to what the other person is saying.  I know you want to speak. Especially when things are going well and you want to show someone that you’re being attentive to her but wait. Let her speak. Listen to what she’s saying. If you don’t hear what is being said how can you even think of responding?

2. Wait to answer. Yeah, time is of the essence. Take to long to answer & somebody’s going to think you’re a dimwit, right? The “wrong” answer also makes you look like a dimwit. Even dimmer. It can turn a great exchange into a “goodbye.” Is that what you want?

3. Pay attention. It’s not enough to “listen” and wait until the other person’s finished. Those are rules for using the sink in a public washroom. Is that what’s going on? If so, then all I can say is Insert foot  in mouth and chew vigorously. You gotta pay attention to what’s being said & not just wait until the other person’s finished. It’s not about “It’s my turn to talk.” You’re trying to respond.

4. It’s a dialog, not a duologue. What’s a “duologue?” Something someone I knew made up or stole from someone else (just like I stole it from him) to describe two people talking at each other. Two monologues that look like a conversation from the outside. Neither is listening to the other except to hear when to start speaking. Like when one pauses for a moment. This doesn’t make for conversation. It just makes for making noise at each other. You got something important to say? So does your partner in the conversation.

5. Relax! This is the big one. Even if you do make a faux pas you can recover from it unless you just screwed the pooch, in which case you’re dead meat anyway. Most of the time your partner in conversation will accept your acknowledgment that you have just started chewing on your foot, especially if you spit it out immediately. Embarrassing? Sure. Can you laugh at yourself? Important to learn. If your partner in conversation laughs with you as you spit toenails, you’re in. If not, apologize for not hearing correctly. Apology not accepted? How bad was what you said? Probably not so bad as you think, it was just the wrong moment. Give it time. Relax because you can

6. Make a good second impression. Really. Try applying the steps above next time. No next time? Maybe not with that person. How about someone else? You are going to speak with someone sometime, aren’t you?

That’s it. Oh, yeah. One more thing. The cure for Foot-In-Mouth is like the way to get to Carnegie Hall: practice, practice, practice. Learn to listen – listen to learn. Fish & whistle – oh wait: wrong song. OK. Listen, wait, pay attention, etc. Courage! Faint heart never won fair whatever.