This is the Drive Time Debrief, episode 213.
Hey friends. Welcome back to the podcast. I'm Amanda. I'm Laura. And I'm Kendra. And today we are finishing out the fifth pillar of emotional intelligence, which is social skills. So before we dive into this fifth pillar, let's zoom out just for a second. Remember, the full framework, emotional intelligence is often described in five pillars.
The first is self-awareness, which is noticing what's happening within you. What am I feeling? What's triggering me? What state am I in right now? Then the second is self-regulation, and that's managing that internal response skillfully instead of just reacting. The third is motivation. Staying connected to your purpose, values, and what matters most, especially when things get hard.
The fourth is empathy. That's understanding what may be happening in somebody else rather than always feeling exactly what they feel, but just being aware of what's happening in the other person, both emotionally and relationally. And then the fifth skill is what we're gonna talk about today, which is social skills.
This is where all of that becomes visible in how you listen, communicate, validate, collaborate, repair, and lead. So in a way, this last pillar is where the other four start showing up out loud.
And I think this one gets underestimated because social skills can sound like charm school or cotillion or polish, or you know, being naturally outgoing, but that's not really what we're talking about here. What we mean is the ability to read the room, to regulate yourself in real time, to listen for what is actually happening underneath those words, respond to emotion without either dismissing it or drowning in it.
You know, staying the course and honoring another person's agency, meaning their ability to be in charge of their own life and help truth and care exist within the same conversation. So in other words, this is where emotional intelligence becomes visible because it's one thing to be self-aware, but it's a completely other thing to understand your own emotions.
It's one thing to have empathy, but social skills are where all of this starts to show up in actual patient care, in actual teamwork, in family conversations, and within the dreaded conflict. And in medicine, especially these skills matter because patients don't always come in neat. They for sure don't always come in emotionally regulated.
Nope. And they don't always have beautifully concise language. Sometimes there is Graham, I'm talking about her cats and the wet food and how she. Well, the first time, I remember the first time in North Carolina, Laura, when somebody told me they put fatback on it. And I was like, what is that? What are you, what even is that?
I had to go ask and feces and goody powders. I'd never heard of those things. So anyway. Yeah. So, patients and people and loved ones come scared. They come to us overloaded, ashamed, angry. There can be grieving, there can be confusion, and sometimes there's a lot of distrust, unfortunately. So today we're gonna talk about what social skills really are, what's happening in the brain when it's going well or when things are falling apart. How empathy fatigue quietly erodes social skills and what it looks like to restrengthen them in a way that helps doctors be both more effective and more relationally skillful. Yeah, I love that. You know, I think back to probably in med school or residency, why didn't anyone just let me in on the fact that patients come in with all of this scared, overloaded, overwhelmed, ashamed, grieving, like I had no context whatsoever that I would walk into a blazing F5 tornado. Sometimes like I experienced it and I was like, okay. Right. But like, wouldn't this have been great information to have had, like starting out, just knowing, hey, you're gonna walk into fear, you're gonna walk into grief, you're gonna. Just even the language, like even if I wasn't well, that would've required talking about feelings.
I know. Oh, oh God. I'm just like, hey, patients are gonna come fully loaded. Like even that, just like, just know when you walk into a room, it's gonna be fully loaded and it's not your fault, like that's the other part. I know. It's nothing to do with you. There's nothing that you could have done. Yeah.
That second star service for this. I know and like, man, it would've saved me, whatever. But anyways, I love this topic. This has been a great series. Y'all definitely not only finish listening today, but go back and listen to all of these episodes. These are priceless. And you know, when people say, oh, that doctor's a great communicator, they don't really mean that you're like entertaining them, that you're like highly intelligent. It means that they felt understood. It means they felt heard. It means that they felt respected for bringing this forward or bringing it to your clinic or the ER or whatever. They weren't steamrolled, they weren't dismissed, they weren't disrespected, they weren't whatever.
That's what they mean. And so underneath all of that is a bunch of sub-skills. And you know, it's not my responsibility, but I just feel like apologizing to all of us doctors who never got this and who never really got this underlying group of sub-skills. You know, talking about emotional validation instead of dismissing everyone, and it's honoring the agency of the patient too, instead of just sliding into, you know, authoritarianism or paternalism.
Right? It's setting an agenda collaboratively instead of just launching into your own priorities, right? I mean, we hear about shared medical decision making, but there's a whole subset of skills in order to make this happen. And it's checking understanding instead of over explaining or apologizing all the time, it's responding to that emotion before piling on more data.
It's like checking in like, hey, I know this is heavy. I just laid this down. Do you understand what I'm saying? You know, before moving to the next step of, and now I'm consulting the general surgeon 'cause we need surgery right away or whatever. And it's repairing. It's repairing the misattunement. If you miss something, just repair it quickly instead of just walking out acting like nothing happened.
That sometimes can be that feel of dismissal or disrespect or whatever that the patient would experience. And these aren't small things, you know? This is really the heart of building that doctor-patient trust. And neurobiologically, this is not just like one little people skills button. You know? This isn't taking that Communications 101 class in college, right?
Anyone else and like saying, okay, I'm good. Social communication depends on networks involved in reading cues, assigning emotional meaning, perspective taking, behavior control. So when a doctor communicates well in a tense room, they're really doing a lot at once. So let's just break it down. You know, a doctor that is doing communication well tracks the patient's face, is constantly looking at them in the eye, in the face.
They're noticing the tone and maybe their breathing increases or just certain bodily cues. They're monitoring themselves all at the same time. Checking in with yourself. Am I getting defensive? Is this triggering me? They're making meaning, they're choosing language and they're trying to respond in a way that the other person can actually receive.
So this is very, very sophisticated and you and I are talking here in the comfort of our home, not in a you know, level one trauma or super stressful situation. Imagine turning this on when the stakes get high. So let's talk about a quick example. Dr. Maya walks into a follow-up visit, ready to discuss blood pressure and diabetes.
Before she even begins, she says, hey, before we dive in, what are the top one or two things you most want to make sure we address today? Sounds tiny, but it's not tiny. That's the agenda setting. Now, picture the opposite. Dr. Maya walks in, immediately starts reviewing labs, medication adherence, diet, only to discover 10 minutes later, the patient actually came in terrified about chest pain that he had two nights ago. So it's not a knowledge problem. That's a social skill problem. And now imagine the patient says, you doctors never listen. A low skill response might be, that's not true. I am listening. A higher skill response might sound like, it sounds like you haven't felt heard. Before I go further, tell me what feels more important for me to understand today. That response does several things at once. It not only validates, but it slows down. It invites agency and it moves more from correction or I would even say like dictating to the person to collaboration.
And that's a social skill. Hey, can I just interject something here? Mm-hmm. Because I'm thinking of at least one client, and that client, if he listens, I want this to be clear because this doesn't mean that we get stuck in the room and let the patient say, you know, talk about their cats and their neighbor and the mailman for an hour when you've got a 20 minute visit scheduled.
Would that be kind? Yeah. Some people might argue that it would be, and it would not be kind to you or the rest of the clinic. You can successfully collaboratively create an agenda and move things along. You're still the leader of that visit and you're inviting their feedback. And I think that the low skill approach that we're reading about here, talking about here is that doctor coming in, not even acknowledging them as a human, but like being a robot. Okay, I see this, this, this. Here we go. Then we're done. There's a happy middle ground where you can connect emotionally and still move the visit along so that you don't kind of get bogged down in there.
Yeah, I think reasonable agenda setting. I think even just opening up the floor. In that higher skill response that said, it sounds like something's more important here. What's been going on? Right? And so that did a whole bunch of things. She noticed like, something's off here and you know, even if she did go into the room and just start right away, like, did you take your diabetes? Have you filled out your log? Blah, blah, blah. Then even pausing and noticing their answers are gonna be maybe tight or impatient or something, you know, something that you could read. And so I think you know that's a very good point. We probably aren't talking about the guy that had the chest pain two days ago that grandma's talking about cats and stuff.
You know, that's gonna be like a low yield kind of thing. But I do think it does take just for us too, as the physician, as the leader, to slow down just a pause, you know, and recognize the situation. So here's another one. Dr. Daniels explaining a new diagnosis. Patient keeps nodding and a lot of doctors might assume like, okay, great, they got it.
But instead, Dr. Daniel says, just so I make sure I explain this clearly, can you tell me in your own words what you're taking from this so far? It's not a quiz, that's actually respect. It says your understanding is actually more important than what I'm saying or the way I'm saying it. Okay. And then the last one here, Dr.
Elena, she's discussing a medication plan with a patient who says, yeah, I don't really wanna take anything that makes me feel foggy or has some undesired side effects. And a dismissive response might be, well, that's just what we use. An agency honoring response might look like, well, that makes sense. Let's talk through some options and some trade-offs.
I'll tell you what I'd recommend, but I do wanna hear what matters to you most. That's that shared medical decision making. There's hardly anything in medicine I can think of off the top of my head that's just one and done. Like this is the only option. There is usually other things, and it may even include just time.
It may even be like, would you like a week to think about it? Right. Obviously, if it's nothing life or limb threatening in the moment you have a week to think about it, let the patient circle back around. Go get some advice, whatever. That's that shared decision making in plain language on the level that they understand.
Yeah, and I think that that's where sometimes we get tripped up. We get very busy, we get overwhelmed. I've not met a doctor yet who didn't feel some level of stress when things got far behind and patients were waiting. And that can make it harder for us to access these higher skills if we even have them, which we may have never had these modeled for us.
A lot of us probably grew up in homes where we were dismissed and my way or the highway or my house, my rules, that kind of thing. We don't wanna have a clinic or emergency department that is my house, my rules. We wanna be collaborative, otherwise we miss out on like the chest pain that they were afraid to tell us about 'cause we seem so determined to talk about other things, or we will miss out on, you know, some error that someone saw happening. They were too afraid to speak up. So we definitely want to be collaborative and have a team approach with all the people around us, if possible. So doctors fall short in this sometimes not because they don't care, but because when we're under time pressure and stress, we will often default to what you might call efficient, but relationally thin communication. And again, we don't have to help people feel like they're in a psychotherapy session or that they have all the time in the world to talk.
Our time is limited and it's important for us to hold boundaries around that too. But when we're only communicating in this relationally thin way, we're only giving facts. We give a recommendation. We move quickly. We answer questions, but we don't really validate their emotions. We don't really invite their collaboration in a plan, and sometimes we'll hear doctors say, you know, my Press Ganey scores are horrible and I'm trying so hard.
There's a lot of different pieces to that and we don't have control over what other people think of us. Regardless, we could show up the best ever, save their life and then they give you a one-star Google review 'cause their car was blocked in the parking deck. So that can happen.
And if we're consistently having feedback that patients are dissatisfied or they don't trust us, or you know, they seem resistant, they're pushing back. If we have a lot of patients who are difficult, quote, difficult, it might actually mean that there's room to improve our own approach.
I have one nurse practitioner that I work with. I love her. She's amazing. She's such a fantastic person, and she ticks off like 90% of the base before I ever get in the room. And it's because of this. It's like, well, this is the way it is. You don't need that. You don't need that because this is what's wrong with you.
So it's just that communication style that's not particularly relational, not treating the person as an equal. Relational can be kind of a code word for treating someone as an equal. It makes a difference, and this is where it's important to know that patients really need to feel that they're being taken seriously.
They need to feel like them sharing what's going on with them is actually registering with you and that their reality has landed with you. So a way to show them that is emotional validation, and this skill, I would argue this is one of the most, if not the most important relational skill to develop. And there are some misconceptions about it.
When we validate someone and we're saying like in the instance above, sounds like you haven't felt heard. Sounds like you're feeling dismissed. What we're doing there is we're not agreeing that we're dismissing them. We are saying, I hear you. I hear the feeling you're expressing and it matters to me. You are free to have whatever feeling you need to have or want to have.
And I'm not gonna argue against your feeling. I'm gonna be curious about it. So validation is not agreement. It's not caving into their will or being controlled by other people. And it's not saying that every fear is accurate, it's saying given your perspective, from where you're coming from, your reaction makes sense, the way you're feeling makes sense.
So if a patient says, I am scared, this means I'm dying, and the doctor responds, let's not jump to conclusions, or you're definitely not dying, the doctor may think they're being reassuring. And I will say this, as parents, I've said this a lot of times. This was pointed out to me by one of my own teenagers. I did this a lot.
What? No, you're totally good at that. I feel like I'm not good at making friends. You're totally good at making friends. 'cause I'm trying to assuage my own anxiety and make him feel something different. It's not reassuring, it's dismissing and it's disconnecting and it makes the patient or the child, or a partner just not feel heard or like they matter and they definitely don't feel connected to you. So a more skillful response would be something like, I can see why your mind would go there. Let's talk about what we know and what we don't know yet. And so that sequence matters. Validating the emotion. I can see why your mind would go there.
It makes sense and that is, if you need one little script to keep with you about validating emotions, your feelings make sense. That's it. Your feelings make sense because they do. Everyone's feelings make sense given their perspective, their experiences, their history, what's happening for them in that moment.
They make sense. So keep that one with you and you can always pull that one out. And that's very validating to people. And then after validating, we can offer the data second. So we're gonna go back to Dr. Daniel here. He's a little case study that we're gonna focus on. He's discussing a delayed discharge with a patient's son who says this place is a joke.
Nobody knows what they're doing. Okay? They must be in the emergency department because that, I dunno, just seems like something that might get said there. So if Dr. Daniel is tired and reactive, he may go straight to correction, or if Dr. Daniel is a doctor who's gone through medical training, because this is how we did it, at least when I was training, fully dismissing other people's feelings 'cause our feelings were completely invalidated as well. So if he's tired, he's gonna say, okay, that's unfair. We're doing everything we can. And it's understandable to say that, and I'm not saying never say that now. I definitely say it sometimes, especially if I really don't like the person, but if I care and I want to connect with them, I'll say something a little bit different, because that wasn't the most effective thing to say.
The more relationally skilled response is, you're clearly frustrated, and I'm guessing part of this is that you're worried your mom is stuck here without a clear plan. Let me tell you where things stand, and then I wanna hear what's worrying you most. And a response like that is doing a lot.
It's naming emotion. It's interpreting their behavior with generosity. So assuming the best intentions. It's easy for us, especially when we feel stressed or under threat. It's easy for us to read people's minds and think they're just complete jerks. I just shared an example in my own mind how like my mind will judge like, oh, this person not worth trying to make them feel better.
They're too far gone. When we reply more relationally we're interpreting behavior with generosity. This particular response gave information and opened the door for more questions, and it brings that family member into the conversation instead of trying to shut him down. That is a social skill.
And when we're able to do this, we're actually able to influence other people's emotions. We can't control them. And there are things that we can do to help other people's nervous systems ratchet down a little bit. 'cause when we dismiss, we're ratcheting them up just like somebody tells you to calm down.
I'm going straight, straight to nuclear baby. Don't tell me to calm down. When doctors are, and people, humans in general are emotionally overloaded, one of the first things that goes right out the window is not your intelligence. You still know all the things and how to do good patient care.
It's more flexibility, emotional flexibility. We might get more short in our speech or more clipped, more corrective. We've talked about going more into that left brain and picking out things that are wrong. We're less curious. We know what's right and wrong. We become very certain about what should be going on, and we stopped asking questions.
We stopped checking whether the patient actually understood. And we become more likely to dismiss emotion because we just don't have the bandwidth to stay with it. So it's important to realize that we're working in very, very challenging circumstances, and this is gonna happen sometimes. If this is how we're showing up a hundred percent of the time, we're gonna, you know, this more clipped, rude, dismissive version, that is gonna drive our own burnout because our patients will hate us and we'll hate them and everyone, it will just not be good. We're gonna show up this way sometimes, and we can have compassion on that, and we can take a little bit of additional effort to kind of move ourselves towards this more relational stance of interacting with people.
Here is another example. Dr. Maya is discussing a poor prognosis with a family member who keeps interrupting and asking whether another specialist can be called, and maybe a low bandwidth response. Less relationally skilled would be, I already explained this. A more emotionally intelligent response would be something like, I can see how hard this is landing, and I think you're trying to make sure nothing is being missed. I'm happy to go through it again and explain what another consult would or wouldn't change. And what we're doing there is validation.
We're validating and we're helping make things more clear, and we're providing structure. We're not just caving to whatever they wanna do. We're not just ordering the full body MRI or the plastic surgery consult for the three millimeter arm laceration as sometimes gets requested. We're validating and providing this clarity and structure. And then one other really, really important, maybe this is even more important than validation. I don't know. I think you have to validate to be able to do this skill, this relational skill, super important: repair. Which humans underuse all the time, and this again doesn't require agreement.
This requires us to acknowledge when we have dismissed someone's feelings, when we have not taken care and treated them as an equal. Sometimes the most healing sentence in a conversation is, I answered too fast there, or I think that came out more abrupt than I meant. Let me try that again. Or I can see that didn't land the way I intended.
Tell me what's going on right now. My desire is for you to feel understood, safe, and well cared for. So if you snapped, missed the feeling, over explained, dismissed, the answer is not to double down on that thing you just did. I mean, you can. That's always an option. I, having done these things in the past, did not like the outcome.
They did not feel good for me, did not feel good in my mind or in my body. The answer is to repair faster and it requires us to accept some accountability for our own actions and our words, and that's okay. We're not gonna die if we admit that we did something wrong. Sometimes, in fact, people will trust us more.
The more we are able to voice our own humanity, people will trust us more. This is a social skill. This is an emotional intelligence skill, and honestly, these two, I think validation and repair are very, very underappreciated relational skills in medicine. And they're like magic. They're magic for connecting with our patients.
Yeah. I feel like medicine does a great job of like, here's all the information. Never mess up. Yep. Yep. Darn it. Because I am a human being, but what I don't know is what to do when I do mess up. But validation and repair is a really great starting place. And I was recently watching a YouTube, some TEDx talk or something on negotiations.
Actually, one of our clients is negotiating a new job and all of that sort of stuff. And she said something that was really curious to me. She's like, one of the best questions that you can ask, and this would apply to patients too. It's a little bit of a trick because it's, tell me more. It's not a question at all, but it opens the floodgates much better than a lot of times our pointed questions do. Mm-hmm. And allows the impression of curiosity and openness and is a really great way for gathering information when there's emotions involved or when there's information that you truly do need but it's not been forthcoming. And that's what's happening a lot of times when we are having a social skills situation.
But, so I'm gonna put that in my toolbox. Tell me more. Oh, I feel like that didn't land correctly. Like, tell me what's going on. So this all brings us back to the fifth pillar because social skills are what happens when all of the other pillars come together in real time. You notice your own reaction, you're then able to regulate it.
You understand something that's going on in the other person's experience. You stay connected to your original goal and then you respond in a way that is both human and useful. And that is the work. It's not easy, but that is the work of growing and becoming and improving all of the time, and it's not to become endlessly soft or endlessly accommodating.
So I think that's why sometimes people maybe aren't open to it because they think they're just gonna get railroaded or that, that's not it at all. It's giving you the ability to get what you want because you are making these conversations much more efficient and much more useful. You're becoming more accurate, more collaborative, more skillful.
So if I were making this really practical for doctors, I'd say the relational skills most worth strengthening are: can you validate before you explain? That might save you so much time. Can you honor agency or their ability to be in charge of their own life while still giving leadership? Can you set an agenda instead of just assuming you know the agenda?
Dang it. That has bit me so many times as I discharge the patient and then the nurse comes back like, well, they said you didn't address the whatever. Like, ah, yeah. Oh, that is a tough one. Can you check understanding instead of just assuming understanding? Can you respond to emotion before giving more data? That I love from Simon Sinek is like if somebody's in their emotional state, it does not respond to logic. You have to regulate somebody else's nervous system, maybe even your own, before you start giving logical data or start speaking to them from the logical part of your brain.
Can you repair quickly when you miss? There will be misses. We're all human beings. It turns out people care less than you think that you made the miss. It's when you refuse to repair, it's when you refuse to acknowledge. It's when you just keep barreling down the road and then they're not validated.
So these are not side skills. These are trust-building skills. And here's one last case. Dr. Elena is talking with a patient who says, I don't think you're hearing what I'm saying. A defensive response is, yeah, I heard exactly what you said. A more skillful response would be, okay, tell me what you want me most to understand right now.
It's that secret question. Right? Again, tell me more. That one sentence shifts the whole posture, and it gives agency to the patient. It invites clarity, it makes room. And here's another, Dr. Daniel is recommending treatment, but before moving ahead, he says something like, I'll tell you what I'm most concerned about and I'll tell you what I'd recommend, but first, what matters most to you as you think about this?
That is how expertise and respect can coexist. That's how truth and agency can coexist. That's how medicine can become less paternalistic without becoming just a, an s-show without becoming leaderless. I'm like, what is a word I can say on air without making it explicit without saying what I actually mean.
So yes, social skills include tone and timing and de-escalation, but in a doctor-specific sense, they also include things like validation, agency, collaboration, comprehension checking. We assume they hear every word that we said, but studies over and over again support that very little of what we actually said is being registered.
We see that in the ER when they're like, my primary care doctor sent me here and said this, this, and this. You look in the chart or you call, none of that happened, but that was what they took from the conversation. And it's not malicious, it's just how it is. Something that social skills include for doctors would be repair and the ability to stay relational under pressure.
Such incredible work. And that is what many patients are hungry for. And the good news is these are learnable skills, so let's get to practicing. I think that's an important point. That last point is so important because sometimes we become so convinced that I'm just a hot head or I just tell it how it is.
Maybe, maybe that's just who you are. Also, maybe there are some skills that could uplevel things for you if you're open to learning them. Yeah, I love that. And you know, bringing it all together, it's not an us first, them. These people are humans just like you. And I'm gonna tell you that being a recent patient against my will, it's amazing sitting on the other side.
It's still a human collaborating or communicating with another human. So all of these are skills, yes, that we can uplevel, but imagine sitting on the other side, and we say it, and it's kind of cliche, but really as a recent patient, I mean, you do wanna feel like you have agency. You do wanna feel like you're in collaboration with the person that's taking care of your life right now.
You wanna know that you understood, right? Because yes, they are giving the best advice. We know you're the expert. You know, speaking from the patient standpoint, that you are in the expert's hands, but just making sure I understand because if I understand I'm actually gonna rest a little easier. My mind's gonna be okay.
I'm actually gonna focus on my recovery because I understood what your plan was and the treatment and the next steps, and then just, you know, offering up that. Yeah. This could be scary. So these aren't fluffy things. This is like a human learning to interact with another human and, I mean, it's emotional intelligence in motion and I think, you know, we could have probably added on another whole semester to med school just to learn these very, very important skills.
And sometimes the most powerful thing a doctor can do is help a patient feel heard, or feel respected, or just feel guided in the process. And that can all happen in the same conversation. So that's it for today's episode. Friends, if you found this conversation helpful, the best way to support us is to subscribe.
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