"Why Won't You Apologize?  Healing Big Betrayals and Everyday Hurts"

Harriet Lerner, Ph.D.


Page 65:

Quote
The worse the offense and the greater the shame, the more difficult it is for the wrongdoer to empathize with the harmed party and feel remorse.

Pages 69 - 70:

Quote
Reduce your expectations to zero for getting the response you want and deserve.  Speak your truths because you need to speak for your own self - because this is the ground you want to stand on, irrespective of whatever response you receive.

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"Show Your Work!"

Austin Kleon


Page 197:

Quote
When you feel like you've learned whatever there is to learn from what you're doing, it's time to change course and find something new to learn so that you can move forward.

Page 199:

Quote
The thing is, you never really start over.  You don't lose all the work that's come before.  Even if you try to toss it aside, the lessons that you've learned from it will seep into what you do next.

"When Patients and Their Families Feel Like Hostages to Health Care"

Leonard L. Berry, PhD, MBA, Tracey S. Danaher, PhD, Dan Beckham, MBA, Rana L.A. Awdish, MD, Kedar S. Mate, MD

http://www.mayoclinicproceedings.org/article/S0025-6196%2817%2930394-4/fulltext?utm_campaign=wihi&utm_source=hs_email&utm_medium=email&utm_content=58466328&_hsenc=p2ANqtz--mmsw9BlXeEVFBdGwulg3jW_zlP_P8DySlUTG-FxAevuMtWhru-Ho8z9EaMHBdUjvumBeJVkuMyTVhxmwH8b0FEA6zjQ&_hsmi=58466328

Mayo Clinic

DOI: http://dx.doi.org/10.1016/j.mayocp.2017.05.015

QuoteWe refer to this phenomenon as "hostage bargaining syndrome" (HBS) because, in the presence of clinicians, patients and their families may behave like hostages negotiating, from a position of fear and confusion, for their health.

QuoteMost commercial services are "want" services

QuoteMedical care is a "need" service

Quotean adaptive response to authority figures who retain de facto control because of attributes such as expertise, prestige, and position

I know that I'm in kind of a dark mood these days, but I don't want anybody to take this the wrong way ... just thinking about power & communication in general terms ...


"5 Ways to Deal With a Psychopath"
Eric Barker
Oct 18, 2016

http://time.com/4533133/5-ways-to-deal-with-a-psychopath/?xid=time_socialflow_twitter

QuoteA person's value is based on where he or she fits into the organizational hierarchy (sometimes referred to as position power), technical abilities (expert power), access to information (knowledge power), and whether he or she controls staff, money, and other assets (resource power).

QuoteA former pawn might challenge or confront the individual, and perhaps even try to bring the situation to the attention of higher-ups. Unfortunately, by this time the psychopath is well positioned through the influence networks already established with others in the power hierarchy. The tables are turned because the credibility of the complaining employee has already been "managed" and undermined.

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"The Six Pillars of the Wholehearted Life: Parker Palmer's Spectacular Naropa University Commencement Address"
By Maria Popova

https://www.brainpickings.org/2015/08/10/parker-palmer-naropa-university-commencement-address/

QuoteLet your altruism meet your egotism, let your generosity meet your greed, let your joy meet your grief. Everyone has a shadow

QuoteWith shadows that go unexamined and unchecked, they use power heedlessly in ways that harm countless people and undermine public trust in our major institutions.

QuoteCare about being effective, of course, but care even more about being faithful ... to your calling, and to the true needs of those entrusted to your care.

See original op-ed by journal editor for complete version.

Doctors are not scientists by Richard Smith The British Medical Journal

QuoteSome doctors are scientists—just as some politicians are scientists—but most are not. As medical students they were filled full with information on biochemistry, anatomy, physiology, and other sciences, but information does not a scientist make—otherwise, you could become a scientist by watching the Discovery channel. A scientist is somebody who constantly questions, generates falsifiable hypotheses, and collects data from well designed experiments—the kind of people who brush their teeth on only one side of their mouth to see whether brushing your teeth has any benefit. Most doctors follow familiar patterns and rules, often improvising around those rules...

Questioning whether doctors are scientists may seem outrageous, but most doctors know that they are not scientists.

If doctors are not scientists then it seems odd to supply them, as medical journals do, with a steady stream of original scientific studies.

The inevitable consequence is that most readers of medical journals don't read the original articles. They may scan the abstract, but it's the rarest of beasts who reads an article from beginning to end, critically appraising it as he or she goes. Indeed, most doctors are incapable of critically appraising an article. They have never been trained to do so. Instead, they must accept the judgment of the editorial team and its peer reviewers—until one of the rare beasts writes in and points out that a study is scientifically nonsensical.

Our current doc is usually lead author on his novel studies, and he's quite good.  Sicherer, when we were with him previously, was at the time very consistent with his adherence to scientific language. 

Some more to think about ...


"Against Empathy: The Case for Rational Compassion"
by Paul Bloom,  2016


Page 35 (talking about the "feeling what others feel" kind of empathy)

Quote
I'll argue that what really matters for kindness in our everyday interactions is not empathy but capacities such as self-control and intelligence and a more diffuse compassion. Indeed, those who are high in empathy can be too caught up in the suffering of other people.

On page 36, he talks about a different kind of empathy - "cognitive" -

Quote
There is the capacity to understand what's going on in other people's heads, to know what makes them tick, what gives them joy and pain, what they see as humiliating or ennobling.

Then on page 37 & 38:

Quote
I'll end with a classic fictional example of the power of cognitive empathy. This comes from George Orwell's 1984

Quote
Ultimately, O'Brien uses Winston's greatest fear - something he had never told O'Brien, something that he had perhaps never articulated to himself - to destroy him.  This is what cognitive empathy looks like in the wrong hands.

"Clinical genericness"
Dariusz Galasiński
10 Apr 2017
http://dariuszgalasinski.com/2017/04/10/clinical-genericness/

QuoteI had forgotten to take off my ID card on which my name was preceded with....yes, you guessed it, 'Dr'. I have no idea whether he thought I was a fellow physician or just someone who could write a half-decent complaint, but his attitude changed completely. He became very polite, I didn't become impressed.

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"Ignoring the narrative"
Dariusz Galasiński
07 Jan 2017
http://dariuszgalasinski.com/2017/01/07/ignoring-the-narrative/

Quotedirect, honest not caring

QuoteBut, yes, every time I am soooo invited to 'share'. The 'listening face', the body tilt, the concern, every time.

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"Just talk"
Dariusz Galasiński
02 May 2017
http://dariuszgalasinski.com/2017/05/02/just-talk/

QuoteWhenever I'm asked about communication skills, I'm torn. I support efforts to make clinical communication better, more useful for me, the patient. But then the linguist inside me raises his (ugly?) discourse analytic head.

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"The patient strikes back"
Dariusz Galasiński
01 Aug 2017
http://dariuszgalasinski.com/2017/08/01/patient-strikes-back/

QuoteHe was the all-powerful man in the castle, I was a minion not to be even engaged with. I was unable to oppose. I don't know why, but I was just crushed by his power. I wouldn't say I was traumatised by it, but the discomfort with the situation was so strong that I promised myself never to feel it again.

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ok ... that's it ... I usually don't quote so much from one person, but I think that his perspective & thoughts on these issues are well worth the read.

Getting back to medical stuff for a moment, I've been thinking more about this concept of "power" lately ... and how it relates to communication ... maybe my recent sociology reading is affecting me?     ... anyway, here are a few (at least for me) thought-provoking articles/posts:

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"Unlearning Our Helplessness — Coexisting Serious Mental and Medical Illness"

Lisa Rosenbaum, M.D.

N Engl J Med 2016; 375:1690-1694October 27, 2016DOI: 10.1056/NEJMms1610127

http://www.nejm.org/doi/full/10.1056/NEJMms1610127#t=article

QuoteBaggett notes, "The simple act of soaking feet inverts the traditional patient–physician power dynamic and conveys to patients we are there to serve them."5

QuoteBaggett's approach, like those of other clinicians who are devoted to helping these patients, essentially affirms our shared humanity.

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An interesting contrast ...



"What annoys you about doctors?"

Bas Kirmani, Emergency doctor

Updated Dec 26 2016

https://www.quora.com/What-annoys-you-about-doctors

QuoteFor patients, here is the terrifying truth; climbing up the ladder has very little to do with what you need, want, or expect.

QuoteThe stuff your doctor needs to do to be a successful doctor has not only very little to do with you, often you are getting in the way.

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After some of the things that I've been through, many of this man's posts really resonate with me ...



Dariusz Galasiński

"The right not to talk"
22 Oct 2016
http://dariuszgalasinski.com/2016/10/22/the-right-not-to-talk/

QuoteSometimes, I don't want to navigate through the narrative

Quoteyou assume the most important communicative right – right to start (and also probably end) communication. This, in fact, tells me a lot about your power

&


"Speaking constructively"
07 Aug 2017
http://dariuszgalasinski.com/2017/08/07/speaking-constructively/

QuoteThe way I see it is that when I am asked to be 'constructive', I am really asked to be respectful. After all, I am addressing the royalty, I mean, the doctors, the crème de la crème of the society, so, I should address them with a slightly bent knee, gratefully genuflecting as I write.

QuoteFor me in order to be constructive, I need to be acknowledged as a partner.

&


"Difficult patients"
12 Aug 2017
http://dariuszgalasinski.com/2017/08/12/difficult-patients/#more-1422

QuoteAnd still there was something off....So, let's have a look at how the author writes about patients

QuoteI started looking at the differences and it suddenly struck me. Patients are nasty, doctors are overworked.

&

My interest in communication has taken a bit of a dark turn lately so I apologize, but I wanted to add a few things to this thread ...



"How to spot a liar"
Pamela Meyer
https://www.ted.com/talks/pamela_meyer_how_to_spot_a_liar

QuoteIf you don't want to be deceived, you have to know, what is it that you're hungry for?

Quotepost-truth society

Quotewhen anger turns to contempt, you've been dismissed.  It's associated with moral superiority.

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"11 Signs of Gaslighting in a Relationship

Gaslighting is a manipulation tactic used to gain power. And it works too well."

Posted Jan 22, 2017

https://www.psychologytoday.com/blog/here-there-and-everywhere/201701/11-signs-gaslighting-in-relationship

QuoteWhen dealing with a person or entity that gaslights, look at what they are doing rather than what they are saying. What they are saying means nothing; it is just talk. What they are doing is the issue.

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"14 Signs of Psychological and Emotional Manipulation

How to spot a manipulator"

Posted Oct 11, 2015

https://www.psychologytoday.com/blog/communication-success/201510/14-signs-psychological-and-emotional-manipulation

QuoteA manipulative individual may insist on you meeting and interacting in a physical space where he or she can exercise more dominance and control.

QuoteBy deliberately not responding to your reasonable calls, text messages, emails, or other inquiries, the manipulator presumes power by making you wait

"6 medical breakdowns in my mother's care. And 1 close call."
http://www.kevinmd.com/blog/2016/04/6-medical-breakdowns-in-my-mothers-care-and-1-close-call.html

QuoteBeing a medical professional myself, I knew what to say to the hospital staff to ensure my mother would get appropriate treatment. Not all patients do.

Tweeted by @HarvardBiz

"How to Disagree with Someone More Powerful than You"
https://hbr.org/2016/03/how-to-disagree-with-someone-more-powerful-than-you?utm_source=twitter&utm_medium=social&utm_campaign=harvardbiz

QuoteIt's a natural human reaction to shy away from disagreeing with a superior. "Our bodies specialize in survival, so we have a natural bias to avoid situations that might harm us," says Joseph Grenny, the coauthor of Crucial Conversations and the cofounder of VitalSmarts, a corporate training company. "The heart of the anxiety is that there will be negative implications," adds Holly Weeks, the author of Failure to Communicate.

How To Say "This Is Crap" In Different Cultures
https://hbr.org/2014/02/how-to-say-this-is-crap-in-different-cultures/?utm_campaign=Socialflow&utm_source=Socialflow&utm_medium=Tweet

QuoteAll this can be interesting, surprising, and sometimes downright painful, when you are leading a global team: as you Skype with your employees in different cultures, your words will be magnified or minimized significantly based on your listener's cultural context   So you have to work to understand how your own way of giving feedback is viewed in other cultures. 

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Tweeted by @AllergyKidsDoc

QuoteAwesome part of my job - I serve as 2nd/3rd opinion for many families. Poor communication # 1 reason why so many seek additional help.

Tweeted by @ezraklein


"Medicare wants to pay doctors to talk about death. Expect political controversy."
http://www.vox.com/2015/7/8/8915841/medicare-end-of-life

QuotePatients, meanwhile, face a different and very significant loss of autonomy when they don't have these conversations. They don't get to decide what type of death they want, what goals will be important to them, and what type of life-sustaining treatment they'd prefer.

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Tweeted by @lucienengelen

QuoteMay all working in healthcare now or in future incl. industry, read this !! What Broke My Father's Heart mobile.nytimes.com/2010/06/20/mag...

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"What Broke My Father's Heart
A Pacemaker Wrecks a Family's Life"

http://mobile.nytimes.com/2010/06/20/magazine/20pacemaker-t.html?_r=2&referrer=

QuoteDoctors peddle their wares on a piecework basis; communication among them is haphazard; thinking is often short term; nobody makes money when medical interventions are declined; and nobody is in charge except the marketplace.

QuoteMy mother was given more government-mandated consumer information when she bought a new Camry a year later.

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Tweeted by @woodrumlaw

"Knowing How Doctors Die Can Change End-Of-Life Discussions"
http://www.npr.org/sections/health-shots/2015/07/06/413691959/knowing-how-doctors-die-can-change-end-of-life-discussions?utm_campaign=storyshare&utm_source=twitter.com&utm_medium=social

QuoteOne reason for the disconnect, says Dr. Babak Goldman, is that too few doctors are trained to talk about death with patients. "We're trained to prolong life," he says.

QuoteMurray says he hopes his essay will spur more physicians to initiate these difficult discussions with patients and families facing end-of-life choices.

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Tweeted by @BMJPatientEd

"Good Death, Bad Death: Notes for my mum and dad"
http://futurepatientblog.com/2015/07/14/good-death-bad-death-notes-on-my-mum-and-dad/

Quote
So, with communication and choice, pathways, plans and shared decision making, I found myself one evening by his bed.

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Tweeted by @UM_IHPI

Ain't the way to die
http://zdoggmd.com/aint-the-way-to-die/?utm_content=buffer71e1e&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

QuoteStrip away the political posturing and nonsensical talk of death panels and the like, and we're left with a stark truth: that we too often fail to have those difficult but crucial discussions about dying, and this failure leads to untold human suffering and billions in squandered resources. We are failing as caregivers, we are failing as family members, and we are failing as individuals—failing to simply have a conversation that ensures that we direct our own destiny. Plainly put, we need to talk about dying.

"The Lost Art of the Unsent Angry Letter"
http://www.nytimes.com/2014/03/23/opinion/sunday/the-lost-art-of-the-unsent-angry-letter.html?_r=0

QuoteAmong public figures who need to think twice about their choice of words, the unsent angry letter has a venerable tradition. Its purpose is twofold. It serves as a type of emotional catharsis, a way to let it all out without the repercussions of true engagement. And it acts as a strategic catharsis, an exercise in saying what you really think, which Mark Twain (himself a notable non-sender of correspondence) believed provided "unallowable frankness & freedom."

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"Why Communication Is Today's Most Important Skill"
http://www.forbes.com/sites/gregsatell/2015/02/06/why-communication-is-todays-most-important-skill/

QuoteIt has become fashionable to say that our present epoch is an information age, but that's not quite right.  In truth, we live in a communication age and it's time we start taking it seriously.

Tweeted by @JBBC

"Communicating with Pediatric Patients and their Families: the Texas Children's Hospital Guide for Physicians, Nurses and other Healthcare Professionals"

https://mediasrc.bcm.edu/documents/2015/76/palazzi-et-al-tch-guide-to-patient-communication.pdf#page=56


I know that this is to help medical professionals communicate with us, but I was thinking we might be able to learn a thing or two about communicating with them.

"25 Essential Books on Storytelling, Copywriting, and Marketing to Read in 2015"
http://learn.onemonth.com/25-essential-books-on-storytelling-copywriting-and-marketing-to-read-in-2015?utm_content=buffer8a40b&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

QuoteTired designers kept arriving at brilliant solutions, and then faced the challenge of explaining themselves. Communication is the art of getting your ideas heard, shared, understood, and adopted. Designing and communicating are separate, but highly related fields.1

I began to research communication, persuasion, and storytelling.