Explaining pain or indeed explaining any symptom or medical condition is a conversation. The critical element of healthy conversation is invitation – a feature that we usually don’t think about when we chat. Good conversation involves seeking permission to contribute and providing an invitation for others to contribute. There are many ways to do this. When, how and what to contribute is a complex snap second decision based on conversation gaps, timing, non-verbal nuances, subtle skills of seeking permission to speak, previous conversation status, knowing or sensing the other’s values, knowledge and emotional status, non-verbal validation of the other’s contribution and knowing when to pursue a topic. The list could go on. Healthy conversation is also about knowing when not to contribute or reasoning your ’dose’ of contribution. No one likes being spoken over.
Didactic delivery can be contradictory to healthy conversation. ‘Didactic’ is a sharp and abrasive word. It’s likely that a one-size-fits-all delivery approach, just poured out without regard for conversation skills or context, will have an abrasive effect. It misses simple but powerful conversation catalysts such as overt invitations “that’s interesting, tell me more” or ”what do you mean by…’ in response to an open ended comment or figurative statement. Even just “hey wow! or even ‘let me know if I am bothering you” or ‘gosh, what did you learn from that experience?’. It misses the powerful non-verbals – a raised brow is an invitation as is supination of the hand. When explaining pain, simply ascertaining if a person wants to know about pain and mutually setting goals are healthy conversation enhancers.
Conversation skills are being lost. Blogs and forums routinely discuss the digital age and loss of communication and conversation skills. There is little in social media conversations to enhance conversation. I also feel that over the years, I am spoken over and spoken at rather than to. Maybe this lost skill is one reason why rote models of explaining pain and health issues are so common.
I would like to share a nerdy habit that I have always had. After dinner in a foursome, I will always do the maths – did we all talk 25% of the time? Did the 75% listen to the 25%? With a patient, is it 50/50? I will admit to rarely achieving this, but I try my best and I try to remember that we are both story telling. And a healthy pain conversation is when the stories emerge effortlessly from both parties.
I would love a conversation about this!