Civil Discourse and Medicine: The Connection
When you hear “civil discourse,” what comes to mind? A room of politically charged individuals debating gun safety vs. gun rights or immigration policy? Sounds stressful. Why would anyone want to engage in something like that? And what could possibly be the connection to learning how to practice medicine?
In this hyperpolarized climate, we sought out opportunities in our community where we could participate in civil discourse. Our motivation was simple—we needed a positive outlook on where our country was going that media, whether it be newspapers, radio broadcasts, or our Facebook or Twitter feeds, was not providing. Listening to news stories on immigration seemed to be putting up walls rather than bringing us together, inspiring the best in us, and alleviating tensions while promoting hope. We became members of Common Ground Nashville, a local group that meets monthly around national and local issues, and Better Angels, a national group in all 50 states that focuses on helping people across the political divide learn to talk with each other in a civil manner. We believe that ideas are strengthened when they are challenged and that the best ideas are generated from a pool of diverse contributors. Our goal is to promote understanding and find agreement when possible.
The story of a woman growing up in a rural area of our state—where knowledge of how to use a firearm protected her and her younger sisters– did not change many Common Ground Nashville members’ positions on the importance of gun legislation. However, after hearing her story we all agreed that we wanted safe communities, including safe schools for our children and safe places of worship.
Our group discussions are rooted in ground rules—being non-judgmental, embracing curiosity, asking lots of questions, listening respectfully, and welcoming others whose views are different than our own. Moderators and even individual members ensure that the environment remains safe from disdain by gently reminding each other to remain civil. Not surprisingly, these ground rules apply to launching discussions and running meetings in our work lives as well.
What does civil discourse bring to practicing physicians, trainees, and staff? The same ground rules and core principles make us better physicians. For example, in really listening to a family member’s story of trying to navigate bedtime routines for a grandchild cared for in multiple homes on different nights, and showing understanding for her challenges, trust is developed. That trust paves the way for developing a realistic treatment plan together that the family will actually implement.
Expressing curiosity is key to disarming the defenses of a fearful patient who might, for example, object to being treated by a caregiver of a certain sex, race, or religion: “Could you tell me a little bit about how you’ve come to believe that another clinician would provide you with better care? I’d really like to understand.” Learning what drives behaviors that might appear irrational on the surface can soften the judgment and allow for expression of common ground. The approach taken by a doctor confronting a fearful patient illustrates this: “As a medical student, I discovered that I secretly preferred a male as my mother’s surgeon, and I’ve learned over the years that my female colleagues are providing care that I consider excellent and often more intuitive than that of my male peers.” Exhibiting curiosity is a useful skill in other relationships encountered in the medical workplace; a set of early career physicians report feeling more open to feedback themselves when approached by a leader who invites them to share more deeply their experience of events that are reported to him. These clinicians consistently provide details that highlight the complexity of situations that have no easy answer, a parallel to the issues found in our political landscape today. This administrator-physician enriches his perspective and improves the chances of better processes and policies due to more complete input.
Engaging in these principles of civil discourse can even improve medical care! Consider the example of an anesthesiologist who has serious concerns about moving forward with an operation that a surgeon feels confident should proceed. The anesthesiologist said, “I’m not sure there’s enough evidence for me to be convinced that this is a necessary course of action. Could you give me more facts so I can better appreciate your position?” Despite the difficulty of confronting a senior clinician, she was able to voice her discomfort, and a surgery was postponed that was later deemed one that most likely would have had serious adverse events. A posture of humble acknowledgement that all of us have something to learn and have reasons for our choices keeps a level playing field so that others do not shut down, convinced that they cannot be heard.
Separating the source of another’s attitudes or choices from the actual person is challenging but very helpful. For example, in the event that the mother of a patient is convinced that a vaccination is more likely to harm than benefit her child, taking the view that a parent is acting on the information that they truly consider trustworthy is important and often pays off. This happened when a pediatrician empathized with a set of parents who refused vaccinations for their child, patiently letting them know what a struggle it was when he had to subject his own child to a risky procedure that had a positive outcome; his nonjudgmental stance gave them space to weigh the risks against the benefits of the decision, and they decided to follow his recommendation.
Want to participate in a civil discourse group? Do a web-search on civil discourse and your city or town. Explore Better Angels, or Living Room Conversations, which provides materials to conduct conversations which generate understanding and enable collaborative problem-solving. You may want to check out this NPR podcast on the variety of groups across the nation engaging in civil discourse. Or you may want to start your own group at your medical center. As Margaret Mead said, “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.”
Beth Malow, MD, MS, Professor of Neurology and Pediatrics, Director Vanderbilt Sleep Division
Catherine Clark, MA, Senior Program Manager, Department of Anesthesiology
Vanderbilt University Medical Center
Creator: Better Angels: Reuniting America