"Cardiology is (eventually) not that hard, the non-clinical stuff is hard if you never pay attention to it" – Mustafa Husaini

One of the obvious, yet overlooked, aspects of being a cardiologist is that we work with people. While medical school curriculum centers on mechanisms, pathophysiology, diagnostic reasoning and society, little time is centered on how we work with one another. Skillfully and honestly working with people is often more difficult than obtaining a basic mastery of cardiology. The quote above is a line I often tell new learners that are rounding with me, as I hope my time with them will not only teach them cardiology, but also start them down the journey in mastering communication, conflict and negotiations.

Communication

There are two key communication themes that I attempt to impart: understanding information asymmetry and identifying crucial conversations. Information asymmetry is an economics term which describes a situation where one party has information of greater depth and quality than the other during a commercial transaction. Such asymmetry can create imbalances of power, breakdowns in negotiations and market failures. Information asymmetry is also readily applicable in health care: conversations with patients, presenting on rounds and lectures.

While we as clinicians are experts in medicine, our patients are experts in their lived experiences, preferences and values. During rounds, I often remind our learners that they have likely spent much more time and effort reviewing the patient's chart and speaking to them. As a result, there is information asymmetry "tilted towards them" which they need to consider during their presentations to me. Lastly, lecturers are often experts in their area and therefore often lecture at their fundamental level; not the audience's. The "too smart to teach" is an example of information asymmetry during academic talks. Recognizing information asymmetry is the first step towards rebalancing these relationships to ensure a just and necessary outcome for all individuals involved.

A crucial conversation occurs when there are opposing opinions, strong emotions and high stakes. Many of our conversations in life – with our patients, family, employer and more – are crucial conversations; yet we often do not realize it. Stopping to recognize a crucial conversation enables one to ask questions and be curious, to speak to listen instead of speaking to speak, and to engage in a dialogue instead of a monologue. By asking questions and listening, we better understand what each party wants, and can then arrive at a mutual agreement. Not recognizing a crucial conversation often leads to frustrations, miscommunication and missed opportunities.

Conflict

There are two realizations that sparked my interest in learning about conflict. First, it is not about how often we have conflict, it is how well we manage it. Second, the goal is not to have less conflict, it is to have the right kind of conflict. There are at least three types of conflict which we all interface with:

1. Task Conflict: Disagreements about the problem, the solution, the decision or anything in between.
2. Relationship Conflict: Fighting about differences in personalities or values.
3. Status Conflict: Where we fit in the hierarchy.

It is imperative that we ensure there is task conflict, and minimize relationship and status conflict. "Stepping down" the ladder of inference, we are better able to mange conflict. The basic idea of the ladder of inference is that many of our conflicts come from making the wrong assumption about other people's behavior. We often argue only about our conclusions and do not "step down the ladder" to share our observations and assumptions which shaped that conclusion. Sharing these observations without our "own story" enables better understanding for each party which enables the transition from relationship conflict to task conflict.

Negotiations

Lastly, negotiation is a tool in our everyday life that we often do not attempt to sharpen. We do this every day; with our patients, colleagues and family. Improving your negotiation skills improves two key areas in life: information gathering and behavior influencing. Author Chris Voss, in Never Split the Difference, states that negotiation is "nothing more than communication with results." The key here is to not think of just the FBI hostage negotiations "at the table" but what you do to "set up the table." In Give & Take, Adam Grant describes "other-ish givers" as those that look for opportunities to benefit others and themselves. They can think in more complex ways and identify win-win solutions that both "takers" and "selfless givers" miss. You can "set up the table" and encourage a creative solution by understanding both what you really want, and what the other party really wants. Improving our information gathering and behavior influencing can only improve our bedside manner, career growth and interpersonal interactions.

References:

1. Jayakumar P, Bozic KJ, Lee TH. Information Asymmetry: The Untapped Value of the Patient. NEJM Catalyst Oct 15, 2019. https://catalyst.nejm.org/doi/full/10.1056/CAT.19.0700
2. Patterson, K., Grenny, J., McMillan, R., & Switzler, A (2002). Crucial Conversations. McGraw-Hill Contemporary.
3. Grant, A. 2021, April 13. The Science of Productive Conflict. WorkLife with Adam Grant. TED Media. https://www.ted.com/podcasts/worklife/the-science-of-productive-conflict-transcript
4. Voss, C., & Raz, T. (2017). Never Split the Difference. Random House Business Books.
5. Grant, A. (2013). Give and Take: A Revolutionary Approach to Success. New York,
6. Lax DA, Sebenius. (2006). 3D Negotiation: Powerful Tools to Change the Game in Your Most Important Deals. Harvard Business School Press.
7. Lee SG, Blood AJ, Kochar A. Negotiation for the Early-Career Cardiologist. J Am Coll Cardiol. 2022 Sep 13;80(11):1110-1113.

This article was authored by Mustafa Husaini, MBA, MD, FACC, an assistant professor at Washington University in St. Louis with editorial assistance by Mohamed Esmail, CFP. Husaini graduated from the executive MBA program at Olin Business school within Washington University in St. Louis and is a member of ACC's Sports and Exercise Cardiology and CV Management Section Leadership Councils.

This article is in memory of his daughter, Aliza, who was born at the start of his MBA and died a few months before graduation. Social Media: @husainim.