Stop Undercutting Yourself

"I can't believe I just said that. Sometimes I am so stupid, I could just kill myself." Those were actual words uttered by a medical student I supervised last year. For years, I had already been thinking about how it might be helpful to share the lessons I've learned about communication in medicine, but that moment truly cemented my plan. Although the student gave a rueful laugh while making these statements, I saw nothing funny about them. They were shocking, really, but we both passed it off as if it were any offhand remark that had nothing to do with the matter of practicing medicine that I was there to teach. On further reflection, I greatly regret letting these comments pass without further examination, and moreover, I believe that how we speak has a profound impact upon the way we practice medicine. Communication is a subject which is more than just briefly touched upon in medical school. A recent review on the subject states:

In the 21st century, teaching and assessment of communication skills in medical schools are well recognized [1]. Effective communication is considered to be one of the most important skills of a physician [2]. According to the Accreditation Council for Graduate Medical Education (ACGME), the American Board of Medical Specialties (ABMS), the Association of American Medical Colleges (AAMC), the General Medical Council (GMC), and the World Federation for Medical Education (WFME) communication and interpersonal skills are among the essential competencies to be taught in medical and residency programs [3–7].

There is an emphasis on the value of communication skills in the medical school curriculum, but the emphasis is on communication with our patients. That focus is warranted, since we serve our patients first and foremost. However, we serve our patients best when we communicate well at every level: with nurses, with supervisors, with colleagues, with consultants. We also serve ourselves best when we optimize communication: a single frustrating conversation can ruin a day at work. Challenges such as these are one contributing factor to burnout amongst physicians. And one thing I've seen over and over again in recent years is communication failures due to projected lack of self esteem and confidence. Although medical professionals are more stereotyped as narcissists and self aggrandizers, many of us suffer from a severe and chronic deficiency in assertiveness. I count myself among those who have suffered this ailment. I am the same person today as I was when I started medical school, aside from a few bruises I picked up of the "hard knocks" variety. However, the way I communicate in a professional setting has changed greatly as I have become more and more aware of the impact of my words and my phrasing upon my success in the workplace. I don't only mean the big things, like insulting one's own intelligence or making references to suicide, which I believe are extreme examples of undercutting, but also communication at the smallest level - the addition or juxtaposition of small words that diminish the impact or effectiveness of what we are trying to say. Through this project I plan to explore how available research and philosophy on communication skills can be interpreted through the lens of medical education, particularly how medical students and professionals speak with peers and supervisors, as I believe this is a neglected area in the current medical education curriculum.