EP50 | From Curiosity to Communication with Dr. Lillian Liang Emlet

If you work in healthcare, you already know this. Conflict is everywhere. In the OR, in labor and delivery, in committee meetings, between physicians, nurses, administrators, and teams that are all trying to do the right thing.

But here's the problem.

Most of us were never trained to handle conflict well. We learned procedures. We learned Diagnostics, but we didn't learn how to navigate the moments when 2 professionals strongly disagree. That's why I developed the SPARK framework. SPARK stands for stop, pause, ask, don't assume, reflect and respond, and create a path forward. It's practical system designed specifically for high-stakes healthcare environments. Through keynote talks, residency workshops, and Spark Masterclasses, I teach physicians, nurses, and healthcare teams how to turn destructive conflict into productive conversations that strengthen teams and improve care.

If your hospital, residency program, or medical conference is looking for a speaker on conflict communication and leadership in healthcare, I'd love to work with you.

You can learn more in the show notes because in medicine, conflict is inevitable, but handled well, it can make teams stronger.

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 beyond modern medicine. Let's trade burnout for boundaries and learn the art of healing with precision and power.

Hello, my peaceful warriors, and welcome to the Scalpel and Sword podcast. I am your host, Dr. Lee Sharma, physician and conflict analyst. I'm going to ask you a question. What is the biggest threat to physician wellbeing isn't burnout, but the way we've been taught to communicate, lead, and adapt under pressure? What if resilience isn't something we build alone, but it's something that organizations grow together and intentionally before things start to break, before conflict becomes disruptive instead of having a chance to be transformative? I'm so excited today to have on the podcast someone who I think is really going to help to illuminate this for us. This is Dr. Lillian Emlitt. She's an associate program director of the Internal Medicine Critical Care Medicine Fellowship of the Multidisciplinary Critical Care Training Program. She teaches via simulation skills and rapid response team leadership, palliative end-of-life communication. and difficult airway management. She is a VitalTalk-trained faculty member and teaches communication skills to healthcare providers in intensive care and emergency medicine. She is also a certified professional coach and the founder of Transforming Healthcare Coaching, which provides coaching services to healthcare professionals. Lillian, I'm so glad you're here today. Thank you so much.

I'm so excited to be here.

So at what point did you really start to see this intersection between physician wellbeing and communication and want to start exploring that?

You know, I would say probably for the greater part of all of our careers, we accidentally cause trauma in the workplace, right? A lot of times we're not kind to each other and we're certainly not kind to ourselves. And we do a lot of accidental communication things that we don't even realize we're doing, uh, in the time. Fortunately, I think with practice and skills practice in the simulation lab, most from undergraduate medical education all the way through becoming a faculty, there are more increased intentional places for communicating, doing more patient-centered interviews, motivational interviewing, end-of-life communication, empathic skill training. The good thing is there is some thread of that, maybe not enough, or maybe we just need more doses of it. But for me, I think the reality, realizing that a lot of times we are unintentionally unkind to each other and ourselves throughout the day.

And what led you from that realization to want to become a coach?

You know, so I think for me, what I discovered when I had a coach, this person helped me level up my communication skills. So believe it or not, I actually was going through a divorce in the middle of the pandemic. And I myself had a mediator trying to help this conversation along. And I realized at some point all of my empathy skills to communicate with families and surrogates and other colleagues with a greater skill in the clinical realm really wasn't serving me and the mediator. It wasn't working. I got a divorce coach and the coach helped me understand How to be more centered, to be able to see another person's perspective, to probably do the things that you as a mediator do in terms of trying to see that there are more facts, feelings, emotions, perspectives, and to be a little more curious. And so she helped me through that process and I realized this is just a whole new level of more amazing skills, even beyond what I already was doing with teaching communication skills for clinicians dealing with family, surrogates, and patients. So I decided to go back in the pandemic to go get additional training and understand how to make curiosity-based questions that really expand an open diversity of thinking, right? Because that's really what coaches do aside from holding you accountable. They also begin to question in a safe way the things we've always created as assumptions. There are a lot of assumptions that we hold as individuals and they come as a natural process of our development. And they're okay. It's okay to have your lived experience, your traumas, your culture, your gender. All of your identities are great. You're a unique human. And we also accept a lot of society's things. And so through coaching, we often question, explore, own, discard, and take on new versions, right? So we often use coaching whenever we are in a place where I can't get any further with what I've already learned. And that's why people always get a little confused, right? Like, well, what do teachers do? What do mentors do? What do sponsors do? Coaches move whenever you need to push against just yourself, where you are the only other thing left. There isn't probably no other, no mentor could tell me how to get through a divorce mediation in the pandemic when I was opening the COVID ICU and dealing with all of the things, right? No mentor can mentor that. It's an unprecedented time. And so it was the coach who actually helped me. Through that process. And that's how I discovered coaching.

Wow.

There's so much in your journey that's just incredible. I love that you were in an incredibly stressful situation, going through divorce in the unit during the pandemic. And I think there are a lot of people who would have that experience. And rather than taking this path of becoming curious about this journey, being curious about developing the skillset. A lot of times people would've said, you know what, it is what it is. I'm gonna survive the process, but I'm not gonna grow through it. And so the fact that you were able to take this experience and not only use it as an ability to improve your own communication, you also made it a way to become curious about where other people were in this journey. And I think this is one of the cornerstones to conflict is this idea that my perspective Is mine. It is the product of my lived experience. It is my worldview. It is the lens through which I appreciate the world around me. And I love how you say that that's part of who we are. It is part of our identity, but to be able to have the metacognition to question that, to say that I'm actually going to sit here and I understand that my lens might need some polishing and I'm going to get someone to help me to do it. I think that is one of the absolute keys. to developing conflict skills and management. So I love that you unfortunately had to go through all of that, but you built this really amazing skillset. When did you discover VitalTalk and when did that become something that you became interested in and trained with?

Yeah, so VitalTalk actually has been instrumental, really the cornerstone, majority of my entire academic career. I discovered it back when I was junior faculty. I think back then we were just revising the curriculum. So really pretty much that first year as faculty, I began, well, my mentor was Bob Arnold and he is one of the founders of the nonprofit Vital Talk. And so back then, you know, the evidence already was quite large for training oncologists and palliative care physicians on how to teach communication skills and how do you pay it forward so you create an army of teachers of communication skills. And so there are hundreds now of all specialties and disciplines with Vital Talk. Who do teach communication skills in different ways, right? So they actually have a DEI module. They actually have a pediatrics, neonatal, nephrology, critical care. There's so many different specialties now represented, nursing and other, you know, chaplains and social workers. Everyone is welcome at Vital Talk because everybody communicates in some way in the healthcare sector. So really, it really was the foundation for much of my simulation communication skills training to do the Vital Talk. Faculty development program. They have a robust faculty development program. It is not for the faint of heart. And at the same time, if you really want to be well, as you and I both know, it is worth that investment in time and practice and mentoring and observation and feedback and recording yourself and listening to yourself and wondering, is this no different from people who get voice coaches and speaking coaches? It is that entire process of Trying, learning, doing, and then seeing what other people think. And then also just hearing yourself and then asking for that deliberate feedback actually that needs to happen to, I'm working on this and can we just get that part good first and then move on to the next problem?

So you not only developed the ability to communicate, you've developed the ability to grow in your own method of communication, be able to critique yourself and actually see where you can improve in your communication. I love that this is an ongoing process. I feel like all of us need to be reminded that as we're developing these skills, they don't just pop out fully formed, that we're constantly improving, refining, and the more experience we have, the better we get at those things. You mentioned mentoring, and I know that as an instructor, you're teaching residents, faculty, you're teaching junior faculty as well. What are some things with communication that you really find maybe they didn't get earlier on in their training, or you find you really have to focus on as you work with them?

You know, I think what's really interesting, there are some people who see really great role models and they know it when they see it, right? 'Cause like during the interviews for people coming into fellowship, they're like, I really wanna do critical care because they had a really great intensivist who showed me, well, how important it is that communicating at the end of life with families, I mean, that's what they're going to remember. Or they themselves were critically ill 'cause, right? 'Cause many of us got sick with COVID So they themselves actually had their own critical illness story and now want to go into the field. And a lot of the memories are actually related to communication and whether that's medical errors, whether that's things done well, whether that's disclosures. And so that's what the good stories.

Yeah.

And I think the other opposite lens is when they don't see things go well and they can begin to compare and contrast and they realize there are a range for how I wanna be or how I don't wanna be as a clinician. And so I think what's hard is not everyone is comfortable, just like not everyone's comfortable with a particular procedure in certain fields, or not everyone loves to teach about, I don't know, fill in your blank sort of physiology. You have to find the right people who, that's the thing they like to talk about, how they can deconstruct it. And just like most teaching, it's deconstructing, noticing, making it a micro actionable thing you can do, whether it'll be pausing more. Using different words, finding different words, sentence structure, rehearsing it outside the room, having a strategy, having a mnemonic for how you might communicate. It's just these funny little muscle things. And we talk about the fact that this toolkit of your words and your verbals and your nonverbals, you do need someone to observe you to tell you that you're really good at this. Keep doing that. I don't know if you knew that, right? I know that you make great eye contact, for example, or you lean forward right when you're supposed to. Keep doing that. Or you really use silence or pausing just at the right moments. Keep doing that. And then also sometimes, you know, noticing that if it's not received well, right? The data is always with the other person. Sometimes it's really nice when you're in the heat of the moment, you can't actually notice what's happening cuz you're just so engrossed in the conversation. It's nice to have the other friend along with you just to notice, hey, I noticed that the other person. Lean back, you know, like there was a facial expression. And when we're talking, it often just goes right past us. It's nice to have that friend in the room whenever you're talking with another person, just to be able to say, hey, just want to let you know what I noticed, because that's data that we missed.

And I love that you're encouraging them to collect that data and you have different perspectives. You may be the person talking, you may be the person observing. And the person who's talking, when they have that feedback from the observer, It's like, okay, these are things that I can work on. These are things I did well. These are things that I can improve. But I'm also willing to bet as the observer, you're learning from the person talking and you're also, okay, I love how this person did this. I love how she leaned forward. I loved how she made this eye contact. Those are things I'm going to emulate the next time I have this conversation with a patient. I think the experience of being the observer also becomes very, very educational. One of the things that I love that you talk about, and especially with your coaching, and I think this goes hand in hand with your training young people. A big thing right now for all of us right now in medicine, especially if we have medical students or residents, is helping them develop a team mentality. We grow up in a silo in medical education. You know, our grades are our own, our residency is our own. We're competing for positions in the match. So all of a sudden we get into clinical training. And we're expected to learn how to work in teams. And this is something that I think is a little foreign to my generation. It wasn't something that was encouraged, but I think now the younger people that are coming up, we now recognize how important it is to work as a team. And one of the things that I think you do so beautifully as a coach is you look at coaching as a system. You're looking at the entire ecosystem that you're coaching. What do you look at if you're coming into an organization and you're the coach and you're helping to build resiliency and communication within this organization? What are some things that you look at initially going into this process?

Yeah, so with our systemic team coaching that we do at Transforming, the reality is we're trying to help people understand where they are in the entire ecosystem. We hear a lot of these narratives, right, on, you know, TV, public media. There's always like, from a particular perspective, it's the system's fault and there's only one way to do things. And we often see this, right? Even within our own groups, right? As we work with another specialty, well, they want that. And we want this, and there's a lot of us them feeling. And yet at the same time, we have four specialties consulting on one patient, and it gets very complicated very quickly whenever we have all four teams trying to make a care plan together because we often are only seeing things from just one view. And this happens on a daily basis in terms of we think this, they think that. It's always very antagonistic. And so. When we think about how that translates even to the policies, how things are organized, supply chains, collaborative projects, throughputs, ways that we can work quicker together, especially for ICU surgery, emergency medicine, right? So that's one whole throughput line that in order to care for a trauma patient from injury entry into the doorway all the way home, there's a lot of people who get involved. There's a lot of different teams that get involved. And so with our systemic team coaching, we're really helping the leaders of those teams in different areas of the entire organization begin to think more willing to collaborate with each other and understand from another perspective so they can actually leverage and become more efficient together. We often work with leaders first because they need to be aligned with their own internal team. And also once they're internally aligned and can begin to imagine, there's one exercise we do, which is the 13th chair. Meaning there's an extra person in this room as we make a policy decision, as we make a clinical service line decision. Who else's perspective have we not considered? Right? We often never think about that. There are unintended consequences because we never actively go looking for our blind spots. We just think we got the right stakeholders. And so I have the chief nurse, I have the chief physician, I have the chief APP, you know, I have one, you know, someone, you know, It was one person. And then when we go system testing, right? Because in simulation, we often system stress test a new system build, get readiness for a stroke activation, like things like that. And then we're like, oh, we really need to involve public affairs and the police because apparently this elevator is locked and the only people who can unlock this elevator would be public safety, right? Like someone else in the building, right? There's all kinds of things that we often don't use this systemic model. To think about even the ecosystem of one building, but that even that one building, I argue you're part of a larger healthcare system. And that healthcare system now is often multi-state, multi-outpatient and inpatient. There's so many ways within an organization that the systemic model, the systemic team coaching really needs to be involved. 'Cause you can find places where you can become more aligned so that people can work better and faster. And have greater places of communication and feel more empowered that you're doing things together.

Oh my gosh, I love that so much. So there are so many things about that that I love. The first one is this idea that you're using simulations to actually get this very big picture on all of the stakeholders. Because so often I think in developing system resiliency, but also kind of helping organizations learn about conflict, as they start working on conflict or if they have a conflict that's already existing, they may see 2 or 3 individuals that they see as stakeholders. They don't understand that the nurses also suffer, the patients also suffer, the physical therapist coming through is going to suffer, that there are so many people who are impacted by this one conflict that they thought they might only be 2 or 3 people. It very often to me makes people more invested. In the process of seeing the system become stronger. Because the majority of people, when they realize their conflict has affected somebody else in that way, I didn't mean for this person to feel this way. I didn't mean for my thing to overflow onto this other person. And then when you broaden their gaze and they realize it has, I think it invests them in the process. So I love that you create that through simulation. You're showing them there are all these other stakeholders that you didn't even think about. That are invested in what you're doing right now. But the other thing that I love that you said is that you're using your processes to build more alignment within these structures. That as people see where they're aligned, not where they're opposed, where they're aligned, that they see how much stronger this communication becomes and they actually start to function more effectively as a system. I love how you're using a simulation and you're using your systems to do that. One of the systems that you use in your coaching has an acronym, which is A-N-D. And tell us about that.

Yeah. So when we think as coaches, you know, how do people get through that arc of transformation? We start with awareness. And it's really interesting to me because some people don't actually want to be aware. Some people are not so happy when I say we're going to start with like an online assessment of your energy levels. And so we have a proprietary assessment called the Energy Leadership Index. Many coaches use different types of assessments. Some people use personality-based assessments. We have 2 different ones. One's a personality-based, one's an energy leadership-based one. But there's all kinds of assessments that people do just to either figure out what's going on in your organization. We, some of them use 360s to figure out how everybody's perceiving everything. There are also team-based, systemic team-based assessments on whether this is a high-value team in terms of how they're functioning. So you gotta know where you are first before you can begin to imagine where you're going to go. Because sure, everyone can have the same goal of being a highly loving, caring organization with billion-dollar impact and revenue that serves the community and gives back, you know, half of it with charitable impact with some other kind of a philanthropic arm. Everyone can have the same goal. But when you assess where you are, not every organization can get there as fast, right? And your strategy is going to be different depending on what your capacity is, personalities and talents that are actually on the team in terms of what's working, what's not. And so assessments is key first, whether you're working with a team or with an individual. Once you know where you are and can reflect how it shows up in the daily actions, behaviors, and thoughts, either as an individual or how this is exhibited as a team, because the team can probably pretty agree that when we're behaving like this, this is what it looks like. When we're behaving like this, this is what it looks like. Because when you look at your scores, our usual question next is, and how can anyone give us an example? Of what that might look like, or how do you feel it? You know, how do you think it? How do you act on it? And then people usually give some kind of example. And then once you know where you are now, then we think about, well, what do you want to switch? It's okay. These are your scores. You understand your scores. Different people respond differently, but like, well, this really bothers me right now. And so I really don't like that score. And I want to change that. I need to fix that because this is what's actually messing everything up, this one particular thing. And so, okay, great. So how are we going to get there?

Yeah.

And then we explore, we unpack and imagine new ways, whether it's data, action. Sometimes it is just a thought. Oftentimes it's just people's mindsets. And like, they actually begin to say all the negative mindset and then we have to challenge them on it. And how true is this? And they're like, no, I am not a failure or an imposter or not qualified. I'm like, great. So how can we interrupt this cycle? So we have to think about new actions all the time. And they can be small little new actions or they can be big new actions, right? For some of our clients, it's Actually, I'm gonna go get an MBA. I'm gonna go, you know, 2 years, just like you knew yourself. I'm gonna go off and do the thing for a while and I'll be back whenever that's the time. So the new action can vary person to person. And then once that new action is taken, oftentimes just like sustained weight loss, just like managing through a big health concern, a big financial concern, it's gonna take deliberate attention to it, right? Because habits take a little while to form. And we often fall off into our bad habits again that we had before, because somehow that habit loop trigger served us in some way before. We can easily fall back into old patterns. We just have to, it's hard to make a new one. So just to think that 2 or 3 coaching sessions are going to just somehow miraculously everything's going to be better is sort of hilarious, right? Because any of us who've done major transformational change, it does take sustained attention, accountability, strategy. And then it is a habit, right? So then what's interesting for me is even just watching. As people change, some things we don't talk about anymore because it is now newly ingrained upon them. But then we all move on to a new thing, right? Because once you've discovered something great and you've changed it for yourself, it's kind of addictive. People come back and they're like, let's move on to the next thing. So then they take on another thing off that assessment. They're like, let's move on to this. I'm like, okay, let's move on to that. So obviously it varies per person, right? For some people, they're like, great, 6 months. I made my whole career pivot. I'm good. We'll just keep in touch. And then they're great. And then it might just be the thing they need, right? So career transitions doesn't go on and on, right? But big system level changes, especially at the team level, easily need 6 months to a year depending how dysfunctional a team is. And the quicker they're willing to accept the assessment, the quicker they're able to move on. I mean, I think that's the hardest thing that I think for most people to really stomach. How stubborn are you? Because if you're willing to even be willing to open the mind a little bit and like begin to see, could there be a different way, then you actually are gonna be faster for transformation. It's the people who are very recalcitrant. And I think some people have labeled or have they called sometimes just not willing to change. Maybe just isn't bad enough. I think everyone's willing to change if it gets bad enough for themselves. It's just, that's the question.

I love that. I love your process beginning with awareness. That you have to know who you are. You have to be able to confront those things. I think when I first got coaching and I got a 360 assessment, I remember crying the first time I sat down with that because there were a lot of things that I was looking at on the 360 that was like, wow, okay. But then you take a deep breath. It's like, okay, well, this is where I'm starting from. And as you start to realize, I can only get better. If I open my awareness, I can only improve. This is only up and The hardest part, of course, is that first step of actually being willing to be assessed and actually look behind the curtain, which I think, like you said, it's really hard to be open to that. But once you do, I think you start to see all of the benefit there that can come. I think one of the things that's also so awesome about what you do in terms of helping organizations become more resilient and become more aware is in my world, Sometimes I don't see people looking for this kind of help and all of the wonderful things you're offering until something catastrophic has happened.

Right.

There's been a horrible outcome. And generally with the horrible outcome has been this, how did we get here? And then as we're going back through all the conflicts that led us to this horrible outcome, you see the breakdowns in communication that have been there for years. You see the people that have been so entrenched in their silos that they haven't understood how to function as a team. Part of what you do that I love is that you help people begin to work on these processes before they become catastrophes. But occasionally I would bet that sometimes you don't get those calls until something really catastrophic or something really bad has happened. But then all of a sudden when that happens, that's when people are sometimes more open. I hate to say that, but sometimes that's when people become more open to embracing this process. One of the things that you also talk about, and I love how you address this, is this concept of cognitive flexibility. What is cognitive flexibility and why is it important to this process of coaching?

So I think the part of cognitive flexibility really is about being able to task switch and set switch. And so the 2 definitions relates to, you know, when we think about learning, Especially in the ICU, there is some thought about the fact that we're working in pretty highly complicated environments. And so it's a lot of overload and whether that's gonna be to how can you process from a sensory perspective. And when you get overloaded, you have to be able to recognize how to slow down so that you can catch back up and speed up again. And so if you don't have that degree of awareness for your own cognition, that's when People make mistakes. And so we think about this in the competencies when we're teaching or learning. What that looks like from an educator perspective is that, you know, do they learn, right, from self-mistakes? And do they have a process to reflect and talk with others and learn from the process? But that's a really global sort of fuzzy holistic. From down all the way more from the thinking perspective, it's whether you can focus and then switch and be willing to just let go of a prior preconceived notion, right? A prior bias, a prior willingness to actually, just like you said in the beginning, change the color of your sunglasses. And that's actually how I talk about the different levels of energies. Like, these are all different ways you can respond when presented with the reality. We all have choice and agency for how we want to show up that day in that situation.

Mm-hmm.

If you're hungry and hurt and traumatized, you probably are gonna choose what we call level 1, which is just hide. Don't say anything, don't speak up, and just Keep your mouth shut. And then you also might be level 2, which is angry, defensive, and just will lash out at somebody. You also could just be like, I'm just sort of neutral. I'm gonna survive this just by being sort of like non-confrontational. But I also am saying yes to the not right situation we have right in front of us. Then there's people who are gonna get up and care about the situation, which is gonna be to nurse and figure out how to be compassionate to the people and actually give to the situation. Then there's people who are gonna be like, well, yeah, this is a huge problem. We had a horrible error and.

Yeah.

This is an opportunity for us to finally do the right thing, make the policy change, do the education, and bake into the system so it doesn't happen again, right? So people, as you hear this story, you can sort of see, oh yeah, I've seen this in my organization before. And we just show up. We can choose how we wanna do it. And I wanna say that also none of these are wrong or right. Doesn't mean the person who wants to hide and keep their mouth shut is any more right or wrong than the person who sees the opportunity. They're just in the moment. Different ways to hear, feel, and see with the situation. At the end of the day though, at some point you have to be flexible enough to rise up, right? So, and part of the reason why you had said you're amazed by how I was able to kind of get through all such stressors in 2020, but it's also because I teach the wellbeing curriculum and I know a lot of the trauma-informed literature is that trauma can be a permanent scar or it can be the greatest thing that ever happened to you. And you have a choice on how you have your trauma become the best thing that ever happened to you, because then you have those skills of whatever it is. And people don't really realize how to turn their trauma into superpowers. One of the biggest things is having this flexibility to say, okay, that's what happened. It's okay that that happened. And then what am I gonna do differently? And can I just try on other people's way of being? I often tell, like, even in our communication skills, You're just trying on out other people's words. And so in our learning labs, you know, people will say the same sentence over and over again cuz they're just trying the sentence on for the first time because they really like their friend's sentence. I'm like, great, try it on. And they're like, okay. And they do. And then it comes out weird the first time. That's okay too, because eventually you do your own intonation, you do your own cadence, you add on a different jargon so that it becomes more relaxed how you wanna vibe.

Oh, I love that so much. I love how you're encouraging the concept of agency as I have the ability to choose how I respond and show up in this moment. And part of that choice is acknowledging what's going on inside of me. Do I need a Snickers bar? Have I had no sleep? Did I have a fight with my spouse? Did my kid do something that really bugged me today? Which of these things is in me right now? And being able to acknowledge that in some way, but also able to choose. my agency in terms of how I show up in the midst of all of that. But the other thing that I love that you do, especially as you're talking about doing these simulations, is as people are trying on these different phrases, and that's something we definitely do working with conflict too, is this idea of doing role plays and actually scripting and practicing. When I'm in a fast-paced situation and I have a conflict brewing, you know, I have a patient that's crashing, you know, they're in the ER and they need to go for a stat laparotomy and everybody's going crazy and I see people start to escalate. What can I do to actually stop this process from escalating so we can get the patient taken care of? And I have stock phrases that I have. It's like, can we just take a sec? I mean, this will roll off me because I use it to get everybody to bring the room down, and then we can actually pause and we can assess what's going on. And give them a safe space to do it. You're actually creating this environment where they can try it out. It may not feel good to you right now, but say it a few times. And then as you say it a few times, if it starts to feel good to you, try it out in real time. And I think the fact that you give them the space to do that is so powerful for them.

Yeah, I do think the use of the improv actor really across medical schools, I think what's really to me the saddest thing is I think once we're in practice, all of the luxury, I mean, it costs money to run all of these training programs, medical schools using improv and actors to be able to help with the communication cuz it's so critical in those early years. Right. But then once we're in practice, For some reason they think we never need a dose of training again. And yet I think we all need that, right? Because if anything, we need, the stakes are higher and we need to continue to role model what it needs to be. And it's really sad when you go back and teach first-year medical students, they have so much empathy. All of their sentences are so amazing. You realize what has happened to me in the last 10, 15 years that it doesn't just come off so easily, right? With the nonverbals, because they're closer. To having the hidden curriculum of healthcare make it evaporate. And so hopefully we can all be champions of pointing out when it's gone, because I think we often also don't reinforce what's going right. My mentor, Dr. Arnold, you know, he talks about the fact that in some ways education is somewhat like dog training. How do we get the dog to sit? We actually praise them, right? We praise them and give them a treat to be able to say, you did the right thing. Good job. In fact, everything often in our workplace is the opposite. No news until something goes wrong. And so all we are reinforcing is sort of like a negative culture rather than thanks for doing the right thing, or thanks for speaking up, or thanks for apologizing when you were rude. Like, I'm glad you recognized it and no harm done. Thanks for just apologizing to each other.

Yeah.

And it actually just happened to me the other night when I was on call and I'm like, yeah, no, no big deal. Like I didn't. feel anything from it, and thanks for apologizing because we all, I mean, you've been in the operating room for 12 hours. Like I would be tired too, so it's okay. So, yeah.

Oh, I love that so much. And I totally, 100% agree with you. One of the great things to me about teaching medical students is getting that kind of, being able to see that in them, seeing the empathy, seeing, you know, that they genuinely want to be physicians and they want to be part of our system. And I think that's always inspiring. And every time, every time I'm around medical students, I come out of that interaction feeling like, okay, dang, yes, this is the reason why I'm doing this job. I want to be that kind of energy. But there was something else that you said that I really want to come back to, especially as an educator and working with students and residents, even junior faculty, and even our colleagues. I teach martial arts. And one of the things that I always used to do when I taught martial arts classes, even because I've done this for a while, is every single student in that class that day. I would say one positive thing to them before they left. At some point during the class, I would say, I love how you're holding your hands. I love how you're doing that kick. That was a great sparring round that you had. And every single person during that day got one positive comment. Now, sometimes you gotta look if someone's really struggling on a certain day, you gotta really find something. It's like, but you find one thing. And even if you give them 4 or 5 things they have to work on, they've left that day with one thing. That's positive. And what will they say when they leave that class? That was a good class. They will leave that class feeling good. And even when you're seeing patients in the office, I will try to find one thing. Your nails look really cute. I love your nails. I love your shoes. I'm really proud of the fact that you took your medicines on schedule. I'm really proud of the fact that you actually kept this follow-up and we got this checked out for you, but you find one thing. And it helps people buy into whatever it is you're doing with them, whatever process you are working on. When you give people that little bit of positivity, they will come back and they will also have the sense that whatever it is that you're working on for them or with them, it is to their benefit and they will buy in so much faster. So I love the fact that you emphasize that.

That's, yeah, that's really a teaching point in general. Just can you notice what's gone well? One thing for every student, that's actually Not so easy. And I just think now again of all the elementary school teachers, right? Because you do need to do that because otherwise you get demoralized. Like, why do I even come here? I get nothing right. Zero out of zero. It's horrible. And so just noticing that we all have to be, just be better observers. Really teaching in many ways is just noticing what's gone right so that we can keep doing it because otherwise it might just go away.

Absolutely. No, I agree with you 100%. So you are working with a group of physicians and you're working on their communication skills. What's one skill that maybe every physician should try to master or maybe work on as part of their skillset? One communication skill.

So I think for some people they also call the bucket of this into like the active listening sort of process, right? Which is just Not responding in the way that you think you're supposed to respond, which is I need to give you my perspective or give you another fact. It's really just recapitulating, did I understand you correctly? Right? So it's oftentimes either the summary or it's like, I heard you say, or what I'm noticing and trying to be a more active listener in just summarizing what you've just heard because that helps you get into alignment very quickly, you know, in terms of whatever it is you're given. From a patient's perspective or a surrogate's perspective. And then being explicit about transitioning, right? Is like, would it be okay? Like always asking permission. Is it okay if I talk about this? Is it okay if I give you the serious news? Is it okay if we now talk about what I'm worried about? Is it okay? We give control back to the other person actually in that sentence because we often don't. Okay. Nobody likes to be bulldozed in a conversation, right? This is also why mansplaining is also very uncomfortable for many people in a room because it's like, I didn't ask for you to repeat and re-explain everything I just said. I needed you to acknowledge and hold and verbally restate what I just said so that I know that you heard me. And so I think that will go a long way in general, the active listening techniques that lots of different communication teachers talk about.

I love that. And you're absolutely agreeing with me. That is one of those things in terms of building alignment. The idea of being a good listener, being a reflective listener, and actually participating, listening as a participatory activity and not a passive one, I think is tremendous. I love that so much. And what you just said, I love this and I'm going to start applying this Monday. That is it okay if I, because that's one of those things that honest to goodness, Lillian, today. That's something I would've used today with a patient. I actually would have used that today, and that's something I'm gonna start incorporating. So thank you for sharing that because I love that so much. So before we close, what's one thing right now as you're doing your work, not just as a clinician, but as a coach, what's one thing you're seeing right now in healthcare that gives you hope for our healthcare system? In our physicians?

I would say probably it is just like you said with the medical students, it's really just the people, right? The people really are there for all of the right reasons. You know, no matter what role you are or whether you're in leadership or not in leadership, people are there for the right reasons at the end of the day, which is to make people better, to make the system better, to be able to advance science, technology, delivery. I mean, no matter where you are, what you're doing. You're there for the right reasons. And I think the heart, right? The heart of healthcare really is still the backbone of what it is. And then there's always like funny incentives and structures and errors that can happen along the way. But if we focus on the people, and this is why I think the reality is probably for the— I've always been a people-focused person, right? Obviously as an educator, but even this next phase of my career in the coaching is really about developing the people because without that. I mean, yes, AI's gonna take over some of the tasks. Yes, we'll become more productive in some ways. We may become more accurate in some ways. We may even be smarter in some ways because we'll have the additional brain of an AI bot with us. But at the end of the day, it's still gonna be people on people, right? No matter how you look at it. So I think it's the people in healthcare.

I love that.

Lillian, thank you so much for being here. This has been amazing. If people wanna reach out to you, if they wanna know more about your healthcare coaching, if they wanna know more about what you do, how best would they reach out to you?

Yes, you can email me at hello@transforminghealthcarecoaching.com, which I know is a little long, or you can find me on LinkedIn. LinkedIn's my favorite social media location. I post every single day. It's my favorite place to be. There's lots of really great humans out there on LinkedIn. But if you're not, we're also on YouTube. We have a podcast, Transforming Healthcare Coaching Podcast, on Apple, Spotify, YouTube. And honestly, if you wanna get closer and just kind of hang out with whatever we're up to, we actually have a small little community called MedThrive Connect. And I'll provide the link for the show notes where you just sign up. You get free information just on our podcasts, our live LinkedIn webinars, and just get close so you know what cool, interesting things people are doing in healthcare to help healthcare professionals be better humans.

That sounds incredible. And we will put the links to all those in the show notes. Lillian, thank you so much for being here. This has been incredible.

Thank you so much for having me. The work you're doing is really amazing and important. 'Cause I think people don't really realize how much communication really is what empowers majority of what we do. Yes, we went to and studied for a long time, but how it gets actualized is the precision by which you communicate. And that's why your podcast is really amazing.

I appreciate you and I appreciate the fact that we've had so many generous people who've given their time and their talent and their energy to helping people see into how these processes make us better doctors.

So.

I appreciate you so much. Thank you.

Thank you.

And for all of our peaceful warriors who joined us today on The Scalpel and Sword, until next time, 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.