6 - Microskills for Conflict Management with Dr. Resa Lewiss

In every operating room, in every ward, in every clinic, and every team meeting, a silent battle brews. Conflict, negotiation, identity. Welcome to the Scalpel and Sword podcast, where I, Dr. Lee Sharma, physician and conflict analyst, Explore the hidden negotiations behind modern medicine. Let's trade burnout for boundaries and learn the art of healing with precision and power.

Hello, everyone, and welcome to the Scalpel and Sword podcast. I am your host, Dr. Lee Sharma, physician and conflict analyst, and I am so excited today to have on the podcast Dr. Risa Lewis. Dr. Lewis is a graduate of Brown University. She did her medical school training at the University of Pennsylvania. She is a Howard Hughes Research Scholar, and she also worked at Harvard Emergency Medicine and Mount Sinai, St. Luke's Roosevelt. She also works at point of care of ultrasound in the emergency room, and she is the author of this amazing book, Microskills: Small Actions, Big Impact. And we are definitely going to try to mine the gold from this book today. Dr. Lewis, thank you so much for being on the podcast. Thank you.

It is more than wonderful to be with you, and I'm not sure I've been in conversation with a conflict analyst before, so I'm ready.

Well, I got a master's in conflict resolution in 2001 when I was in a really rough patch professionally. I just didn't know if I wanted to keep practicing medicine and was wondering if I needed a career outside of medicine and went back and got my master's while I was working full-time raising small kids and a wife of a physician. But it's been one of the greatest things I've ever done because it literally changed how I practice medicine. It changed how I approached my professional career. It gave me tools. And what I think is so cool about your book and why I'm so excited to get into this today is I think you break this down so beautifully and in such a way that people who are hearing the podcast and hopefully will go get the book are gonna have not just actionable steps, but a reference that they can go back to again and again and again. At what point did you sit down and realize it's like, this is something, these microskills, I would love to know how you came up with this definition of these skills and what made you want to put it down on paper?

Thanks for that question. And when I think about it, it goes way back. It goes way back, I think, first to realizing that I've had the experience, certainly a few in college, but definitely when I got to med school, of looking around. Number one, I was super excited that I was in med school. Like, I'm one of those people that wanted to be a doctor my whole life. Yet, no one in my family is a doctor. So, when I got there, I was like, wow. And there were a lot of children of doctors, and there were certainly people that seemed to me knew how to navigate the space more than I did. Sure, I had skills from being a really good studier and listening, paying attention, you know, being a rule follower, but there's so much more to navigating the workplace and doing well in school and then ultimately in your job.

Yeah.

And I was acutely aware that I felt like I had missed out on certain of these rules. If I were to make a sports reference, the playbook. I felt like there were people that had a copy of that playbook and I didn't get a copy. So, for many problems, goals, projects, even like habits, when I looked at other people that they seemed to be good at something, but I'm like, oh, I must not be good at that.

Mm-hmm.

I started figuring out ways to achieve these projects, these goals, these habits, these skills. And one way was speaking with people like, how do you do this? And many of us probably have spoken with someone that seemed to be really good at something. And when you ask them, they're like, oh, I don't know, it just happened. Or, oh, you know, I just tried it. No one gives you actually actionable behaviors or breaks things down into small concrete steps that you can learn. So when I've talked about this book before about writing and how I didn't consider myself a writer, sure, I wrote essays to get into all those different stages of study. But I never considered myself comfortably, confidently, or competently a writer. And it all came to a head about 7 to 8 years as a faculty member. So, I got that far along and I was in New York City and I really thought that an academic path was right for me. But where I was working wasn't completely structured and set up for academic physicians, certainly an excellent clinical practice for physicians, but it wasn't 100% academic. And I knew there places that were more academic that would support me with resources in that way. So I actually called back to where I had trained in Boston and they had said, let us know when you want to come back. And I took them literally. So I called and I was like, I'm ready.

Wow.

And they looked me up on PubMed, which is where peer-reviewed publications get posted. And in terms of scientific and medical journal publications, 8 years in, I had 4 publications, and one was from medical school. So, I wasn't writing. I was doing all sorts of other things, productive as an emergency physician, but not publishing. Very much then and there realized, okay, this is a currency. I don't currently have much currency, i.e., writing and publishing, but I really wanted to. I wanted to have a career in academic emergency medicine. how to write down into 3 steps. And that came from speaking with people like, how do you do this? And the people that were willing to have an honest conversation with me said, you gotta just write.

Yeah.

And, you know, someone else shared with me that it's good to edit and be a peer-reviewed journal editor where you— so then you see other people's examples. And the other thing was reading. I've been a lifelong reader. I started deliberately reading books on writing.

Wow. And all of that gave you such a great framework to start putting your life experience in a context that you could share it with the rest of us. I also, I love it that as you're talking about writing, it's like you didn't look at the fact that you had 4 publications and go, oh no, well, that's it. You said, no, I'm going to actively engage in this process. I'm going to collect the tools that I need to actually become a good writer. And you didn't shy away from that. I feel like curiosity It's such a big part of success that you were curious about the process, and being curious led you to producing something that's helping so many other people.

And it's all about small steps, like small actions, hence micro skills. And it was like one book or one peer-reviewed article. But also, when I started doing the writing, it started small. It was like a case report. And by that point, you shared that within emergency medicine, I did extra training in ultrasound. It was easier to get case reports accepted for publication. So, if you were to look at my publications now, I have a good number, but these aren't necessarily like out NIH-funded research studies. Some are case reports, some are case series. Started small and slowly built from there, and my confidence built and my competence built. You get better at it the more you do it.

Yeah, that is so cool. I think sometimes there is a tendency to look at people who have done what you have done and are doing and think, oh my gosh, she just woke up one day and wrote a book.

Oh, no.

There was so much that went behind that. And I think the idea of a micro-skill, I don't have to do all the great big things all at once because that's not really feasible. I want to break it down into small things that I can do every single day. And as I do the small things, the small things add up to the big things. And that becomes something that, oh, okay, well, this led me to a place where I actually did something. But I still think the small things are big. But if you perceive them as something being bigger, then that's really cool because that journey led you to that point. I really want to jump into your chapter on conflict resolution. And I got to hear Dr. Lewis speak last Saturday. So, literally, I met her 4 days ago at the State Medical Association meeting in Alabama. And she gave one of the keynotes and was just phenomenal. I love the fact that you dressed like your icons. You had icons on your slide and you dressed like the icons, and every woman in the audience was like, yes, because that was so cool. I loved that. And it made a lot of those icons more memorable. You were talking about your icon being left-handed and that you're also left-handed. There was a lot that I think really allowed us to keep those images and take those messages with us and loved that about your talk. As we start getting into conflict, I think one of the things I also loved, and I really just wanted to make this its own point because I thought it was so powerful, was having a personal board of directors, having people in your life that are your sounding boards, that you know will give you an honest answer if you ask them a true question, and surrounding yourself with those people. And one of the other doctors in the audience who is a good friend of mine, and we are in a group of about 8 women, most of us are doctors, but we're all medical. One of the texts that she sent out right after your talk was, I want to thank all of you for being my personal board of directors. And the next time we get together, I'll explain that. Of course, I was in the audience going, Yes. Because I thought that was so neat that she immediately translated that to, these are my people. And we are the people that when we have a conflict situation, those are the people that we reach out to, to be our honest mirrors, to actually give us true feedback. And I loved it that you spoke about it, and immediately there were people in the audience who were texting their personal board of directors and saying, thank you. And so, as somebody who I feel like also has been blessed enough to have that. I hope that's a message that people listening to the podcast can take home. And I wanted to make sure that I brought that out because I thought that was such a cool concept. But I'm referencing that back to your chapter in Microskills about conflict. And one of the first statements you make in the chapter is that 85% of us, 85%, and it's probably closer, probably a higher number than that, will encounter conflict at some point in our career. And that conflict isn't necessarily a big screaming match. This can be very small things that we encounter personally. You and your co-author, I think, do a nice job of using, like, narratives from your personal careers to highlight this. But one of the ones I want to bring up is when we are in conflict or in that situation, one of the most important things that we have to draw out is that we are part of that situation. And being part of that doesn't mean we've done anything negative. Or anything wrong. Situations are situations, and conflicts exist. And one of the things that you'd mentioned was that you were emailing a colleague, but the email was going on a Saturday. And so, because the colleague was getting the email on a Saturday, they were reading it on the Saturday, and then the following week, they'd mentioned to you, hey, this email upset me over the weekend. I felt like that was work coming in. And I loved how you handled that. I would love to talk about that more.

So, thanks for bringing that example up. And for audience members who weren't in the audience in Perdido Beach and who haven't read the book yet. The book is comprised of 10 chapters, and it's a business book. Our audience, we think, is people that are ready for school, ready for work, and skewed a little bit towards early career, but certainly career people really resonate with what we talk about. And we try to illustrate these microskills and designate— this book is different from all the other business help books.

Right.

In that we actually break it down and give behaviors. We tell people how. You've touched on a few of the microskills that we have spread throughout the book, and that is great because that's actually intentional. These microskills are additive, and they go across skills. And once you learn one microskill, you bring it with you to the next, and they slowly build upon each other, and you don't even know. You're gonna pull out this personal board of directors, and then you do, when all of a sudden you find yourself navigating conflict.

Yeah.

So, microskills for self-care, one of those is your board of directors. And for some people who aren't familiar with that term, it's this concept of almost a roundtable of people that you trust, you respect, and they are committed to you to help you navigate your professional career. They're the people you call for specific things, like maybe you have someone you call when you have questions about managing your finances. Say you had a bad shift and there's someone that you call We use that term failure friend. You had a bad shift or you had a bad patient outcome and you just want to talk about it, no judgment, and someone who'll know what you're talking about. Or as I say, when you're trying to figure out who's on your personal board of directors, who can you name that every single time you speak with them, you just feel better? The story which I will share comes from our chapter on polished communication, talking about email and email culture. Now, many of us think, email, like, I know how to email, like, what's the big deal about email? But, oh my gosh, there's so much nuance to email, and we can all be better. So, I shared this story that I ran an every Monday meeting, and it was the ultrasound section within emergency medicine.

Mm-hmm.

One Monday, we all gathered, and one of the team members said to me, He said, Larissa, when you send me an email on a Saturday, I get really stressed out. And I was surprised. I'm like, what do you mean you get stressed out? I'm thinking, we're emergency doctors, we work all hours, we work days, we work weekends, we work nights, we work holidays. You know, we just send emails whenever. Why does it matter? And he said, I know that when you're sending it to me, it's not emergent because it's an email. Otherwise, you'd text me or call me. But you're my supervisor. So, when I see an email come into my inbox, I feel like I need to open it up, read it, And even sometimes get to work on it, even though I know I probably don't need to get to work on it until Monday or Tuesday. And I was so appreciative that he shared that with me and that he felt comfortable offering me that feedback.

Mm-hmm.

Now, there's a theme in this book, like, I do try to have growth mindset. I try to think of everything you can learn from. We can always be better. I've always had that mantra of trying to be better.

Yeah.

And so no one had ever said that to me. And it made me think how many other people have felt that way, but just not had the courage to share that. And it turns out one of the taking care of self and healthy workplace culture behaviors that we can all adopt is rather than sending emails at any time, that we can really write the email but schedule the send. And the microskill is scheduling the send. And, you know, there's something in the UK called the Athena Swan Charter, and that actually sets rules and guidelines to have healthy workplaces. And one of the specific rules that comes out of that Athena Swan Charter is that meetings and emails should really happen and be sent from Monday to Friday, 10 to 4, meaning, quote, business hours. Now, to be clear, we're all physicians, and we know the workplace does not function 10 to 4, Monday to Friday only.

Mm-hmm.

But there is an element, like, when we really think about It— are emails that urgent that they can't actually be received into someone's email inbox during those days and hours? No, I mean, that's fine. And it really changed the way I did things. I, 100%, my mind is on, I'm always thinking about things. We encourage people, go ahead and write the email, get it down on paper.

Yeah.

But you don't have to send it right then. You can schedule and send it for Monday at 8 AM.

I love that. I love it that, number one, that we're pulling things from other countries. You talk about what they do in the UK, but the idea of creating a space in which this happens. I have created an actual boundary to say, yes, I respect what you're doing. And I also too, I love the idea of, you don't want to lose the thought. It's like, you obviously had something very good to share. You don't want to lose that, but I'm also going to respect that other person's boundary. By making sure that it occurs at a specific time.

Oh, I was gonna say, if it's that urgent or emergent, then probably email's not the right medium. And so, you can text someone, you can pick up the phone. There's a global aspect to one of the reasons to think about email and sending it respectfully. It came out of an article that my co-author and I wrote where we talked about, rather than thinking about your own email inbox, we want you to have a very generous email culture where you're thinking about the other person's email inbox. And when people have email coming into that inbox, box. And it comes off this global notion that we have a burnout epidemic. And it's really important that you protect your own, as well as your team members', ability to separate from work. Yes.

One of the things that you talk about in the chapter on conflict resolution that I loved was creating this space of psychological safety. One, one of the things I loved about that, and you kind of open the chapter with it, is the idea that conflict is going to exist. It's going to happen. And a lot of times, I think when we are in spaces that aren't as safe, sometimes people try to deny conflict. You do touch on conflict avoidance because I think that's such a common style that people have when it comes to conflict. But I also sometimes think the reason why we have conflict-avoidant cultures, and we do have conflict-avoidant whole cultures, is because we don't have these skills. We don't have a micro-skill to approach, communicate. And rather than get in an uncomfortable space with it, we're just going to deny that it's even occurring.

Right.

So, creating that space of psychological safety where people do feel comfortable, the person did feel comfortable coming to you and saying, okay, Dr. Lewis, I thank you for the email, but it does put me in a headspace on Saturday that I don't need to be in. Can we do it? But that person, you created a space where that person could do that. I want to go to the book because I have it marked and I do love how this is broken down. One of the things that she talked about in the micro skills was recognizing conflict. So, Talk to us a little bit about that particular microskill and how people can start to break that down to recognize it, because a lot of times conflict happens around us, and we may not even be aware that it's happening.

100%. I think you know it when you see it, but your eyes have to be open to it, and you have to be aware that it's happening. And it's not just happening, but often you're a part of it. So we talk about one of the microskills is recognizing conflict, and that specific story was shared by my co-author, where she was actually a tutor. When she was in college or high school. And then that follows by actually acknowledging your role in conflict. And I share some stories in that chapter where there was a workplace that I was a part of. And in fact, my mentee would talk to me about this faculty member that everybody talked about. Everybody would say, how's it going with that faculty person? Because everybody had a—

Mm-hmm.

conflict with that person. Everybody had either a verbal type of conflict or even sometimes like a bit of a body language, sort of getting in people's personal space. And this person was known to be volatile and unpredictable and would throw resident doctors out of the emergency department. And what I observed from hearing about these ongoing interactions was when you don't deal with conflict, it actually decreases morale in the workplace. You know, we're now hearing this term moral injury. I really think it was a moral injury to people to know what it was like to work with this person, to know that they were uncomfortable because they never knew what mood and what volatility was gonna emerge from this person. But also, I think it had been going on for years, like over a decade, and this person was slowly—

Wow.

Promoted and almost rewarded for this very toxic, noxious behavior.

Mm-hmm.

That disrupted the psychological safety of the workplace. And as I shared in the talk, when there's not psychological safety, people don't do their best work. And people don't feel safe, people don't speak up. And first, thank you for even acknowledging, I'd never seen it, that my team member felt safe to speak up. That had never been reflected back to me, so thank you. People didn't feel safe with this person or safe to speak up, and this issue had lingered and been thread throughout the culture of the workplace for over a decade, as I shared. And I really saw what it did to people. And also, this is why people will leave the workplace, because they don't feel safe. And they don't feel like someone who is a consistent cause of conflict is not being dealt with. I agree with you. It's human nature, I think, to avoid conflict because it might be difficult. People aren't comfortable with the conversation. Difficult conversations are hard, and I'm going to circle back to the personal board of directors. Your personal board of directors contain people who are great people with whom you can role-play conversations and can tell you— say you don't recognize your role in conflict. You can say, this happened at work, and be honest with me, be radically honest, like, what was my role? And those people you trust and you feel safe to actually say to you, hey, from what you're sharing, Here's where I think you actually did play a role in that conflict. So that goes back to even, again, having those people in your life that you can really have honest conversations with.

Wow.

That is so great. The idea of, if we're going to learn to have difficult conversations, that we have an opportunity, we build our personal board of directors to practice that. You know, we're building a skill set to be able to engage that way. Also, I think it is so cool drawing that parallel between moral injury and these systemic— because moral injury is a systemic That's what makes it different from burnout. Moral injury is systemic. It is the system asking somebody to do something that goes against their own moral fiber. And burnout, where it's more characterized as something that's more of a personal— and when the system starts to take ownership of conflict, and especially if there are specific actors that are involved in creating that toxic culture, when the system lets that go, it is basically telling the person who is The victim or complicit in that conflict, we really don't care that you're suffering. We're letting this go. We know it's affecting your work. We know it's affecting your personal life. We know it's affecting your emotional functioning. But one of the things that you also bring up in the chapter, which I think people sometimes don't think about, is conflict has a cost that's also financial and also related to patient care. We are not going to do our best work when we are caught in a toxic conflict culture and we are being purposely gaslighted, then no one's going to put their best work out. If you're really trying to get people well-trained and have good patient care, having this system that perpetuates this moral injury is basically the fast track away from that. You also talk about an acronym to recognize gaslighting. And I think one of the things when you talked about conflict, it's not always great, big, and bad. Sometimes it can be more subtle, and being able to recognize that we're in that situation is So important. Can we talk about DARVO? Because I think that's such a great thing for people to learn about.

Yeah, I'm really glad you brought up DARVO. And there is an amazing PhD psychologist who— this has been her life's work. Her name is Jennifer Fried. And she has a website and has a lot of published work and some books on these sort of workplace phenomena that she has put a name to. And I find often having a name helps us feel better because we can actually call it out.

Yep.

So, she talks a lot about institutional betrayal, and that is what happens when bad actors are allowed to be in a workplace, not have any professional improvement plan, get actively promoted, and everybody knows that they are bullies or they are verbal violencing or they are sexual harassers. That causes betrayal for people, and I think ultimately moral injury. Institutional courage is what we'd love to see, the institutions doing the right thing. And the individual agents of those institutions are the leaders, the supervisors, the people that need to have the difficult conversations. Gaslighting, I think the audience is probably familiar with. I think it was the word of the year in 2022.

Yeah.

So DARVO is a kind of gaslighting. And it's an acronym, as you state, it's D-A-R-V-O: deny, attack, reverse victim, and offender. I became familiar with this because I witnessed a phenomenon, an incident where I worked, and I really struggled with what it did to the true victim. Mm-hmm. And I'll explain what it is. And I ended up— we wrote an article about it. And so, when I became aware of this term, it perfectly described a scenario that actually we wrote about, as I shared, and I don't know that we used that example in the book, but essentially, there was an unstable patient. A bunch of people were called to the room to help with resuscitation. In the act of resuscitation, a more senior supervisor verbally Violated a trainee and actually was witnessed to have put hands on the trainee.

Oh, no.

As a way to protect, basically flipped it and proactively tried to control the narrative, wrote to a bunch of people, basically tried to paint the trainee as having professionalism challenges. The trainee needed to be spoken to. But meanwhile, this was a witnessed incident. So I was shocked. I was shocked that basically the perpetrator reversed it and tried to make the true victim the offender.

Wow.

Deny, attack, reverse victim and offender. And I was shocked because I'd never seen this play out real time. I guess impressed with how seamlessly this person went into this sort of scenario of painting themselves as the victim when they weren't, and it was witnessed. And then the more I read about it, it's actually, once you see it, you can't unsee it. And you see it in industries outside of healthcare. It's not just a healthcare thing by any means. And in fact, if you want to Google South Park Darvo, there's a whole scene about Darvo.

Oh.

It's, yeah, but it is a way that people transfer power. And weaponize power, agency, and a more senior role or more access to resources to flip that dynamic and use that dynamic to protect themselves. It's very ugly to see. And it's unfortunate when the person who gets this turned on them somehow suffers or the institutions believe that they are the true perpetrator when they're not, they're truly the victim.

Wow. And it's kind of like when you make a diagnosis for the first time, once you make that diagnosis, once you see that illness script, you'll never unsee it. You see it again, you'll know it forever. And the same thing with DARVO. Once you saw that play out in real time, you couldn't miss it.

Yeah.

Okay, I know what this is now. And it also puts you in a place as somebody who is in medicine, has students, that you actually can recognize it. And because you have power and agency Because of your career and your professional achievements, that you're able to help other people recognize that and then take agency over it. You mentioned being, um, an institutional agent for change, an institutional person who has courage. There's actually a name for that in the conflict resolution literature. It's called being the agent of reality.

Hmm.

That if you are the person that comes in and is speaking truth to that, it's like, you know, I'm going to take the mask off this situation and this is what I'm actually seeing play out. That is one of the most powerful things you can do as somebody who plays witness to that conflict. Because I think very often when people, and I will say, especially women who are in that situation, who feel more powerless, who feel like they are in more of a junior role, they feel like they are speaking on their own. And when there are other people who can be agents of reality and say, no, sister, I saw that happen to you. I saw that play out in a meeting.

Yeah.

where I work a few weeks ago, where a female leader was being attacked in a meeting. And she did beautifully. She held her ground. And at the same time, so many women went to her after and said, you were awesome. You handled that conflict beautifully. And I think that helped her not be in that situation where she was actually able to recognize the DARVO. She's like, okay, so it wasn't just me. I was in this. Like, you were in it and you handled it Well, so we became her short-term board of directors, able to give her that support.

One of the challenges, unfortunately, Jennifer Fried also speaks about that we need to honor the whistleblower. And what you just shared, the person that speaks up or that pulls the mask off or comes behind the curtain, too often the whistleblower is not honored. And that whistleblower becomes the person they try to quiet Or, you know, gets negative consequences. And for that reason, many people are afraid in institutions to speak up and call things out. And often, you're right, I think we as women or people that are trying to create safer, better, more respectful workplaces, you know, will come up and tell the person you did great. And this is what we even talk about in the book. These institutions are much more powerful than we are as individuals. And also, we do have agency. And so, this book is also about helping people realize their agency in the workplace. Yes.

One of the things that you talk about, and I think it is the conflict chapter, one of the microskills is documenting, actually sending emails and CCing. We talked about using email for specific things. But one of the things you talk about in the book is if we are going to be that agent of change, if we are going to be that whistleblower, that one of the things that we do want to do is make sure that we have another level of documentation or have maybe other people who are witness to what we're trying to do within that system so that, number one, we don't feel alone. I think that's such an important part of it. But the other is that there is some level of— I don't want to say protection, but some level of—

Sure.

paper trail to let us know that this is what we're trying to do. Unfortunately, you're absolutely right that people who are trying to be those agents of change, so often the system doesn't want change. The system is happy where it is.

Mm-hmm.

And the people who are in power, who may be using conflicts to either gain more power or to do certain things, situations to favor themselves, they can use that system for that. So, trying to move within that system, sometimes And you do, there's a whole part of this in the book.

This book is so good.

But there's a whole part in there about if, you know, is it time to leave my job? Do I need to leave? That's not really an option most of the time or something we want to do, but we still want to see systemic change. So, having microskills to lead us through that systemic change is so valuable. How do you eat an elephant? One bite at a time. And that's what the microskills are showing us.

It's a good time to actually bring up the 3 truths. When we wrote this book, We started with 3 truths. Time can only be spent. Think of it as a currency. The world is not equal. And that taps into what you just shared. When we say the world is not equal, not all of us have the same access to financial resources, pedigree, network, or knowing the workplace rules. And that's what we're trying to provide here.

Mm-hmm.

So, what you shared about the paper trail, definitely, if you're the whistleblower, sure, paper trail. But we're trying to empower the reader who might find themselves in conflict in the workplace. And a lot of people are like, I have no idea what to do. I have no idea what to do. So we're really trying to give these actual, like, start by date, time, and try to do it as immediate recall as possible. The day, the time, what happened. And if you remember direct quotes and just keep it, don't put it on a computer or in an email or on a document that's going to be found. Put it on, write it in a journal or put it on a document that you know will never get found. And maybe you'll never need it. But maybe you will, and we forget things. And especially in a conflict that goes on over time, it's hard to keep details straight. That's never a bad idea. And that's also because maybe you don't want to ever act upon it, but maybe you do. And so if you do decide you want to act on it, maybe whatever that means, legal or HR, and we even talk a bit about, you know, one of the reminders about who does HR serve, but—

Right.

I've worked at institutions where there's a Title IX office or there's an office of professionalism. Or there's an ombuds. There's all different outlets for where workplace conflict can potentially be worked out.

Yeah.

I also, one of the things that you talk about with conflict that I think is so cool, that I think what, you know, it's such a brilliant suggestion of making this documentation, writing things down, but not necessarily to send to somebody, as that personal record, is that part of being in conflict and kind of walking into that as a humble participant is If I have a role in this, I need to acknowledge it. And doing that kind of documentation/journaling allows us to be more reflective about what our part in this conflict could be. And sometimes if you sit there and you start journaling and writing things down, it may be, okay, the light bulb just went off and I see that maybe I'm complicit in this way. And if we're truly being transparent in the process, people say, okay, well, now I see that maybe this is contributing. Let me try to correct this. Let me go to my personal board of directors. I'm working through this and I was doing some journaling and I I see that this may be a pattern. Do you guys think? And that way, you're reflecting for yourself, but you're also collecting data that you can go to your personal board of directors and really see. That's, and I think also too, that's taking the ego out of the conflict. So often, when we get in these situations, it's our ego that's pushing this forward. And if we can get our ego out of the way, we are much more likely to have a transformative solution. It's not always about resolving it. It's about trying to get something better on the other side. And I thought that The idea of writing that down and what you just said about keeping that sort of documentation, but not necessarily to share, is so powerful.

Yeah. And I think when we visualize this personal board of directors, there may be people your age, there may be people much more senior who have a lot of experience. They've seen a lot. Perhaps they've been a chairperson, perhaps they've served as a residency director. Who knows? But if they have age on you, they've just probably seen a lot. You referenced another microskill we talk about a lot is pausing. When we bring up pausing, we talk about pausing before accepting an opportunity. But what you just shared, pausing before you react, pausing before you decide how you want to react, just that pause is never a bad idea. It's always a good idea.

Oh, that's abs— oh, absolutely. I think one of the great object lessons about pausing, which is so cool, is that conflict can be very emotional. And if we don't pause and our emotions start to take over, we can dig ourselves into deeper holes. We're not necessarily going to get good transformative outcomes because when you're talking emotionally, you're not talking, really trying to get a solution. You're really more being cathartic about the conflict. And if you can pause and step back and give yourself, get the emotions out of the way, you're much more likely to be clear with your communication. You're much more likely to get a more positive outcome on the other side, as opposed to just barreling straight through, I'm mad and you're going to hear about it. I think one of the things that you talked about in the book in terms of when people like beat the wall, we all need to do that, but maybe go to someplace else and go do it. Go to the bathroom and beat the wall in there before you come back out and try to reengage. I think that's such an important thing. I want to just touch on really quick before we leave, because I love this book so much, that one of the things that you do in this book is that you actually break down the stories, but you're also breaking down the skills. And we have our infographics as well. It really is like, I can always go back to this and I can always reference what I need to do if I'm in the middle of a situation. And so I'm taking my pause break, but I can actually go back and I can read the chapter about intentionally holding, practicing these difficult conversations. And I just, I love that so much. But the one last thing I wanted to touch on was that you're balancing this idea of competence and confidence.

Yeah.

That I think, especially if there are younger women listening to this podcast, women in general, maybe in a more male-dominated workplace, that we're balancing, we're owning that we have professional ability, that we're good at what we do, but we also have to balance that with being confident in where we are and what we're presenting. What are some microskills around doing that?

There is a brilliantly titled Harvard Business Review article from which then a book was written, Why Do So Many Incompetent Men Become Leaders? I'm not making that up. That is truly the title.

Uh-huh.

It was based on market research that looked at competence and confidence. And there is a gender dynamic here. Men are rewarded, promoted, accepted if they appear confident, and that confident is read as being competent. However, Almost always, women are much more competent leaders in terms of like leadership attributes, characteristics. Women in many of the industries that were surveyed, women were more competent. However, when they tried to act confident, it wasn't received as warmly or as positively. They were thought of as bitchy as opposed to like, wow, decisive.

Right.

And we've even seen probably these charts or these breakdowns of one thing that's considered a positive attribute for a male leader, it's a negative attribute for a female leader. So, you know, we have a tough line to toe. There's a book that I recently read that I really like, I think also because of the title itself. Allison Fragale is a professor of business at the University of North Carolina, and she wrote a book called Likable Badass.

Mm-hmm.

And I think there's an aspect of what she wrote that's very true. We, as women, the way we're judged in the workplace is we have to be both competent, but also sort of kind and warm. And that's the balance that we walk. And that chapter, when we talk about confidence and competence, we're calling out what we know to be true and letting the reader know a little bit of Here are the numbers, here's what happens, and here's how you can make sure— I mean, to be clear, as physicians in medicine, we need to know our stuff, like you need to be competent. But how do you wear that competence? It's interpreted differently if you're a man versus if you're a woman. And part of the intention, I think, of sharing that is to just inform, kind of like, again, filling in that, those knowledge gaps that unless you get a copy of that workplace playbook, you may never know. And you're like, why am I not well-liked? You know, it may just be because of things beyond your control. But once you're aware of the playbook and of those rules, or some people will call it the hidden curriculum, you can navigate professionally much better.

That is so awesome. Yeah, the idea that there is a hidden culture, hidden conflict. And being able to find out what that playbook is, that was so important and so helpful. My mom was a pathologist, and one time she had a girl who was one of her mentees that was a 3rd year at Johns Hopkins, just started the wards, and called her mother crying in August saying, I don't understand why the nurses hate me. I do the same thing the guys do, but they don't help me. They're so mean to me. And the mother didn't know what to do, so she called my mom and was like, you know, she's crying. My mom was like, well, let me talk to her. And so, mom called her and was like, so tell me what's going on. And the medical student told her and said, okay, this is what I want you to do. I want you to go bake a big batch of cookies. I want you to take them to the floor, take them to the nurses and say, look, I know we got off on a bad foot, but I really want to work with you. And whatever I did, I'd like to know what I'm doing so I won't do it again. And she said after that, the nurses bent over backwards for her, but she also got to know the culture. She got access to the hidden playbook. It was one little thing. It was baking a batch of cookies. And that got her access and that served her well her entire professional career. But it took somebody who'd been in practice for another 20 years, who was her senior, to tell her, there is a hidden playbook. I'm going to tell you how to find it. So I think that's so beautifully stated. I love that. So this is a special day. For your book. Do you want to share with us why this is a special day?

Yeah, I was delighted when you invited me to come on the podcast and we selected this day because today is our 1-year book release anniversary. 1 year ago was when the book dropped, and it was the first time I had like a mainstream book drop. And it's been amazing, fun, fun, fun experience speaking, meeting people like you, and having the opportunity to share the content. With the hope that truly it helps people. It really helps people do better at school, do better at work, have a more successful, fulfilling, stress-free professional life. And so, yeah, it's lovely to celebrate the birthday with you.

I am so excited that you're here. And just congratulations on having something that's going to help and has already helped so many people. You can get the book on Amazon. I have already shared this with a bunch of people. Please go buy this book. If people want to find you, Dr. Lewis, how can they find you?

I'm on LinkedIn, and I welcome outreaches and connections on LinkedIn, Risa E. Lewis, MD. I have a website, risaelewismd.com. I'm also on Instagram. And yeah, feel free to check me out, reach out. I love to speak with people, workshop with people, author talk with people, and just, you know, overall find ways to help people grow their skills and fill in their skills gaps.

Well, you are definitely doing that, and you've definitely done that with our listeners today. So thank you so much for being on the podcast. This has been fantastic. Thank you, listeners, for being part of our discussion today on Scalpel and Sword. I am Dr. Lee Sharma. Next time, peaceful warriors, be well and be at peace.

Every episode is an invitation To speak, to negotiate, to choose. I'm Dr. Lee Sharma. Join the dialogue by subscribing to Scalpel and Sword. Until next time, peaceful warriors, may your choices be sharp and your voice be even sharper. This podcast is a reflection of lived experience and research in conflict resolution. The Scalpel and Sword is not intended as medical or legal guidance. For personal matters, please consult a qualified professional.