All surgeons work in groups, but few training programs focus on the importance of the interpersonal skills essential to building and developing high-functioning teams. Daniel Eiferman, MD, MBA, FACS, shared critical lessons during yesterday’s interactive workshop Navigating Difficult Conversations.

Dr. Eiferman identified three tenets that create difficult conversations: differences of opinion, high emotions, and high stakes. Based on neurochemical findings, the brain does not operate at an optimal level when these conversational elements are present.

“We fail at difficult conversations when we don’t feel safe anymore,” Dr. Eiferman explained.

When one or more participants in a conversation begins to feel unsafe, it can evoke two potential responses. The first is silence or withholding meaning from the conversation. The second is violence or forcing one’s perception and reasoning onto the conversation. Neither usually leads to productive solutions, Dr. Eiferman noted.

He shared several practical strategies to ensure that others feel safe during difficult discussions. The first proposal was to leverage Rapoport’s Rules, which state that before verbally disagreeing with another person, one must attempt to:

• Rephrase the other person’s position
• List mutual points of agreement related to the relevant topic
• Express what one has learned from the other person’s stance

“If you’re able to state the other person’s argument more clearly than they can, you’re going to be in a good position to help them see the other side,” Dr. Eiferman said.

Dr. Eiferman also discussed Not-Invented-Here Syndrome, characterized by people’s tendency to reject products, research, and knowledge they did not create themselves.

“One of the things you have to do when you’re having a difficult conversation is to guide the conversation in such a way that the other people feel that they came up with it [the solution] themselves,” Dr. Eiferman said.

The best way to guide another person to a conclusion they believe to be their own is through open-ended questions. Dr. Eiferman noted that using a calm tone and relaxed body language are key considerations with this strategy.

He cited studies that showed speaking in overstated and absolute terms decreases one’s influence in a conversation. Conversely, speaking naturally makes people more open to the ideas being shared.

Feigning ignorance is another option to help successfully navigate a difficult conversation, Dr. Eiferman suggested. Positioning the other person in the conversation as “the expert” causes them to relax and more enthusiastically answer questions posed to them. Once they feel safe in the conversation, open-ended questions can be used to gain insight into their point of view or expose contradictions and problems in their logic.

Other ways to increase the perceived safety of a difficult conversation include reestablishing a mutual sense of purpose and respect, Dr. Eiferman said.

When an individual feels as though the person they are speaking with is working toward the same goal and considers them an esteemed colleague, elements such as high emotions or high stakes are less likely to derail the conversation. Even small gestures such as nodding at key points made by the other person can create a sense of engagement and respect.