Discussing the Grandkids: If RBG and Antonin Scalia can Find Common Ground, Then so can We

From the 1/22/2021 newsletter 

Director’s Corner

 

 

Discussing the Grandkids: If RBG and Antonin Scalia can Find Common Ground, Then so can We 

 

 

By Adina Kalet, MD MPH and Kathlyn Fletcher, MD MA

 

 

This week Drs. Fletcher and Kalet team up to argue that there are ways in which nurturing a patient-physician relationship resembles the healing our society needs today …

 

 

As clinicians, we learn to build rapport quickly. Most of the time this is easy. After all, people come to physicians and other health professionals seeking help or advice and are predisposed to trust us. Under most circumstances, we use our verbal and nonverbal skills to put the individual at ease and make an opening invitation, something along the lines of, “Tell me, what is going on?” or, “How can I help?” to get the patient telling their story. Evidence suggests that establishing a narrative thread, by encouraging the patient to speak uninterrupted and actively listenining  is the most efficient way to get to the “heart of the matter.” It provides information  for clinical reasoning and also establishes the therapeutic alliance needed to ensure shared decision making and a workable plan to address the issues that need tending to. And it usually takes under two minutes for the patient to come to the end of their story.  

 

Most of the time, this process works as it should, but occasionally, even seasoned clinicians find themselves struggling to make an initial connection with someone. When that happens, I (KF) pivot to something that I suspect we can connect about.  Given that I practice at the Veterans Affairs Medical Center and that many of my patients are older, my go-to is the grandchildren.  I have found that  when interactions aren’t going well, asking about grandchildren brings a mellowness that descends like magic.  Most people can’t help but smile.  Pretty soon the pictures are out, and we are connecting on a new level, with tenderness, talking about hopes for a better future.  

 

 

Recent events reverberate 

 

We can’t stop thinking about what happened at the US Capitol Building Wednesday, January 6, 2021.  In the days since, we have talked to many colleagues, friends and learners.  We have heard the same words time and again: shock, fear, shame, anger. 

 

Obsessively watching the news and checking newspaper websites has proven unproductive (not surprisingly), although it has been really hard to avoid.  As more details become available, the terrible implications of that day seem to increase, as do our anxiety and sadness.  Talking about the events does not lead to sense-making or understanding, and only reinforces negativity.  As we faced our colleagues and programs, we asked ourselves, How can we move from despondency and anger to action? How can we stop the feeling that we are banging our heads against the wall? 

 

Independent of one’s political views, we suspect that the thought of engaging the “other side” in dialog about the issues seems exhausting and futile.  But what other way is there?  

 

I (KF) found inspiration in an unlikely place, my email inbox! A message from Chad Kessler, National Director for VA Emergency Medicine, provided important advice about talking with  skeptical VA patients reluctant about receiving the COVID-19 vaccine.  He reminded us that, in some cases, providing facts – particularly when so much is still unknown – is not helpful.  For people fearful of the vaccine, trust in their doctors is more important than explaining the results of the randomized controlled clinical trials that led to emergency authorization. So, his advice was to focus on building the trusting relationship rather than trying to convert patients into vaccine believers. Asking about their health beliefs, listening to the answers, letting them know you care about them and their health, understanding their fears and concerns and, well, maybe asking about the grandkids, is time well spent.  

 

Perhaps the way forward isn’t to convince other Americans that they are wrong and that we are right.  Perhaps the way forward is simply expressing caring in different ways, finding ways to hold different views without fracturing relationships, and sharing a commitment to our common future, as embodied in our children and grandchildren. 

 

 

Reaching across

 

The New York Times reported on a nonpartisan project that brought 526 strangers from across the US and  the political spectrum together for a four-day retreat where they talked in small groups  about a wide range of issues that affected their lives.  The description of the project was inspiring.  Participants reported gaining perspective on how political and social policies affect other people’s lives.  It sounds so civil!  What is to stop of us from doing something similar in our own spheres of influence? 

 

 

An unlikely friendship as a beacon of hope

 

On the surface, the famous friendship between Justices Ruth Bader Ginsburg and Antonin Scalia defies comprehension.  And yet, it grew over decades across their tenures at the US Circuit Court of Appeals to the Supreme Court.  These two storied judges certainly did not agree in their work. Scalia regularly attacked the ideas expressed by RBG, but he never attacked her. She regularly and vehemently disagreed with his legal philosophy but had a deep and abiding respect for his, “captivating brilliance, high spirits, and quick wit.” They had a deep, respectful, and caring relationship with each other based on shared loves of  opera, theater and, of course, grandkids, sharing many meals and social outings.   These beautiful relationships which occur despite polarizing differences in politics seem exceedingly rare and precious these days.    

 

 

As physicians, we have the privilege of trustworthiness and the skills needed to find common ground. We routinely must navigate differences in belief systems toward solving a shared common goal. Perhaps we should expand our influence on civic discourse as well.   Asking about the grandkids, actual or only imagined, can focus us on our shared futures.  

 

 

 

 

Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin

 

Kathlyn E. Fletcher, MD MA is a Professor and Residency Program Director in the Department of Medicine at the Medical College of Wisconsin. She is the co-Director of the Graduate Medical Education Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.