Dear Crucial Skills,

I am a physician and I have to admit that, although I am respectful toward my patients, I have great difficulty when I am dealing with fellow physicians and nurses who, in my opinion, don’t seem to know basic skills to care for our patients.

My frustration with their ignorance often manifests itself not necessarily in the words I choose, but more in the way I voice my opinions and in the tone of my voice. I am dealing with people’s lives and am frequently pushed to go too fast. Often I am sleep deprived or emotionally exhausted. These things make it even harder to be as respectful as I would like to be with colleagues.

I totally understand that my lack of respect just makes the situation worse, but I don’t know how to deal with ignorance in people who I think should know better and who often have egos that prevent them from listening very well. Please help.

Dr. M

Dear Dr. M,

Thank you for writing such an open and revealing letter. It’s clear you’ve thought deeply about this concern, and your good intentions shine through. I see three elements to your situation:

1. Crucial Moments: In key situations, you are both emotionally exhausted as well as in the middle of a high-stakes medical issue.
2. Primed Stories: You’ve become especially sensitive to certain problems: caregivers who “should know better” or “have egos that prevent them from listening.”
3. Visible Actions: You show your frustration—not in your word choice, but in the way you voice your opinions and the tone of your voice.

I can imagine I might do the same. And yet, as you note, these lapses just make the situation worse.

You’re already motivated to maintain a respectful relationship and you already control your choice of words. However, you realize your frustrations are seeping through anyway and damaging relationships. What more can you do? Here are four tips you might try.

1. Identify the crucial moments. The more you can do to recognize when you’re in these moments, the more prepared you will be. Take a pen and paper and map out when, where, and with whom you are most likely to experience these crucial moments. Focus on the moments where you are most at risk of being disrespectful to others.

2. Apply the skill “master my stories.” It sounds as if, when you are emotionally exhausted, you are especially apt to use “villain stories“—to interpret others’ actions in a negative way. And when you judge others, the verdict shows on your face.

James Gross, the head of Stanford’s psychophysiology lab, is the leading researcher in a field called “emotional control.” According to Gross, we control our emotions in two very different ways. One way is to suppress them—we rage inside, but keep our faces calm. Gross explains that this approach results in immediate cardiovascular costs as well as a variety of long-term negative impacts. Living your life behind a mask is not good for you. In Crucial Conversations, we call this “going to silence.”

The second way we control our emotions is through reappraising the events that have made us angry and re-evaluating the situation. This second strategy is the “master my stories” approach we teach in Crucial Conversations. Gross says people who use this approach are more successful in controlling their emotions, as well as happier and healthier over the long term.

So, what do you do? Right now, while you’re calm and relaxed, ask yourself the following questions: “Do I really believe the people I get frustrated with ‘should know better’ and ‘have egos that prevent them from listening’? Or are my stories symptoms of the pressure-filled moments and emotional exhaustion?”

If the problems are real, address them using your crucial conversations skills. But don’t wait until the crucial moment, when you are exhausted. Instead, select a time when you can have high-quality dialogue.

If you decide your stories have more to do with the pressure of the situation and your exhaustion, ask yourself how you would like to handle these frustrating moments. Assume the caregivers around you are reasonable, rational, and decent and that they are trying to do the right thing. Then ask yourself, “What can I do to help them help my patient?”

3. Prepare before the situation. It’s always harder to use these skills in the heat of the moment. So establish a rule for yourself and decide now what you will do and say when you find yourself in that situation. For example, if I’m in one of my crucial moments and feel intensely frustrated, I will say, “I know we both want what’s best for the patient. Let’s each share our perspective.” Create a rule, pick the words that will work for you, and write them down.

Establishing these if/then rules in advance is very powerful, especially when the moments you need them involve a lot of stress and competing demands. They work in two ways. First, they highlight the crucial moments, making it more likely you’ll recognize these moments when you’re in them. Second, they help you move from “consciously competent” to “unconsciously competent.” Instead of having to think about and make decisions in the moment, you act on the decisions you’ve made in advance. (Peter Gollwitzer at NYU has published several interesting studies showing how these rules work).

4. Enlist support. Ask your colleagues to help you recognize when you’re starting to go over the edge. An anesthesiologist I respect told his team, “In general, please call me by my first name, Jim. But if you think I’m becoming intimidating or not listening, then call me Dr. Smith. That will be our signal.” I like this cue because it’s subtle and respectful. Making this request is also a powerful way of convincing people that you really want to do what’s right.

I hope these ideas help. Let me know how it goes.

David