Trouble Yes, and...ing: Part 1
Greetings all! Busy busy busy. I had the Hospital Medicine Mystery Case of the Week this afternoon. That session is an example of me Yes, and…ing the situation at my job. When I was a chief resident for our Internal Medicine residency in New Orleans, I facilitated lots of teaching of common diagnostic principles using challenging cases. I found it a beneficial way to teach and engage with the ideas that make Internal Medicine interesting to me. When I moved back to Omaha, there wasn’t anything exactly like it done at the academic center where I work. So, I started doing it. We have a trophy and a label maker to put your name on it if your group wins the competition. I told one of the first groups to do it that I was going to go find a trophy to be a traveling trophy. A student said she had one we could use. I said that I was looking for a very specific feel to the trophy. She said it was a trophy for 4th place at a dance competition…that she stole. To which I replied that that was exactly the feel I was looking for. We now do it every Wednesday and another physician helps me with it. It started as just something that I did because I enjoyed it, and it was an opportunity to have more fun at work
Today’s discussion is going to be centered around times when it is difficult to practice Yes, and… in the hospital. Saying that we should practice Yes, and… in the hospital is very easy. The times when it is convenient to practice in the hospital are also very easy. The time when it is needed most is in challenging conversations when practicing the principle is also very challenging but has potential to make the biggest difference. I will provide three examples from my day today and some resources for further thoughts. The three general examples from today are 1. when the other person’s reality is a hard reality and 2. when the person has dementia/delirium and their reality changes from visit to visit. 3. when the person is so burnt out that they don’t acknowledge their reality.
The hard reality was a challenge for me today. I kept wanting to say Yes, but… When I did say that, not explicitly but in effect, I could see how unsatisfied my patient was with the response. The broad strokes of the patient are that he had a medical intervention one year ago that made his life much more difficult and now states that he would have never had it done if he had known what was involved. He can do the things he needs to do in spite of the medical procedure but cannot do many things that are important to him. As a result of these problems, he began using methamphetamines again after years of sobriety and was living on friends’ couches. His only option was to discharge to a homeless shelter. This was not an acceptable solution for him. Every time I tried to add to our reality together, after accepting his reality, it ended up in a non-acceptable solution. I also had several Yes, but… statements in our conversation. I understood his reality. I was empathetic to it. I had nothing to add to this reality. This makes Yes, and…ing very challenging.
To be continued tomorrow! 3 weeks are in the books! Blogging! Improv! Healthcare! HEALTHCARE IMPROV BLOGGING!!!!!