136. “Because I Said So” | The lowest common denominator of communication

In this episode, we share a story of miscommunication between a resident and a nurse, highlighting the importance of humility and inquiry in clinical settings. We examine why leading with curiosity instead of ego can save time, build trust, and improve patient care.

We Discuss:

“Because I Said So”

• Communication mistakes, like saying “because I said so,” can take years to repair and damage trust within a team.
• Lack of knowledge in a stressful environment can lead to defensive responses, making simple inquiries feel like personal challenges.
• Reframing responses to curiosity-driven inquiries can prevent unnecessary conflicts and encourage collaborative decision-making.

Cherubic Buddha vs Grumpy Gravel

• When fresh and relaxed, it’s easier to approach questions with curiosity.
• As responsibilities stack up and task saturation grows, the same questions can feel frustrating or even intrusive.
• Our egos may flare up when our identity as the expert decision-maker is challenged, making it harder to face questions gracefully.
• How we handle questions at different stress levels reflects our emotional bandwidth and readiness to collaborate.
• Recognizing the impact of ego on decision-making can help us maintain clarity and openness, even under pressure.

You May Feel Frustrated, That’s OK

• It’s natural to feel frustrated or irritated when questioned during high-pressure moments, but it’s essential to recognize and manage that response.
• The stress of time pressure or being overloaded can trigger instinctive pushback, even when the inquiry is reasonable.
• Controlling your emotional response to these situations ensures clearer, more productive communication.
• Acknowledging frustration doesn’t mean succumbing to it—it means preparing to respond thoughtfully.
• Leadership involves balancing emotions and maintaining an open mind to avoid knee-jerk reactions that harm teamwork.

Pushing vs Pulling

• Rather than pushing back when questioned, it’s more effective to “pull” by asking for clarification and engaging in dialogue.
• Pushing back on questions can damage professional relationships and discourage further communication.
• Pulling, through inquiry and curiosity, opens up the conversation and allows for shared understanding.
• Cultivating a “pull” mindset helps uncover valuable insights from team members who may see things you missed.
• By pulling, you create a collaborative environment where everyone feels safe to share their thoughts and concerns.

“Tell Me What You’re Thinking”

• Asking “Tell me what you’re thinking” turns potential conflict into collaboration by inviting others to share their reasoning.
• This simple phrase can transform an interaction, fostering a sense of teamwork and respect for the other person’s perspective.
• Seeking the “why” behind questions reveals critical information that could be missed in high-stress situations.
• Understanding the subtext behind inquiries prevents miscommunication and leads to better patient outcomes.
• Encouraging open dialogue ensures team members feel valued and heard.

Reasons a Nurse Might Question a Doctor’s Order

• Why nurses ask questions: you know something they don’t, they know something you don’t, or you both see the situation differently.
• Past experience may be influencing either party’s judgment, highlighting the need for discussion.
• Everyone on the care team is vulnerable to professional risk/liability, so understanding why a nurse is concerned ensures better decisions.
• Providing clarification ensures safer outcomes and a more unified approach.

Why Inquiry Saves Time and Improves Care

• Taking the time to inquire instead of reacting defensively creates long-term time savings and improves patient care.
• Brusque responses can damage relationships, making colleagues less likely to bring critical issues to your attention.
• Fostering a psychologically safe environment encourages team members to communicate openly, improving outcomes.
• Inquiring into others’ perspectives can prevent small misunderstandings from becoming larger issues down the line.
• When communication is open and respectful, the team operates more efficiently and avoids costly errors in care.

The Other Person’s Special Knowledge

• Every team member has special knowledge that others may not, and unearthing this knowledge leads to better decision-making. In this case, that special knowledge is the reason they are asking the question (only they know it)
• By pausing to ask questions, you empower others and create a more informed, collaborative approach to care.
• Recognizing when there’s a difference in perspective and seeking to understand it ensures critical information isn’t missed.