Q&A: How women oncologists can convert difficult conversations into authentic connection
How individuals listen and connect during difficult conversations with the high-stakes relationships in their lives determines their engagement levels at work and at home, according to Neha Sangwan, MD.
“Oncologists have often had to ‘shield themselves from feeling’ in order to get up every day and help patients who have such devastating and potentially life-threatening diagnoses,” Sangwan, internal medicine physician, communication expert, and founder of Intuitive Intelligence, said during an interview with Healio. “In general, female physicians often experience a double dose of empathy — not only are they healers in service to others but, biologically, female bodies produce higher levels of progesterone (the ‘tend and befriend’ hormone) that enhances our need for connection and belonging. In addition, women are often the ones organizing and leading their families and communities.
“However, when we avoid challenging conversations, short term, we may shield ourselves from discomfort and pain temporarily, but over time this self-created protective barrier limits our ability to experience joy and excitement,” Sangwan added. “The unintended consequence of feeling our emotions less is that we often lose our joyful connection to meaning and purpose.”
Sangwan spoke with Healio about specific communications skills from her book, TalkRx: Five Steps to Honest Conversations that Create Connection, Health & Happiness that women oncologists can use in challenging conversations, such as delivering bad news to patients or communicating with challenging colleagues and higher-ups. Specifically, she described a five-step process, called The i-Five Conversation, a simple framework to communicate clearly, concisely and compassionately in a variety of situations.
“If you know you shy away from conflict because you’re too busy or have had adverse outcomes from challenging conversations in the past, that’s all about to change!” Sangwan said. “Imagine the energy you will receive by knowing how to confidently engage in any conversation that comes your way.”
Healio: Can you explain your technique called the i-Five Conversation?
Sangwan: Sure. Whether you’re dealing with a challenging conversation at work, or having trouble talking to a loved one, the i-Five Conversation bottom lines what’s important to you and where you have questions or gaps in the communication. Once you get clear about what’s happening internally — what you think, how you feel and what you want — it simplifies communication with others.
The ‘i’ in i-Five represents ‘interpreting’ and ‘integrating’ the five essential components of an honest conversation.
The ‘Five’ represents the five steps to having clear, concise, compassionate conversations in your high-stake relationships:
- interpreting data in two ways:externally and internally (from your body’s physiology, eg, heart racing, stomach hurting, etc);
- interpreting your thoughts;
- interpreting your emotions;
- interpreting your desires; and
- integrating these four areas of awareness into taking action (to have a conversation, draw a healthy boundary or make an agreement).
How effectively you interpret and integrate the five components of the i-Five Conversation and whether you’re willing to take personal accountability for your part will absolutely determine your success in communicating and influencing others.
Healio: How should women oncologists apply these communication skills in conversations with patients, particularly when communicating difficult news?
Sangwan: Oncologists have a unique role because their first meeting with a patient is often one where the patient is somewhat shell-shocked, in denial or disbelief. In that vulnerable moment, patients have a limited ability to absorb new information because their fear can be overwhelming, especially if they have been scouring the internet and running worst-case scenarios in their heads. They are suddenly facing their mortality and have many time-sensitive choices to make.
It is most important for us as clinicians to initially abandon the physical and intellectual approach to healing their cancer, and instead recognize this healing moment as the opportunity for a sacred exchange. We should do what’s counterintuitive — instead of leaping into the data of a patient’s history and describing their treatment options, we should slow down, listen deeply and connect emotionally and to what matters most to them. This small but powerful step solidifies trust, deepens connection and ultimately saves time over the course of the physician-patient relationship. At these pivotal moments, one of the most powerful ways we can do this is through deep listening.
As physicians, we, of course, need to keep moving forward in our day but we also need to approach each conversation with an expanded perspective. We’ve trained for decades to be a trusted consultant, providing our patients with the latest research and recommendations that would give them the best chance to heal. Often, when the decision isn’t black or white, they may ask our personal opinion, as well — ‘Doc, what would you do if this was your family member?’ When we provide our opinions, it can be surprising or disappointing when a patient refuses a treatment or has a contrary opinion. Our ability to be present for not just the words they are saying, but also what emotions they are feeling and what they value will build a powerful bridge to healing — for them and us. We have to take into consideration more than the external data (research articles, double-blind, placebo-controlled trials, etc). When we expand our perspective and become curious about this person’s unique life experience, we invite a deeper level of connection and healing. Their unique life experience includes, but is not limited to, their pain tolerance, discomfort, quality of life, and level of family and community support. Our professional opinion + the patient’s lived experience = integrated decisions. We must take each patient’s uniqueness into account when having challenging discussions and honor their right to make a different decision than we would, given their situation.
Second, how do we listen to our patients on a level that bridges us not just physically and intellectually, but emotionally, socially and spiritually? The sacred exchange between doctor and patient is an opportunity to not just cure a patient, but to catalyze their healing on a deeper level. As physicians, this encounter can also heal us, by reconnecting us to our meaning in medicine. To maximize our impact, it’s crucial that we know how to lean into the discomfort of end-of-life conversations and not subconsciously feel that this is somehow too time-consuming or a failure on our part, should this be the outcome.
You may be thinking, ‘I don’t have enough energy to engage on this level.’ The secret is creating healthy boundaries — taking care of ourselves while being fully present for the patient’s experience. Drawing healthy boundaries is not a skill taught in medical school or residency. In fact, our survival depended on overriding our own needs to be in service to others.
I’ll share how I do it. As I enter the room with my patient, I remind myself that each patient is on a unique life journey and has their own lessons to learn, some enjoyable and others devastating. No matter what their circumstance, I focus on the power of the human spirit to overcome adversity and choose to envision them as strong, resourceful and capable. Before walking into the room, I set my intention to maintain my own energy while being a compassionate and loving presence for them. Then I create healthy boundaries by imagining myself as a ‘human fan’ gently radiating love and compassion in their direction as I listen deeply to what their body, mind and heart want to share. Once they are finished, I allow for a few moments of silence to take in what they’ve shared. Sometimes I place my hand on their shoulder or knee and respond with some version of, ‘I hear how devastating this diagnosis has been and the valuable time it has robbed you of. I also hear how much you value your physical health and independence. I will do everything I can to assist you in navigating this next chapter with the best information and resources possible. I’m here to help.’ When I listen deeper than their words and name the emotions and what I hear they value, it is often an instant and meaningful connection that strengthens our relationship, builds trust and allows us to make decisions more efficiently and effectively. They have always responded positively to my genuine presence and care for them.
Healio: How can women oncologists walk away from these difficult conversations without taking on its pain and stress?
Sangwan: When we experience people struggling, our empathy and problem-solving nature can reflexively kick into high gear. This powerful combination of circumstances along with the urgency of life-or-death diagnoses can result in complex scenarios to navigate. In these instances, drawing healthy boundaries can seem selfish or uncaring. This is absolutely not true. We must expand and balance our perspective to include our own self-care as we care for others.
As I described above, I listen deeply to my patients while holding them as strong and capable and experiencing myself as radiating love and compassion toward them. This way, it’s an outward type of radiation rather than an inward absorption of their emotion (where I’m taking on their devastation, shock or pain).
When I say goodbye to them, I also consciously say goodbye to their grief, shock and devastation. I allow everything that they are carrying to go with them on their journey. This is not because I don’t care. In fact, it’s the opposite. I know that people are only vulnerable when they trust themselves and they trust each other to share what’s closest to their heart — a sacred exchange. This also allows me to expand my own capacity to be present for my next patient.
The purpose is to have healthy boundaries that allow you to connect deeply and powerfully to your patients without taking on their pain. This is how you get to stay on fire in your career without burning out!
Healio: What tips can you share when having difficult conversations with higher-ups and colleagues?
Sangwan: In a meeting or conversation, when someone says something that surprises you, it’s important to first notice how your body reacts. For example, you may feel your throat constrict, your stomach sink or your heart begin racing. In that moment, an effective way to bridge to the other party is by getting curious, not furious. It’s as simple as asking the question: ‘Can you tell me what you mean by that?’ Usually, there is some miscommunication or misunderstanding, that once illuminated with a question, allows everyone to reconnect.
The next step is counterintuitive — give away that which you wish to receive. It’s important to know your own unspoken judgments about the conversation you are about to enter. If you don’t think your colleague or chief listens to you, then your job is to first listen deeply to them rather than showing up to the conversation with a disempowered demeanor.
Another example might be that you want someone to respect you. In that case, ask yourself, ‘How can I show up in this meeting in a way that shows them respect?’ If you want someone to understand your point of view, first seek to understand theirs.
One of the many lessons we are learning in the world right now is to lean into the important conversations we need to have. People are learning to be more vulnerable, authentic and real. Curiosity, listening and mutual respect are some of the most important steps to re-establishing our connection to one another.
Healio: Is there anything else that you would like to mention?
Sangwan: As a special gift to the reader who is ready to dive in and master challenging conversations: please download your complimentary audiobook, TalkRx:Five Steps to Honest Conversations that Create Connection, Health and Happiness, as a gift at
http://doctorneha.com/audiobookgift with the Code: HEALIO.
In addition to teaching leaders, teams and organizations how to have authentic conversations, my next book is titled Self-Care in Healthcare: Burnout Solutions to Protect Our Healers. My team and I also lead a virtual 8-week program to support physicians and front-line providers to identify and heal burnout that is being transformed into a CME offering. Email admin@doctorneha.com if you want to be notified of the next program or join our conversation online at the outlets listed below.
For more information:
Neha Sangwan, MD, can be reached by email at dr.neha@intuitiveintelligenceinc.com; on Instagram @doctorneha; on Facebook (Neha Sangwan MD); on LinkedIn (drnehasangwan) or at her website, doctorneha.com.
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Sangwan N. Master communicating with the most challenging personalities in your life. Presented at: World Happiness Summit 2022; March 18-20, 2022; Coral Gables, Florida.
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