Difficult Conversations??
Frequently, I’m asked about how to have difficult conversations within the personal injury and compensation scheme. I have my default response, though, recently, I invested some time to having a good hard think about this topic, and I kept coming back to one question - Why are some conversations “difficult?” I pondered;
Is it difficult for us as the professionals to discuss certain topics?
Is it difficult for our clients and patients to discuss certain things?
Is it difficult for some other reason?
A little from column A,B and C?
The Cavernous Knowledge Gap
Many years ago, as a young rehabber, a difficult conversation was any discussion beyond the weather. From my musings, I came to the conclusion that it was a combination of the limitations in my own knowledge (mainly technical), and a lack of confidence because confidence only comes with experience. Over the years, I have been involved in thousands of cases, I have spent countless hours deep diving into regulation, legislation and guidelines. I’ve read hundreds of research articles, listened to a myriad of stories from injured workers and their families, spoken with medical people, chatted with claims managers, and engaged with employers. I have been obsessed with perfecting my skills as a rehabilitation consultant, spending an arguably unhealthy amount of time assessing my actions, critiquing my own decision-making, and studying strategy. Then there are the hours of reading back on file notes, reviewing reports and emails, and repeatedly replaying conversations over in my mind. Did I listen enough? Did I give the correct information? Did I prematurely articulate?
All of this in an attempt to fill the cavernous holes in my knowledge, to find new and innovative ways of doing things, to gain experience and with that, confidence. As a young rehabber, I set off on the endeavour to be an expert in workplace rehabilitation. Frustratingly, the more I learnt and listened, the wider the knowledge gap became. The daunting realisation of just how much there was to learn, and the distance needed to travel to reach expert status. Or if the notion of expert was just an illusion. What surprised me though, is this – I like standing in the abyss. In fact, it’s pretty fucking cool and exciting. It makes me feel like an explorer.
Another exhilarating benefit of this constant analysis and learning is that, now, I rarely see any conversation as being difficult. Yes, off course, conversations can be frustrating, annoying, tedious and tiresome. But difficult? Nope. Though, the wordsmiths amongst us could argue that these are all synonyms for the word “difficult.” I’m looking at you Amy Rose - move along, nothing to see here.
Back to Basics
Let’s go back to the basics, shall we. The inter-web provided three main definitions for the word “difficult”
1. Needing much effort or skill to accomplish, deal with, or understand. In a sentence: "she had a difficult decision to make"
2. Characterised by or causing hardships or problems. In a sentence: "a difficult economic climate"
3. (Of a person) not easy to please or satisfy; awkward. In a sentence: "Bob could be difficult"
In pondering these definitions and their relationship to rehab, there are many examples from my own career which would meet each of those definitions. In general, as “professional strangers”, a phrase coined by Rosemary McKenzie-Ferguson, to achieve our mission and purpose in healthcare and injury management requires much effort or skill to accomplish, deal with, or understand. We put in a significant amount of sacrifice and effort into studying and trying to become experts in our very specific field whether it be clinical practice, consultancy, or management. Our results come from constant practice and evolution, and, let’s be honest, a lot of fucking-it-up, making shit up along the way, and making mistakes. We learn best when we fail whilst inching ever closer to the elusive expert status.
The very nature of injury management is characterised by hardship and problems. The rehabilitation strategies we recommend will definitely cost money, time, effort, and physical and emotional energy. Long-term workers compensation is a pathway to poverty with a person’s wage benefit usually less than their normal income. Moreover, professional strangers meet a person during a pretty crappy time in that person’s life. As such, it is our responsibility, our duty to be nice.
For those keeping score, let’s complete the trifecta of difficult. The injury management system by its very nature involves many people. How many people does it take to manage an injury? These many people come many personalities, intentions and motivations. The very simple fact that each human is different, we are constantly compromising and trying to find that one sliver of overlap on the venn diagram where everyone’s needs and wants are met.
It’s a constant losing battle for professional strangers. One decision could simultaneously satisfy one person and dissatisfy another. It’s a rare occurrence for everyone to get exactly what they want in injury management.
So, how the heck do we work in a system when everything we do seems to be so damn difficult? When every decision will concurrently hit and miss? When a common saying is “Shit! One of my cases just blew up”
Having worked in compo since 2004, here are some of tid-bits, things that I have learnt along the way, things which might or might not work for you, and things I wish someone had told me.
Knowledge is Power.
Spend time understanding legislation, guidelines, regulations, and policy. A good starting point is reading the information fact sheets which are available on every regulator’s website. There are information sheets for injured people, employers, Doctors, and allied health professionals. There are frequently asked questions (FAQs) in compo and rehab such as questions about wage benefits, medical approvals, worker and employer obligations, and timeframes. By knowing what are the FAQs, you will learn what are the answers, or at the very least, know where to find the answers. The thing is, try as we might – we will never know everything about anything. We will be constantly learning, refining, adapting and shifting. Build a diverse community of peers who have various experiences and areas of knowledge and be an active part of that community.
Be Curious, Not Furious.
Accept that every person has their own intentions and is looking out for their best interest. This is not a bad thing. This is the reality. We have been raised to be know-it-all professionals and this is no longer serving us well. Our role as professionals is to provide information to empower people to make their own, well-informed decisions. Even though, at times, our experiences will give us a good idea of what will be the outcome, we must respect the decisions of others.
Shut Up and Listen. It’s Not About You.
As my friend, James Ellis so eloquently phrased in Episode 5 of The Intelligent Rebellion Podcast. “Premature articulation is the dumping of information on people way before they’re ready for it.” Again, we have been raised to be know-it-all professionals and this is placing too much pressure on us. We need to move past the egotism that we are the catalyst for change, that we are solely responsible for facilitating an outcome. Challenge yourself to listen with a clear and open mind, one where you hear every word being said and to not always have an opinion or response. Recently, this is the skill which I have been practicing the most. Allowing the people whom I speaking with to guide the conversation and then asking them what information they would like or need to help make a decision, rather than prematurely articulating.
Play by the Rules.
Nobody likes a cheat! Only bad humans cheat on purpose.
Early in our career we sometimes break rules which we didn’t know existed. Take the Mulligan. Though, even early in our career it is our responsibility to play by the rules and demand that others do the same. Over the years, I have seen a significant disparity between the number of instances injured workers are reprimanded versus the number of instances a professional is reprimanded for breaking the rules. The culture of professionals protecting their own has to stop. We must hold ourselves to a higher standard.
Final thoughts (for now).
Let’s finish where we started. How do you have a difficult conversation?
Cheers for now, -Rhea.