Difficult conversations need tenderness – Dr Kathryn Mannix

When Kathryn Mannix was a junior doctor, she learnt the hard way that, when not handled carefully, a difficult conversation can be painful for both sides.

“We had a man brought in with a cardiac arrest, we’d been attempting resuscitation, and we hadn’t succeeded in restarting his heart,” Dr Mannix recalls.

Usually it was up to the most senior doctor on duty to talk to the family while a junior doctor, as Dr Mannix was at the time, would write up the notes.

Instead, for the first time in her medical career, Dr Mannix was given the task of breaking the sad news of the man’s death to the patient’s spouse.

In her early training, she had been told to give a “warning shot” and then get straight to the point, which she did.

It didn’t go well.

“This poor woman was just so horrified that she stood up, she shouted, she called me a liar, and the next thing, there was this kind of blinding pain in my face and orange stars,” she tells ABC RN Breakfast.

The news shocked the woman so much that she punched Dr Mannix in the face, then crumpled in her seat and wailed.

I was horrified because I further brutalised her in a really dreadful situation,” she says.

Hearing the commotion, a “very experienced” emergency department nurse came into the room and took over from Dr Mannix.

“She sat next to this weeping, disconsolate woman and just rewound the whole thing,” she says.

The emergency nurse used questions to help the woman work through her shock and grief. She asked if she knew her husband was sick and whether she’d been worried about his health.

“She said: ‘Well, yeah, he had his first heart attack a few years ago. I think we’ve been on borrowed time since then’,” Dr Mannix recalls.

“Just using questions instead of telling her stuff, she had really helped her to build herself a bridge to walk across. … she was able to compose herself to go and sit with her husband to get herself into the place where she was going to be absorbing this really bad news.”

What took place that day left a lasting impression on Dr Mannix, much longer than the bruise she sustained.

And it’s one of many poignant experiences that prompted the London-based palliative care doctor to write her book Listen, in which she considers how to have the important — or what she describes as “tender” — conversations that often get left unsaid.

Awareness in the workplace

Those who work in human resources are also often called upon to have tender conversations about things like performance management, misconduct and redundancies.

Louise Ingersoll is a director at Western Sydney University’s Human Resources and Management School of Business.

She says preparation is essential for these conversations, particularlyabout something like redundancies.

“It should also be in part known by the individual that it’s potentially going to happen,” Professor Ingersoll says.

“That, while at the individual level, can still be incredibly difficult and requires empathy, a delicate touch, and an awareness of what this may mean for that individual — it shouldn’t be something where someone is blindsided,” she says.

John Shields, Professor of Human Resource Management and Organisational Studies at the University of Sydney Business School, agrees conversations around redundancy can be particularly difficult.

“There’s frequently emotion on both parties part. The great fear that managers have about these things is causing additional stress to the individual concerned,” he says.

Often the first response [of the employee] is anger, he adds.

“When there is seriously bad news put on the table, individuals quite frequently respond with anger. They lash out,” he says.

“The challenge to the [HR] person conducting the discussion is to actually move all parties, including themselves, beyond that initial stage of anger and denial to a process of discussion about what has happened and why it has happened and what will happen next.”

Professor Shields likens it to the emergency nurse’s approach to de-escalating a difficult conversation.

“She came in and completely re-framed the dialogue from one of ‘Here is the bad news’ … to what I call a problem-solving approach.

“[She did this by] using narrative and open-ended questions and storytelling as a way to help the individual move into a different mindset, as stressed as they are.”

Taking our ‘armour’ off

Dr Mannix worked in cancer care with advanced illnesses before becoming a palliative care physician, so having tender conversations has been a regular occurrence throughout her career.

She says people avoid difficult conversations — whether it be with family, friends or in the workplace — because they fear that they will become emotionally distressed or cause emotional distress in another person.

“Even just calling them challenging conversations, difficult conversations, you feel yourself bracing … you’re kind of getting your armour on, you’re going to do this tough thing,” she says.

“And actually, I think perhaps the thing we need to do is take our armour off and say, the reason that this is feeling sensitive to me is because actually there is tenderness involved, there is pain possibly involved.

“And I’m prepared to be in that painful place with that person. So instead of calling them challenging conversations, I’m calling them tender conversations, because I think it changes the attitude we take into it.”

It’s also good to steer away from giving someone a talking-to, she adds.

“Reframe it as giving somebody a really good ‘listening-to’, particularly when you’re talking about teenagers, [it] can be a game-changer,” she says.

By allowing that person to tell their story, they’re hearing it for themselves, she says, likening it to waking up in the middle of the night, worrying and feeling overwhelmed by it.

“But the next day in daylight, if you start to think about it, if you start to talk to somebody about it, you start to be able to see some of the little bits that maybe can start to change that,” she says.

[And that’s] the first step towards making the bigger change that you might need to make.”

Credit: ABC News