"Wait...What??!!" moments - Part 6


It seems like magic when we observe a good communicator. How did they know to do what they did and choose just the right words? We wish we could be like that. The wish is brief, then we get back to our to-do list. We often judge our own relative amateur status, then move on, never giving ourselves the credit that we could get ever closer to our desired characteristic. We don’t sustain the thought. We don’t nurture the thought. The deliberate practice of reflection is giving our actions and our goals a “good think”.

Ericsson said that to become expert at any skill, one needed to set goals, critically focus on specific weaknesses, and devote undivided attention to improvement. That’s why we spent time tying knots. When we committed to lifelong learning and when we bought into the concept of relationship-centered care, we accepted - at least intuitively - that every interaction has the power to support or erode the elements of our relationships with teams or with patients. When we commit to deliberate practice of communication, we commit to having honest, constructive self-evaluation and open, direct, constructive interactions. With time, those interactions become System I, intuitive, part of who we are.

When we take time to judge the edges of our communication competence, the sources of bias and error in our thinking, the situations that went well and those we’d like to have gone better, we can set ourselves up for success because we learn to see those critical moments before they arise (fatigue, multiple admissions, work with that one colleague…) or recognize them when they arise , skillfully navigating to calm waters. We Think.

Or, in today’s academic coinage, “reflect”. With discipline, we reflect in, on, and for action. Reflection on action is thinking about something that has happened and taking its lessons. Did it go well? If so, why? The assessment prepares one for the next time. Reflection for action is preparing for the next time using the lessons one has learned, for example, the next time one must give tell a patient unwelcome test results, respond to a surprising or intrusive act of another, or the next time one must evaluate an employee’s performance. The practice of reflection on, and for action, will aid us in reflecting in action. Reflection in action is when it counts; that’s what we are setting ourselves up for. What do we observe about the situation, the others involved, and ourselves in the moment. How have people responded in the moment? Has someone’s history, presentation, or actions caused an affective reaction in us? What adjustments should be made as we continue the interaction in order to get the best result from it? Commitment to reflection in, on, and for action in interpersonal communication is the critical part of our education that, in many cases, took a back seat to basic sciences. No offense intended (indeed, thanks!) to our basic science professors!