Space Captain: learning to live together through the years

Here’s why I like the song called “Space Captain” in the video above. It reminds me of the necessity of learning to live together, which is what I always think the title of the song ought to be. This song has been covered by many artists. It’s longevity must have a good reason. I think its because the song is about what it takes for people on the planet to thrive–we have to work and live together.

I’ve been a consulting psychiatrist in the general hospital for most of my career. I’ve had some very difficult conversations with my colleagues about how to manage particularly challenging situations in which patients are delirious or struggle with long hospitalizations are demoralized, or who have longstanding patterns of adapting to stressors in general with unhealthy coping styles. These conversations are pretty much always as the authors of a sort of bible about handling difficult conversations describe [1]. Difficult conversations are like hand grenades. If you hang on to them they can blow up in your hand. You can’t avoid them. It’s far better to open the conversation with colleagues and patients by listening carefully first, then trying to sort through the 3 conversations Stone and others describe:

1. The “What Happened?” Conversation: This is mainly about the content of a consultation question or the expectation the consulting physician had (both explicit and implicit) and what the consultant’s approach was–as well as how that was communicated.

2. The Feelings Conversation: This is about the inevitable matrix of emotions in which difficult conversations occur. They run the gamut and they’re usually intense and basic, like anger. This is where you have to decide whether to just keep a lid on them or discuss them. No matter what the choice, it’s ideal for all the stakeholders to at least acknowledge their own feelings. “if you don’t have your feelings, your feelings will have you”.

3. The Identity Conversation: This is about our professional and personal identities. All too often these are threatened by questions about whether we think we’re being called “competent” or “incompetent”. It’s not hard to see how lack of recognition of this conversation can lead us astray and interfere with collaborating in the service of what is always the main goal: providing high quality health care to patients.

1. Stone, D., B. Patton, and S. Heen, Difficult conversations : how to discuss what matters most1999, New York, N.Y.: Viking. xxi, 250 p.

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