practice advisor for Alaska Shoulder and Orthopedic Institute to the stage as she helps us tackle difficult conversations with empathy and professionalism. Whether working with high-stress professionals like physicians or managing workplace conflicts, Olivia will provide the tools to make these discussions productive and compassionate. Thank you. All right, thank you everybody. Before we jump in, I just want to take a couple of minutes to acknowledge a couple of things. The first being I know that there are communities here locally and within our proximity that are suffering because of the hurricane. So glad that that did not disrupt this. So I just want to take a moment to acknowledge gratitude that we can all be here, that everybody was still able to show up. I am loving the themes and the synchronicity that are coming out of these sessions. I kept hearing and listening to everybody and thinking that's so good and very similar will come out of my presentation as well, but I just wanted to express gratitude. I am an empathizer, so I know and I love that. There will be some story sharing for sure. It is one of the ways that I communicate. A friend of mine, it was interesting, the gal who gave the People Connect conversation, super interesting. She said we all have the same amount of emotions, we just express them differently. That was a little bit new to me. I always identify as a feeler. A good friend of mine always says I'm one of the most comfortable swimming in the deep end of the pool, and that makes sense to me. We all have these pools of emotions and physicians have them too, which I will get to in this presentation. Oh, I think I might be going backwards. Here we go. So what I wanted to cover, so thinking about putting this presentation together and how to approach it, communication is such a broad topic and you can go so many directions with it. You can go very technical, like give me the list of the things I should say, give me the list of the things I can do. A lot of it is, as we know, body language and facial expression. So I like to think that communication is both art and science, and both of those are very fluid and constantly moving and constantly evolving and progressing. So just thinking about how I wanted to approach this, I really came down to what I would call two pillars for today's conversation, and that would be values and awareness. And so we're going to work to develop a values-based framework for communication. I'm going to give you some tips, some practical things that you can do to cultivate what I would call both reflective and reflexive practices. How many people are familiar with those terms? Reflective. We all hear reflective a lot. What about reflexive? Does anybody know what that is? Okay, great. I'll teach you something new there. And then we're going to take those two things into navigating those complex challenges. We're going to talk about talking to your audience, the timing of conversations, and then how to address and mitigate disruptive behaviors, which I know we all see in the workplace. And I swear I'm going to get the direction right. Okay, so what I want to do here is instead of introduce myself based on what I do or what my accomplishments are, where I'm from, I want to introduce myself based on what I believe. And this is a word cloud of just some of the things that I believe. I believe in vulnerability, in boldness, compassion, sacrifice, intellectual humility. But if I had to really boil all of that down into one thing that I believe about leadership and my leadership style in particular is that it is not about me, but it starts with me. Everything has to start with me. And so that is the framework that I'm really going to, I want you to think about as we move through all of these slides. All of the leaders that I look up to and admire and the leader that I want to be, if I had to put it into a picture, would be this. They're very, very strongly rooted in their values. They know what they believe. They know who they are. It is a very, very strong foundation. They also have this middle ground here, what I would call the trunk of the tree, which is the actions and the practices to take those values and actually grow them into something. Those growth points, the things that move them into what I would call the outcomes. We talk a lot about outcomes in health care and I think a lot of times we also get stuck there. Outcomes this, outcomes that. What was the outcome for the patient? What was the outcome, outcome, outcome? And we forget sometimes to do what I would call a root cause analysis and figure out, okay, what are the practices and the values that are driving those outcomes? Because if we don't like the outcomes, we can snip off the branches, we can snip off the leaves, but it doesn't do anything to actually change the ongoing growth. And I know for me, and I'd be curious to know just by a brief showing of hands, what COVID showed about our collective and individual values? Because a lot of those, for me at least, a lot of those values were very dormant. And then crisis happens and I forget if it was C.S. Lewis or somebody else, maybe Oswald Chambers, who said crisis doesn't show care, or doesn't build character, it shows it. And so just taking, you know, the last few years to really reflect on, okay, what are our collective and individual values? Because the outcomes were not desirable for a lot of people. And so really going back to that root value system. I want to talk first about reflective practices. Reflective practices are inward facing. It is looking under the hood of your own car, your own things in your life, and actually really tinkering with them and playing with them and finding and getting familiar with them. Some of these are done in solitude. The awareness and the self-discovery piece in maybe more spiritual practices, some people call those devotions, meditation, those things where you're alone and you're just with yourself and you're really, like I said, looking under the hood of your car and analyzing the things that you believe, or why did I react a certain way to a situation, or why is this thing that shouldn't bother me, why does it bother me? Coaching is great. I highly, highly recommend coaching. Coaching is, I do it together with therapy. Therapy is very backwards looking, like what happened to inform this? Coaching is very forward-facing, forward directing, what am I going to do about it? How am I going to act differently? And so all of these are done, what I would say, in community and they're just as important as the ones that happen kind of in solitude. Your network, both personal and professional, is very, very important. I have developed over the last couple of years what I would call a personal board of directors. I have five to seven people that I call if I need something or I know that I need to hear something hard, I don't know what it is and I don't need the yes-man who's going to tell me what I want to hear. I need that person who's going to tell me what I need to hear and those are the people that I go to. Jana is one of them and round of applause for Jana because I put on, yes, for being on my board of directors and then also because I put on lotion without asking and she's sensitive, so we've had a difficult challenge sitting next to each other. But just taking these moments to do the reflective practices and looking, like I said, under the hood of your car and figuring out why. And I'm going to share a real quick story about how this can work. I had interviewed for a new position at a completely different company, I think it was 2021 maybe, and I'd worked for that company before. It's kind of where I grew up, professionally speaking. It was one of my first professional jobs and I made it through the interview and the interview went great and I got the offer and I didn't feel great about the offer. And I, whenever I feel it, and I don't know how many of you are familiar enough with your own body and listening to your own body to know when something just doesn't sit right, but it just didn't sit right. And so I just got alone, got quiet and asked, okay, this is this is the perfect job. I know these physicians, I know some of the people on the team, I can do the job, capacity is not my problem, why doesn't this feel good? I thought this would feel better. And so I just started thinking back about the interview and one of the physicians in the interview had asked, you know, do you see yourself in Alaska for the next five years? And I answered yes. But when I replayed that conversation in my head, I felt like I'd lied about it. I don't like lying, it feels ick. So I'm like, great, why do I feel like I lied about a question that I know I answered honestly? And so I just started asking that question a little bit differently. Do you think, so yes, unless, you know, parents dying, something that would take us out of state, I really didn't feel like we were gonna leave Alaska in five years, that's fine. I just started asking other questions about in that five-year framework and when I came to the question, do I see myself in practice administration in five years, the answer to myself was immediately no. And so I knew in that moment I had to turn it down. And I went back to them and said, look, I'm, thank you for the spend of your time in interviewing me, thank you for allowing me the time to reflect on whether I should take the job, but I really can't. Well, interesting the slide that you had at the end. I could, but I just don't want to, right? The PB says that. I didn't want to. I was tired of small practice administration. I wanted something different. I knew I could. I can do it. I didn't want to. And I knew enough about myself and about relationships to know that if I took that job knowing I didn't want it, we would both end up resenting it at some point. But that's just an example of having that self-awareness to listen to your body, listen to your emotions, and step away and take that time to actually reflect and get some of those answers for yourself. And then once I came to that, you know, I did run it kind of by my professional and personal network and make sure that I think this seems right. I know it's good on paper. It's perfect on paper, actually. Everybody was in agreement. So that's, that is a reflective practice. A reflexive practice is then outward-facing. You've tinkered with the car, you've adjusted some things, now how are you showing up in the world? How is the car that is you, how is that driving? Is it handling corners better than it did before? Am I able to sit in conversation with people and respond more empathetically? Or am I listening to understand instead of listening to respond? And are those adjustments actually showing up in real life? This is very important to leadership because, as has also been said by a couple of people, leadership is not about force, it is about influence. And you will, if you are being watched, you are in leadership. Doesn't mean you have to have a title, doesn't mean you have to have the pay, doesn't mean all of those things. If someone, a child, a relative, someone at work is watching you, there is a leadership component there. And depending on, because of how we worship hierarchy around here, which is a totally different conversation, the higher you are in the hierarchy, the more people pay attention to what you do. But the point is, people do pay attention to what we do. And so it's important to understand, okay, I've made these tweaks with myself. How is that impacting the people around me? How am I showing up in the world? How are they responding to me? I will make a caveat with that, however. The entirety of the other person's response to you is not you, as has also been said. It is important to understand, you know, I've worked with, well, let's go with surgeons. When they say something hurtful, it's normal to be hurt, right? So sometimes it is worth saying, okay, is the way that I'm showing up negatively impacting somebody and is there anything in that I can control? But also being very aware that a lot of that is up to the other party. People say about women a lot, well, you're really intimidating. The question I like to ask, is that true or are you intimidated? Because that's different. So just understanding there is that symbiotic relationship. It is not completely me, it is not completely the other person, but I am wholly responsible for me. And so the part that I'm responsible for is the part that I have to take complete ownership of and make those changes. So bringing values and humanity to the communication game. I love to ask people all the time to rethink nothing is personal, it's just business. Someone that mentored me said that a lot. Researched a little bit. Does anybody know who actually came up with that term? Oh, I forget his name, but he was the accountant. It was a man and he was the accountant for the mob in Chicago. Probably not a set of values that we want to bring into business. And so I love living in the and. I hate either or. I hate binary thinking. I like to live in the and. And so it is both personal and it is in business. And the other soapbox that I like to get on is healthcare is not an industry. It is a humanities profession. We need to start referring to it as that. We are in the business of people and the people doing the work are people. This is not an assembly line. It's not industry. It's not industrial. We are not creating things from matter and resources. We are dealing with human beings. And so living in that space where it is both personal and business. So emotional expression. And I have a story that I'll share around this a little bit later, but emotional expression is acceptable and in the professional environment so is emotional regulation. Learning to self-regulate happens a lot in those reflective practices. How do I regulate myself? How do you engage with other people to help regulate them? We all have emotions and there's nothing wrong with them. It's just really how they're handled. Empathy is important and objectivity is important. We have to have both. And then it's important to connect and it's important to have boundaries and make sure that those connections are healthy. One of my values, as I said, is intellectual humility. It's been said here a couple times too, which I already love because it's a great platform to expand on that, is that the recognition and acceptance of the limits of my own knowledge and your own knowledge. And that shows up as being willing to be open to new ideas. We don't know everything. We know a lot and we know even when we're right, something about the other person and their situation could make that fit wrong. For example, we are meant to breathe, right? We breathe every day. We do it so often we don't even think about it. So we should breathe. Well, if you're underwater, you should not breathe, right? So there are times when what you know to be true or have done by personal experience may not fit in someone else's situation. And if someone else is underwater, take a pause and think about whether or not that instruction to breathe is actually appropriate and actually helpful. It's a willingness to revise one beliefs in light of new evidence. That's sometimes very difficult and evidence is sometimes manipulatable. So, you know, taking that time to step back and reflect and think about it before arriving at a conclusion is one of the hallmarks of intellectual humility. And readiness to engage in respectful dialogue, and I'll get to that a little bit later as well, but it's also curiosity to just learn from others. We have our own experiences and those are the entirety of our experiences and every person in this room has a completely different life experience and things, whether it was the way you were raised or the professional experiences that you have, that can bring a lot of diversity and light and a lot of flavor to our lives if we allow ourselves to engage in those curiosities. This one, I had a rad tech send me this. Multiple views and why it matters. We all know in orthopedics, I was in an upper extremity practice and, you know, my hand doc always wanted these multiple views of hands and the context for this photo was when Prince William came out of the hospital after the birth of his and Catherine's third child. And so he was telling the press that it was his third child, even though they knew, but from the one view it looked like he was flipping them off, which may also be entirely appropriate, but the point is it's good to get out of kind of our static solidified spaces and start to go around that circle and look at things from around and above and beneath. My mother always used to say, don't believe anything you hear and only half of what you see. And this is a really great representation of that is you, these two viewpoints alone, and there are more than two viewpoints, tell a completely different story and it's important to get those stories from those people, even sometimes from the same person. I mean, you can observe something about a singular person from one view and it can be completely different if you come at it from another approach. This is one of my favorites, Bernice King. I believe she's Martin Luther King Jr.'s either daughter or granddaughter. I posted this on Twitter a while back and I've printed it out and hung it in my office. It's a reminder that we can challenge each other without diminishing each other. And I know for myself and a lot of people, especially when we tend to think in terms of black and white or only one way or the other, that there is either challenge or there is insult and there's nowhere in between. And so either we have all insulting or we have some of these spaces where we're too afraid to have the conversation. We don't know how to challenge people in an appropriate and healthy way. And so things just go by the wayside. Cultures can become very passive-aggressive. And so really living in that creative tension of being able to challenge each other without diminishing each other and all these all will come together as a couple of stories, I promise. One of my other soapboxes, well, I already mentioned it already. I would love to see humanity brought back to the profession of medicine. I don't know that it's been done intentionally, but there's a lot of ways that the system of healthcare is constructed that can be really dehumanizing. And we know that when we talk about it from the patient perspective, right? We don't talk about it a lot when it comes to what the experience of being in healthcare is for the physician or for the PA, but we know about burnout rates. That's also another conversation. So really just bringing humanity back into our professions. And so I did, being the curious person that I am, I did a whole lot of research and put dehumanization on a spectrum. When we think about dehumanization, we tend to think to go to the very far extremes, things like the Holocaust and genocide and all these things that end up in, like I said, the outcome. But the outcome doesn't matter. You have to trace it all the way back to the roots of where it starts. And so if you put dehumanization on a spectrum, this is what it looks like, and every single one of these I have seen in my profession as an orthopedic healthcare administrator, automatic assumptions about individuals is the lowest. Implicit bias is the lowest on that spectrum. If I said surgeons are and asked you to fill in the blank, what would that fill in the blank be? Right? But it can influence our perception, reducing us to stereotypes rather than really complex human beings, and so being, again, reflective and aware of what our values are and making sure that our values are actually showing up in the way that we lead and the way that we speak to people is really important. I also keep this in front of me and just study it, because nobody is completely immune from this. We all have implicit biases about other people. Objectification regarding a person as a commodity. You get a physician in a really vulnerable space and ask them whether they feel like a human being or a commodity that they're just there to produce. They feel like they're there to produce, and guess who's asking them to produce? So how do we talk about business in a humanizing way? Because business matters. You can't run like no money, no mission, right? You have to have resources to run a business. How can we humanize it? I'm not going to go through all those in the interest of time, but just something to be thinking about, that we are all these complex human beings, and so we all struggle this, and we all flex between these at any given time. I don't think any of us want to. That's the thing. I don't think anybody wants to dehumanize another person, but this is how it can show up. And so just remembering that, especially in high conflict. It is really easy to get into the name calling or the assumptions or some of those things. I know, you know, one of my physicians, I correct him all the time, talks about nurses eating their young. And he's even said, like, DOs are just MDs who couldn't get into MD school. So any of, yeah, right? See, we hate it. We hate it, but it happens all the time. And recognizing when we do it, and then having the courage to stand up and say, okay, that's, like, that's not okay. We need to not have that kind of language here. Because someone asked earlier, what was culture, right? There's a thousand ways to define culture. One of the ways that I would define it is the worst or best behavior that you allow in an organization. And so how do we correct those? We have them through the hard conversations. Root cause analysis. I love this quote, and I have to lean in because it's so pretty, I can't read it. Beneath every behavior is a feeling, and beneath every feeling is a need. And when we meet that need, rather than focusing on behavior, we can begin to deal with the cause and not the symptom. And that, back to, I'll just go into this, back to this, putting it all together. Yes, our values and our beliefs drive our outcomes. So do our needs, though. And very often, the need that goes unmet will show up in some of the most disruptive behaviors that you will see. Pause here for a little bit of story sharing. I had come out of a pretty difficult, both personal and professional relationship. And I was in a relationship with a young man in a non-professional relationship. Abusive is the word that I would use to describe that. And doing all the work around that, getting out of it, leaving it, going through therapy, learning a lot about myself. And then I got into orthopedics. And, you know, going about my job. Uh-oh, the battery's running low. Somebody have a, and I remember looking at physicians and for the first time thinking, is he an asshole or is he traumatized? Because a lot of the behaviors that he was exhibiting were a lot of the behaviors I was exhibiting when I was exiting this relationship. And that started a whole other yarn ball of kind of pulling at the curiosity of what that means. But there is substantial evidence for the fact that physicians are under a lot of stress. Med school is traumatizing. It takes a lot from a human being to cut into another human being. This is the work they're doing every day. And then we question them why their productivity is low without ever asking what we're taking from them or what it takes from those human beings to do that work. And so, of course, these disruptive behaviors are going to come out. It's not attributable to every single behavior. There are some low character people. You can find them everywhere, right? But by and large, when you believe the best and you think about a person as a human being, a lot of those disruptive behaviors, if you stop and ask the questions, actually come from very deep, unmet needs or very faulty beliefs about who they are, about what they're supposed to do, what we expect from them, as their administrators, people in society, that they can do no wrong. We like, you know, I think Chicago Med, who watches Chicago Med, early, one of the early seasons, two of the characters were physicians were talking and one of them said, what's the difference between God and a doctor? And the answer is that God knows he's not a doctor. And we laugh, and it's true, and at the same time, when you look at the research, we, as a society, believe that doctors are God-like. So, when you go back to that dehumanization spectrum, the question that I've started asking is, believing someone is God as dehumanizing as believing they're trash? And the answer is yes, actually. Because if you can't fully engage as a human being, if you can't feel what you need to feel, you push all that down, the outcome is not good. And so, never, ever are those disruptive behaviors okay, but I would challenge everybody to pause and rethink how you come at those and handle those disruptive behaviors. So, oh, there we go, I'll give you a few lessons from real life. So, now I'm going to move into story sharing. So, balancing compassion and professionalism. I had hired a new grad right out of fellowship. He came in, as most of them do, thinking that I'm done learning. I'm just going to do my job now. I don't need to learn anything. And so, he didn't read all of our internal policies and procedures and some of the things that our founding physician had found really to be helpful in overall process. And I came in 8 a.m., good day, feeling good, doing my rounds, walk into his office, good morning, and he just lit into me. I'm going to count the number of swear words, threatening to quit his job. This is unacceptable and it was on me to fix it, and this happened in front of my nurse supervisor and my lead M.A. And I had been swimming in these waters long enough to know that even though it wasn't fun to get screamed at and it was definitely inappropriate, there was more going on here than met the eye. And what had happened was he, I don't know, a few weeks before that, he had seen a child who had a fracture and was bringing the kid back in for a follow-up. And he wanted x-rays for that follow-up. And the rad tech took off the cast and the fracture fell out. So, have to reset it in clinic, recast it, all of the stuff, right? So, he's immediately screaming about firing the rad tech and I have to fix it and all this stuff. And he's just going on and on and on. And so, I just asked the other two to leave and said, look, I need you to just take a breath. I need you to take a beat. I will find out what happened. Figure out a way to reground yourself and just go about your day. We'll come back at the end of the day. And so, I took all day long. And what happened was a mixture of things when I took that time. And really, and this is what I ended up telling him is, OK, you have a license and are at the top of the food chain here. So, you are a leader whether you think so or not. We all depend on your notes. It was our internal policy and procedure that for especially children in casts with fractures that the physician was supposed to document x-rays in or out of cast at the end of their note. It was up to the rad tech to read the note and then do appropriately. And if it wasn't in the note, the rad tech should have checked. So, two things didn't happen. He didn't give any instruction in his follow-up. He just said x-rays at next visit. First mistake. And really, where the responsibility lies, he's the leader, he should have said. However, the rad tech also knew that if there was no clarifying comments in the note that he should ask about in or out of cast, that he should have asked and he didn't ask. And so, it was multifactorial, multiple responsibilities, including the physician. And so, we had all those conversations and just broke it down through the process. At the end of the day, I came back to him and said, look, I like first of all, are you in a good place to have a conversation? Because that matters too. Timing matters, right? You can't just unload on somebody if they're not ready. And he said he was ready and so we went on with the conversation. And so, I just told him everything that I'd found in the process and reminded him that at the end of the day, you are the one that will be on that stand in a courtroom. You are the one with the highest license. This is on you. So, you need to remember that. If you're not familiar with our policies and procedures, that's also on you. You need to do that. I said second of all, but like all of that aside, human to human, what is going on? Because I will never, ever take away your right to feel however you need to feel. I will question your right to behave however you want based on how you feel. And it was a very long and laborious conversation, but at the end of the day, he was feeling, he was in a shame spiral. He was so ashamed of appearing incompetent in front of the children's parents. And as soon as shame got a hold of him, and who knows what a shame spiral feels like, right? You can't think. It screams, you know, and I've struggled with it. I used to tell my husband like this little voice that I'm not good enough, which is rooted in shame is always there. And sometimes it whispers and sometimes it screams, but it never shuts up. When it's screaming, what's the only response to that? Scream louder. And so guess who got it? I got screamed at. But human to human, I know what shame feels like. I know what it's like. I mean, and for men, I mean, incompetence for men, that's a whole other session we could do, right? And so I just asked him, go, what mechanisms do you have in place to pause and reorient yourself, go reflect, go decompress, and then look at it more objectively. Ask what you could have done wrong instead of coming in and screaming at me, because I guarantee you that will never happen again. This is like absolutely inappropriate. So I say all that to say the disruptive behaviors are never okay, and they're almost never what they appear to be on their face. And so it just takes that time to step back, let people cool off, find out the facts from the multiple perspectives, from the multi-stepped process, and then come back later for what can hopefully be a really constructive conversation. And I left that job shortly after that, and unfortunately from people I know that still work there, I don't know that he's done that. But it's also a lot of hard work. I mean, anybody who's done internal work around shame, that is messy deep water to get into, and they're already indoctrinated through their experience in med school that they can't make any mistakes. And so how do you go up against the systemic lie? It's just, it's really, really hard work, and not everybody does it. But in, I use that story as an example of the ways that being grounded in all of our values can really be embodied in those conversations, and then having the conversation, like having the courage to speak up and have that conversation. It's not, you know, I was raised, again, to believe that doctors can do no wrong, and you never tell them no, and you never confront them, right? And there used to be in the OR where what they say goes, you don't get to challenge them, and so just developing that courage to challenge them when necessary. Second story, so know your audience, meet people where they're at. The guardrail here, again, is your values, and this is a little bit different story. Again, brand new physician, right out of training, doing good work, it was all fine. He found something in the contract that he didn't like, and so we'd been having conversations for quite some time. He wanted to change it. I didn't feel it was appropriate, and neither did the founding partner. The attorney agreed, so, you know, he was in the wrong. But I'm trying to have a diplomatic conversation with him about it, and it just, it wasn't happening. He was slouching in his chair. He was dinking around on his phone. He was playing on his computer, and three days over a week, I tried again and again to have this conversation. He just would not engage, and so I moved into kind of, so there's, when we talk about reflective practices, there's the active reflective practice, which is to actually sit and analyze and kind of dig around inside, and then I have what I would call more passive, which is just like put it in the back of your brain, right? You know something's wrong. The universe is going to figure it out. We'll just put it back there and kind of wait, and so I did that. I was just like, it's not life-threatening. He's still getting paid. Like, it can wait, and I think it was the next week, I was watching a movie. Who's familiar with Chronicles of Narnia? Have you seen the movies that they made about him in the last 10 years or so? Well, so there's, in the second movie, there's a scene where, you know, the children have left Narnia, and then they go back years later, and time is different between us and Narnia, and so they're back as children again, and Lucy, one of the kids, is on the beach, and there's this bear coming towards her, and if you know anything about Narnia, all the animals talk, right? They're friendly. They're people, pretty much, and so she sees this bear come out of the woods, and her mental model was animals in Narnia are friendly. They know me. I used to live in rain here, and so she starts walking towards this bear, and this bear charges her, and another member of their party ended up having to kill the bear so that Lucy didn't die, and, you know, she's heartbroken because she's used to animals who can talk, who are your friends, and she asks, you know, she was paradigm-shifting for her, and the dwarf who killed the bear said, if you treat an animal like an animal long enough, it'll start to behave like it, and it clicked, and I thought, I don't know if he knows how to have a healthy conversation, and so I laid my values aside, and I conducted a social experiment, and I walked back into his office, and I was not nice. I did not sit across from him. I stood up. I made sure I had the bigger position. I called him names. I demeaned him. He sat right up, straight spine, eye contact. We got it figured out in like a half an hour, and then I just left it, and I came back about three days later, and I said, you know that conversation that we were trying to have about your contract, and he's like, yeah, yeah. I said, remember the three times before when it didn't really work, and he's like, well, yeah, and I said, do you remember the fourth time when it worked, and he's like, yeah, and I was like, do you know the difference there? He's like, no. I said, I had to be a bitch. To even get you to engage, and I don't know why. Why is up to you and your God or whoever and your therapist, but I will tell you, I will not behave like that. That is beneath my values, and you deserve better than that. It won't happen again, but it worked, and if we're going to continue working together, we need to figure out why it worked, because this is not okay. I'm not going to lower myself to this again, and he did. He came back another three days later, so this conversation, this probably got a whole month, really, once he put all the stages of it together, and he came back and very vulnerably told me, you spoke to me like an attending. Which further confirmed my theory that they're abused in medical school, conversation, but he had adapted to that. He had maladapted to being verbally abused in order to have a conversation. It was all he knew, and it took, you know, he didn't change right away, but what, all of that and his vulnerability to tell me, yeah, that's how I'm used to being treated, gave us a new starting point. So, when he did start to disengage or sometimes started to be the attending, because that's the other thing, you know, they get treated this way, and then they graduate and think, oh, it's my turn, and then they just, it's cyclical. Abuse is cyclical, and so, but all of that to say, because we were both able to have that hard conversation and, you know, admit, this is where I get this really bad behavior, it gave us a new starting point to say, no, no, no, no, this is not happening, walk away, go do what you need to do, and we'll have this conversation when you're in a better place, but this pattern cannot continue. And so, those are my two biggest stories about how the embodiment of values can show up in communication and even the challenging conversations, and so, to wrap it back up with this, really the challenge is, yes, the outcomes matter, but they matter less than the values and the practices from which they're coming. And behavior modification only goes so far, you can only trim so many leaves and so many branches so far, you can even tack fake stuff on it to make it look like it's good, but if you're not working and living in these spaces when you approach your teams and your people and communication, you just won't get as far. I don't, I think we have a few minutes for questions, comments? No? Thank you. Thank you.

communication

empathy

values

awareness

intellectual humility

healthcare

professionalism