Getting into the Groove:  Self Examination of the Academic Detailer Before Meeting the Apparent Over-Utilizing or Mal-Utilizing Test Orderer

Yesterday, I attended a terrific one day course entitled Health Care Leadership:  The Difficult Conversation in Health Care.  It was taught by two legal beagles, The Honourable Judge Heather Lamoureux: Chartered Mediator and Elaine Seifert, Q.C.: Chartered Mediator.  They are the authors of “Resolving Conflict Improving Communications monograph.”  My intention in attending their presentations was to “sharpen my saw” so that I would be better able to communicate with physicians who were either using tests inappropriately or generally over-ordering.  This type of communication can never be a lecture or a confrontation as it would lead to polarization and minimal, useful interaction. 

Our group generated some questions that the initiator of the Difficult Conversation must think about before interacting with the other party.  I list them below:

What are the goals?  What do we want to achieve?

What is the overall plan?

What are the barriers to the communication?

How do we encourage mutual conversation?

Do we have enough time?

Do I have the time and patience to this?

What is my frame of mind?  Am I too tired?  How do I feel?

How do I stand in this situation?

What assumptions am I bringing into this discussion?

What interest groups are involved?

Do I care what this person thinks and feels?

Am I the right person to have this conversation?

What is at stake?

What are the issues?  What is the real issue?

What are my biases?

What is the narrative?

What are the rules?

What are the objective standards?

What is missing in my story?

What does the other person know?

What is the other person thinking?

What are the other person’s feelings?

How do I contribute to the problem?

How have I enabled the behavior?

How has the system enabled the behavior?

Why was this not addressed earlier?

What words do I use that are authentic and will not derail the conversation?

What are the short term and long term plans?  (Need to document these plans - cell phone photo works well)

What is the exit plan including setting up another meeting or bringing in a more powerful individual?

I am sending this list to several of my associates who interact with some physicians who typically order 40 or 50 tests on each patient seen.