Communication Matters September 6, 2023
More on reframe
“Our thoughts determine our lives”-
On the whole, most of us speak too quickly and too much. And the more educated we think we are, the more likely we do this. One of the most important communication tips we can have is to speak inwardly first and then reframe those words before we speak them. The more we practice this inward reframing, the more natural this becomes.
It is a crazy shift. You are overwhelmed. You have several hours left. The traffic goes off—it is a “difficulty breather” code red coming to your side in 5 minutes. A nurse comes to you and says “the orthopedic resident is here and we are ready for the procedural sedation now.” Another nurse comes up and says, “the family in room ten is very upset; they can’t believe you are sending their grandmother home!” Meanwhile, a phone call has been trans-ferred to your phone to answer a pharmacy question…” Your first response is a feeling of emotion …panic, fear of not being able to do all of this, anger that the system is not de-signed or not performing in a way that allows you to do your job better. You are at break-point.
After the emotional eruption, come the internal words. “I can’t take care of people safely in this environment.” “Why hasn’t the family said anything until now?” “Where has the ortho-pedic resident been for the last two hours?” “Why the hell am I the one that has to speak to the pharmacist?” “I hate this job.” “I hate this life.” Most of these initial thoughts are protec-tive. And most of them blame other people. When pointing the thoughts and guilt outward is not enough to take the pain away; we point them towards ourselves.
How do we find freedom from this daily trap of overwhelming inward emotions and thoughts? First, we take a long breath and exhale. We must “let go or be dragged” by our fear and anger. We step back with a more detached perspective— “These people are not out to make my work difficult; this happens every day in the ED 24/7 and almost always it works out. EMS is managing the difficulty breather for now” Then we flip it from “not about me” to “glad I’m here.” We internally say, “I have worked in the ED for X years now—there are not many people with the skill set to meet this challenge.”
You use your own value system to motivate you to plot a strategy. I am going to talk to the pharmacist first while I am walking back to the procedural sedation. I am going to be par-ticularly nice to him and thank him for calling to clarify the medication, ending with “have a good day.” I am starting the procedure with ketamine and asking permission to step out when the code red difficulty breathing comes in (everyone nods). I thank everyone for un-derstanding and smile. I ask the tech to notify me when the code red hits the door while I step briefly over to room 10 while they are injecting the ketamine in the procedure room and tell the family in 10 that I really want to hear and talk about their concerns. That her grandmother will not be dismissed until we have a chance to talk with them and explain
that you are needed in another room for an emergency and will be back as quickly as you are able. You hang out in the sedation until the EMS patient is in the room.
In 5 minutes, you have turned a defeating situation into a winning one. And it all began with reframing your thoughts. You made the situation less personal and even less im-portant. You looked upon it as another daily crisis to figure out. And you were even able to say “I have become a professional medical crisis manager and today I was able to do an even more challenging puzzle than I have had in a while. It is days like today, that make me better.” You give yourself the freedom to be uncomfortable without feeling disabled.
Your thoughts are not false simply because they do not reflect your emotions. In fact, you could say that your emotions are not your best self because they do not often reflect your values. You and I must train ourselves to re-shape our thoughts in keeping with how we want to think and speak and act. And in our thoughts, we determine our lives. We also help shape the thoughts of those around us. “I am wounded” can be transformed by practice into “I am here to heal.”