Opening a can of worms: (1) asking a simple question that unexpectedly brings up many complications; (2) a therapeutic strategy to help patients and family members understand and support each other.
Interacting with patients is a complex process, tricky to analyze or summarize. However, there is one thing we know for sure —sometimes the interaction will verge on and then evolve into a difficult conversation. Unexpectedly or predictably, we often find ourselves facing uncomfortable topics such as stigma and cosmetic concerns, resistance to change, family pressures, unrealistic expectations and disappointment. Difficult conversations certainly can occur when the appointment includes a family member: now there are multiple perspectives and additional tensions to consider. When these moments occur, we have a choice—do we avoid or engage?
Avoidance is understandable: we equate these kinds of conversations with “opening a can of worms,” or unintentionally asking for trouble. There was a time when I dreaded even the prospect of these conversations, and would wonder: if I engage in this conversation, what good could possibly come of it? Surely the wiser course of action is to duck out of the situation altogether!
But after reading Difficult Conversations: How to Discuss What Matters Most (Stone et al., 2009), I knew I had to work this out. Yes, essentially we do ask for trouble when we engage in difficult conversations, but there is such a thing as “necessary trouble,” i.e., the expected stress points patients and their family members naturally experience and need our help with. Even though uncomfortable, good can come of it. When we approach a difficult conversation as a therapeutic opportunity, we give patients and families the chance to describe their experiences, hear others’ perceptions, clarify misunderstandings, and hopefully find their way back to the common ground they share as a family.
Nowadays, I find it helpful to reflect on actual or hypothetical difficult patient and family conversations, and discuss them with colleagues. Since our instinct is to recoil from “can-of-worms” conversations, we probably need to practice readiness for the times when these conversations come our way. If you are interested in further reading, a recent article in the Hearing Review provides examples and additional thoughts on difficult conversations in family-centered audiologic care. It is encouraging because it highlights that becoming comfortable and effective with difficult conversations is a learnable skill for hearing care professionals.
If you have suggestions on managing difficult conversations, we would love to hear from you in the comments section below.
Reference: Stone, D. et al. (2009). Difficult conversations: How to discuss what matters most (10th year ed.). NY: Viking.