and welcome to the Women's Leadership Education and Development Program webinar sponsored by the American Society for Gastrointestinal Endoscopy. My name is Marty Roth and I will be your moderator for this webinar. Before we get started there's just a few housekeeping items. There will be a question and answer session at the close of this presentation. Questions can be submitted online at any time during the presentation by using the question box on the right-hand side of your screen. If you do not see the question box please click the white arrow in the orange box located on the right side of your screen. Please note that this webinar is being recorded and will be available for future use. At this time I would like to introduce lead director Dr. Jennifer Christie. Dr. Christie has been a board-certified gastroenterologist for over 14 years. Currently she is an associate professor of medicine in the Division of Digestive Diseases at the Emory School of Medicine and director of gastrointestinal motility and clinical research. She is chair of the ASGE membership and diversity committee and served on the ASGE training committee from 2012 to 2015. Dr. Christie recently achieved the distinction of ASGE fellow. Additionally she has served as co-director of the first-year fellows course sponsored by ASGE. Thank you Marty. Good evening. Thank you Marty. Good evening lead participants. I am delighted to welcome you to our lead webinar on effective communication. Of course joining us today is my partner in crime lead co-director Dr. Vanessa Chammy. Dr. Chammy received her undergraduate degree from Colgate University and her MD from the University of Virginia as well as her residency was done there and she is now a professor of medicine at UVA and director of endoscopic ultrasound. I now would like to introduce the presenter for today's call, Dr. Cynthia Yoshida. Dr. Yoshida was born and raised in Southern California. She received her degree at the University of California Davis, her undergraduate degree and her medical degree from the University of Kansas. She completed her GI fellowship training at UVA where she is interim chief of GI and hepatology and she is also a fellow of the AGA and active member of ASGE. Dr. Yoshida also wrote a very awesome book known as No More Digestive Problems, the first consumer book specifically designed to address women's digestive health. She is married with two children and lives in Charlottesville, Virginia and loves to travel. So thank you, Dr. Yoshida and welcome. Thank you, Jennifer. Good evening everybody. Thanks so much for taking time for your busy schedules and around the holidays to attend this webinar and a special thank you to Jennifer and Vanessa for inviting me to give this talk tonight. So I'm going to be talking about effective communication and the goals of this talk really we're going to focus on the importance of effective communication. We'll look at some tips to improve your communication style and what to do if your message isn't getting through. It's so important for you to realize that in your everyday life your effective communication is important to your patient care, to your professional success, to leadership and also in team building. Can I get the next slide? Thank you. So as physicians and endoscopists we spend a huge amount of time interacting with people every single day. So think about the number of people you talk to, email, consent, see in clinic. These are your patients, the nurses, the fellows that you work with, your colleagues, your secretary. The poor communication is going to result in lack of compliance and poor patient outcomes. Your patients will be dissatisfied if they don't really understand what you're saying to them and this can lead to medical legal problems and overall in turn this can lead to physician burnout just because it's such a hassle to go through the daily process of not getting your message out. So effective communication is important not only for patient care but also with regard to your professional career. So we're going to discuss tonight how to be defective, sorry, how to be effective in a number of different scenarios. Next slide. So as we venture into this subject it's really important to distinguish between information and communication. Information is giving out but tonight we're going to focus on how you make sure that you're communicating well, how we make sure that your message is getting through. Next slide. So let's start by talking about effective communication in the patient care setting. So in endoscopy and the inpatient service and clinic we know that in the last decade there's been a huge amount of evidence documenting the impact of good communication in health care and some examples include the Institute of Medicine's patient-centered care model as well as Kaiser Permanente's SBAR. So Kaiser has this huge database of about 9 million people and their research foundation has been studying quality and safety for over 50 years. I'm sure most of you have been trained in SBAR in your hospitals. It stands for situation, background, assessment, and recommendation. It's the way that we as health care workers communicate with each other about patients. So here's an example. So the ER calls you and says Mr. Jones has come in. He's a 59 year old man who has a turkey food impaction since 2 p.m. this afternoon. That's situation. Background. They tell you that he's had a history of GERD and he has been in your practice in the past before and had a dilation in the past. Assessment. He's unable to tolerate his secretions but he's otherwise stable and recommendation. I think he's going to need endoscopy. Can you come in? So it's four sentences all with pertinent information that just cuts to the chase and gets the information across that's really important for you in communicating what's the most important things about the patient. So medical students and residents are being taught these communication skills every day during their training but for those of us like me who graduated after the last decade we probably have never had any formal coaching in communication skills and so I think it's important that we're wary of this and we pay attention to the way that we talk to patients. Next slide. So this is the Institute of Medicine's patient centered care model. This where SBAR looks at provider to provider communication the Institute of Medicine's model is more about how we should communicate with our patients and all of you I think do this probably about using clear language making sure that you have empathy and that you listen to your patient. Making sure that it's open-ended and that you have a dialogue with the patient and it's not just a lecture to the patient. Making sure that you give the patient what they need and I think that there's no question that clinicians who are able to explain listen and empathize are the ones that are going to have better outcomes overall with their patients. Next slide. So in the next slides we're going to look at why effective communications matters for your patients. Why it improves outcomes, how it can improve patient adherence, safety, how it can improve patient satisfaction and overall decrease your malpractice risk because it doesn't matter how smart you are if you can't communicate with your patients you're not going to be able to help them. Next slide. So why does effective communication matter for patient safety? Research shows that when communication breaks down that it's the patient that suffers. In a 10-year study they found that the majority of medical errors were due to poor team communication and even the US government has put together a handbook on ways for providers and patients and their families to improve communication. So throughout this talk I'll try to give you a lot of examples of things that I do in my practice that hopefully I can make this more meaningful for you and so you can help to use this in deciding whether or not communication practices can be useful for you. So I do open access colonoscopies almost every day of the week and for me good communication is imperative with my team, my sedation nurse and my tech. It's really imperative to getting good outcomes for the patient. So before the next case starts I always make sure that we discuss who the patient is, what we found up in the last colonoscopy if I did it, how much sedation they had. I think that's really important for the sedating nurse to know how much they can expect the patient to get. Definitely you know what scope or equipment that I need if I need APC or if I'm going to need to have certain snares. It's like kind of a pre-procedure timeout for patient safety and also before the case so that we're focused on the patient and we're mindful of the next patient and what they're going to need. Next slide. So effective communication also decreases your malpractice risk. Most malpractice claims result from a breakdown in communication so keeping open lines of communication with your patient provides information but remember that it also projects empathy. So an example here, we're all endoscopists. Our procedures have risks and we will have complications. So it's really important I feel to be open and honest and even really transparent about any complication event that you had. Say you had a post polypectomy bleed. For me it's important that the patient understands what happened and why it happened but there's also two other parts that I think are personally important to me. Number one, to apologize. Being sorry that the event occurred, certainly that it wasn't intended. And two, for me it's important for me to see them through the hospitalization post the complication. By communicating with them through all those points then it also makes sure that they understand that you care about them and you have empathy for them. So I'll give you another example. So if I do an EMR, endoscopic mucosal resection, of a sizable polyp and I'm sending the patient home that night, I always give my patient my cell phone number and my home phone number. It's a good communication method with them. It lets them know that if something happens to them that night and they have a problem, they can call me. They don't have to go through all the hassle of trying to go through the fellow to tell somebody else what's happened to them in that day. And you might be wary of doing this but I'll tell you in the 20-odd years that I've been doing endoscopy, I've never received an inappropriate call and people are very thankful about the fact that you care and that you're willing to actually communicate with them if there's a problem. Next slide. So effective communication is also really important for your health care team. The team that you work with has to feel supported and respected, valued and understood. And in order for that to happen, you have to be able to tell them what you're feeling and what's going right and what's not going well. Good communication is important to decrease nurse turnover. It increases their job satisfaction and probably yours as well. And really think about it, it increases the quality of your working relationships. In order for you to work well with your team, particularly endoscopy, you need to have a culture of mutual support and you need to have a clear understanding of everybody's role. And ultimately why is team satisfaction important? It's because it profoundly impacts patient satisfaction and patient safety. Next slide. So we talked about patient care but effective communication also matters for your career. So as you take on leadership positions in your practice or your division or your hospital, it's important that you really hone your communication skills. So before I came back to UVA, I was actually in private practice and was a solo practitioner and so I had to manage my own business. So you might think I'm a nerd and I am a nerd but I have Forbes.com bookmarked on my web browser and I read a lot about leadership and business. And really in some of the most effective articles that I've read about leadership, strong effective leaders have mastered the six basic functions of management. Leading, planning, organizing, staffing, managing. But communicating is also definitely in there because clear communication ties all of these things together. I think it's a really important key to being a good leader. Next slide. So this comes from this Forbes article called The Communication Secrets of Great Leaders. Comes from an article in 2012 that the best communicators have good situational awareness, they're great listeners, they are good at reading people, they meet the needs of those that are communicating with, and lastly they can change up their message if they need to. So look at this list. There's nothing in here about how we speak. It's about understanding your audience and reading the room. So as an example, I think Jennifer told you at the top of the hour that I took on the interim chief of GI about three months ago and I recently had to give an hour-long presentation to our hospital's executive cabinet. The dean and the CEO and the CFO were all there. And at the beginning of the meeting the dean apologized but he said he had to leave after 15 minutes. So he wanted me to start my presentation by discussing clinic utilization because that's the piece he wanted to see. But this was in the middle of my presentation. So one could get flustered but being adaptable is really important. Knowing my subject was really important and meeting the needs of my audience, i.e. the dean, was also important too. And I think I was very successful in getting across what he needed but also in presenting what I needed everybody else to hear as well. Next slide. So how can we communicate better? In these next slides I hope to give you some tips to help you to improve your own communication skills. And as we go through these tips I'll try to give you more of my own personal experiences and hopefully you can think of ways to apply them to your practice. So tip number one is be honest and earn trust. So this is a kind of two-for-one. But honesty and trustworthiness really go hand-in-hand. In my book this is the most important key to effective communication. I really believe in transparency. So let's start with trust. If I don't trust you then I'm not going to open up to you and I'm not going to communicate you and we can't have a dialogue. So you can attempt to demand trust but it rarely works. You need to really gain it and you need to have a reputation of character and integrity. I think it's also important to remember that if people do trust you they're also going to be more willing to forgive you if anything goes wrong. Next slide. So when the trust account is high communication is easy, instant, and effective. If you trust your leader you'll invest the time to take risks in ways you never would have if he or she had a poor reputation or if they lacked integrity. So it's a lot easier to speak to your chief or your hospital administrator if you trust her. Next slide. So being honest and earning trust is difficult especially within the workplace and this is from a Sheryl Sandberg's book Lean In. I hope many of you have read her book or at least watched her TED talk on YouTube. She's the current COO of Facebook. A lot of what's in Lean In is really not only for women. She has a lot of anecdotes that I think can be helpful to both men and women and she has a chapter in her book called Seek and Speak Your Truth and she writes it might be difficult to be completely honest in the workplace because all organizations have hierarchy which makes people less likely to tell the truth and I think we all find that's really really true. So for many, and I put in parentheses women, speaking honestly in a professional environment carries a lot of fears. You don't want to be seen as not being a team player if you're you know really a forthright and honest. You don't want to appear to be negative or nagging. You don't want to appear, you don't want it to look like even though you're trying to give constructive criticism that it's like you're trying to be nagging or be negative and oftentimes we worry that speaking up will call attention to ourselves and it might even open us up to attack and all of these fears are the same voice that's in the back of our heads that urges us not to try and not to sit at the table and Sheryl Sandberg in her book makes us a big point of saying that you need to do these things to be able to to lead and also to sit at that table. Next slide. So it's not easy to be honest but it's important and I practice this quote from her book in my own interactions. She says communication works best when we combine appropriateness with authenticity finding that sweet spot where opinions are not brutally honest but they're delicately honest. So I'll tell you a story. I did an EGD on an early man sorry on an elderly man during my fellowship when I was very very young and I learned a really valuable lesson. He had a really large gastric cancer and after the procedure I met with him and his family and explained in detail about the cancer and what I thought and the family asked a lot of really tough questions like how long does he have to live and you know things and I answered that honestly because that's what I thought they wanted to hear and a year later when he died after he died his daughter came to me and she said to me that she wished I hadn't have been so honest with her father because he lost hope and I'll tell you it was an incredibly valuable lesson for me that I carry with me today. I learned that day that there's a difference between being brutally honest and being delicately honest. So the next time you have to talk to a patient and give them bad news or the next time you have to evaluate your secretary or give feedback to one of your GI fellows be appropriate be authentic but definitely practice delicate honesty. Next slide. All right and that anecdote is a good segue into my next tip for effective communication and that is timing is everything. Definitely don't assume that somebody's ready to have a conversation with you just because you're ready to have a conversation with them. Spending time to kind of get ready and pave the way for a conversation is better than coming off as a bull in a china shop. Remember that the best communicators possess a heightened sense of situational awareness and they're skilled at reading people so use those skills to help you with timing. Next slide. So here's a good example of timing especially like if you need to give bad news to a patient. My three pieces of advice when delivering bad news to a patient are number one sit down, number two the golden rule treat patients like you need like you'd like to be treated yourself and number three is listen and most of all pay attention to the cues from your patients and their families to assure that what you're telling them is in the right time for them to hear your message. Next slide. So tip number three is be specific and be clear. Cut to the chase. Your goal is to weed out the superfluous and it's definitely going to make it's important to make your words count. So I'll tell you that in Sheryl Sandberg's book she gives this example where Mark Zuckerberg was trying to learn Chinese. So he surrounded all of himself with all these native Chinese speakers at Facebook to help him learn the language more easily and one day a woman was trying to explain problems she was having with her boss and Zuckerberg didn't understand her Chinese so he kept saying to her simpler please. She tried again but he still didn't get it so again he said simpler please and she finally blurted out in Chinese my boss is bad. And it's simple, clear, message delivered. Obviously you don't need to be so blunt but being specific and being clear are more likely to get your message through. Next slide. But it's important to remember that brevity is not the same thing as clarity. You're not necessarily supposed to be brief you just need to make sure that your message is going through. Next slide. So as an example think about your endoscopy reports. Almost all of us use endoscopy writers and endoscopy writers and they're great because they're efficient, there's commonality of language, they allow you to do coding, but the bad part about them is they're generic and they oftentimes lack information. And I'm a stickler about my endoscopy reports. So if you see a math like this in endoscopy I've literally seen a report like this on the right, findings, you know, Billis 60 millimeter mass in the rectum, you know, recommendations of weight path, CC, the PCP. Next slide. So endo reports to me are essentially written communiques. They don't have to be novels but they have to communicate the important information that you and others are going to need to take care of the patient. The PCP needs to read this, understand what you're going to be doing next, definitely the surgeon, the radiation oncologist, the oncologist, all need to know what your next steps are going to be as well. And the surgeon definitely to understand where the tumor is and to help them to decide what the next steps are. And if you don't do it well, it may be something a lawyer gets a hands-on, his hands-on, his or her hands-on. So make sure that your words count. Be specific and be clear. Next slide. Okay, tip number four. Don't assume anything. You don't want to assume that others understand what you're saying. It's really important that you clearly communicate your objective. If you don't, it's likely that you're going to spend so much more time clarifying and so much more time reinforcing and that wastes your precious time. Next slide. So I hope that during this talk that you'll think about your own day-to-day processes and ways that you can improve communication with your patient, your staff, and your colleagues. So as an example of don't assume anything, think of this in context of your endoscopy day. Think about how you communicate with, say, open access patients with their prep instructions or about stopping their anticoagulation. Oftentimes we have these instructions that are all written or maybe they might be on a website, but if a patient arrives prepped for their colonoscopy and you didn't adequately communicate about stopping their Coumadin, you could cancel their procedure or do it or if they have a bad outcome they're unhappy and they're more likely to be litigious. If you're having problems with your colonoscopy preps, maybe it's not because of the patients. Maybe you need to look at how you're communicating those prep instructions. I mean look again maybe at your website or look again at the instructions that you have that are written or maybe even listen to how your secretary or your schedulers answer prep questions over the phone. Don't assume that everything is going right. Perhaps you need to take a refresher and make sure that you're communicating the message that you have to your patients to get a better outcome. Next slide. Okay, so tip number five about communication. Do it often. You need to keep lines of communication open because it fosters trust. So when Sheryl Sandberg took the job as COO at Facebook, she knew that she needed to communicate with Mark Zuckerberg. So she went to him. He was her boss, but she went to him and asked him to meet weekly so that he could give her feedback. And he agreed, but he told her that he wanted feedback from her as well. These meetings were great, she says, because they kept open lines of communication. Over time, they gave each other honest feedback and it became easier and easier to do to each other and it helped them to build a very strong relationship and to build trust. So for you, if you're co-moderating a session at DDW, make sure that you keep in contact with your co-moderator to make sure that there is lines of communication that are open. Or when was the last time you sat down with your secretary and had a session with reciprocal feedback? How are things going? How can we do things better? We're GI fellows. It's useful to communicate often so that you can establish trust, but also to make sure that you know exactly what they're thinking as well. Next slide. So tip number six is to get personal. Like the last scenario with Mark Zuckerberg, effective communication really can help you to develop meaningful relationships. Personal engaging conversations are so much more effective. In classic business theory, they tell their leaders or their CEOs to stay at arm's length, and in medicine that equates to being clinical. So some doctors might be brilliant, but they might not be able to show any empathy. And in health care, that can sometimes be acceptable. Some patients are willing to sacrifice care and empathy for knowledge. The whole, I don't care if he doesn't have a bedside manner as long as he's smart attitude. But I'm sure all of you who have those patients in your practice who you've really connected with, communicating with them and caring for them is so much more of a richer process. So getting personal in some kinds of communication makes it better for all parties. Next slide. So this is my other part of being a tech geek. I also have Seth Godin's blogs. He's a marketer and an entrepreneur. And when I was in private practice, he gave me a lot of thoughtful insight into business and marketing. And so I subscribe to his daily blog. And in this little tidbit from one of his blogs from 2013, he said, the last 10 years have seen an explosion in asynchronous messaging. Here we are in the middle of a communication age and we're actually creating a system that's less engaging. So things like email, Twitter, they're all asynchronous messaging, asynchronous communication. So both parties can deal with the interaction at their own convenience. The problem is there's no dialogue. So communication oftentimes becomes worse. So that's an example here. Think about how you communicate pathology results to your patients post polypectomy. Obviously the best way to be, the best thing would be to call the patient and have a discussion with them and answer questions. But that's impractical and it's too time-consuming. There's a practice around us that has this method where they, after the colonoscopy is finished, they provide their patient with a telephone number and a secure PIN number. And at discharge from their colonoscopy a few days later, the patient will call, enter the PIN, and then we'll hear a recording of their doctor who's left a message about the polyp. And it's usually like 15 seconds of a message. Good news, Mrs. Jones, your polyps are adenomas. We'll see you back in five years. Not my way of doing it. I think that you have to think about how you're going to communicate results. Can you do it better? And think about that when you're talking to patients and you have to communicate an impersonal message. Try your best to make it personal. For me, I send letters to patients, and again, that can be impersonal too. But I try hard to, in some ways, remember something about the patient at the end of the letter. So I will hope that they had a great breakfast at Tip Top, which is a local restaurant, or remind them or thank them for allowing me to participate in their care, or just wish them a happy holiday. I think getting personal makes a difference in communicating with your patients, and they'll definitely remember that. Next slide. All right, so tip number seven, know your subject matter. This is no-brainer, right? We need to master all of our skills and the material to make sure that we're an expert in what we're sharing. In order to communicate well, you have to understand what your subject matter is, because people aren't going to be interested in listening to you if you don't know what you're talking about. Next slide. So Lee Iacocca said, you can have brilliant ideas, but if you don't get them across, your ideas aren't going to get you anywhere. And a more appropriate quote for this topic about knowing your subject matter is, if you don't know your subject matter, you can't have brilliant ideas. So I'll tell you an anecdote here. I was asked to be on the finance committee of another GI society. Having been in solo practice, I had managed my practices finances, but it was really pretty clear to me at my first finance committee meeting where we discussed investments and emerging markets and budgets and employee compensation that I really needed to do my homework. So I read. I talked to my son a lot who was an econ major and I learned a lot about the subject matter so that I could effectively sit at the table. It's really important that you know your subject matter so you can communicate more effectively to the people that you're speaking with. Next slide. Next tip is have an open mind. Don't be afraid of dissenting opinions. I know it's difficult, but definitely try to be receptive to some feedback. These can challenge you. These can stretch you and closing your mind is only going to limit any new opportunities from happening. I've learned so much from being open to feedback from people and asking people for feedback about the presentation that I gave or how I could do things better. I think this makes a great difference in improving your style of communication. Next slide. I really, really like this quote. It's probably my favorite of the whole talk. Effective communication starts with the understanding that there's my point of view, my truth, someone else's point of view, your truth. Rarely is there one absolute truth so people who believe that they speak the truth are very silencing of others. I really try to take this into account in my own practice of communication. Here's an example. Say you want to discuss pay raise or a schedule change with your division chief. Walking into my office and saying, you don't pay me enough is not constructive and I'm not going to take that well. Remember that statements of your opinion are always more constructive in the first person I form. Definitely a lot better to say something like, my RVUs are up. I just won a teaching award and I believe I've been working hard and I'd like to talk to you about a raise. This is your truth. Thinking about her perspective, your division chief's perspective, her truth beforehand, how she has to deal with budget or she might have to deal with other things also prepares you and promotes you in having a more productive dialogue. Next slide. Tip number nine is be prepared and write it down. I can't emphasize this enough. It's so easy to overlook the value of writing down your thoughts or your intentions or even your visions. Preparing beforehand and writing a basic strategy has incredibly helped me to ensure clarity, to make sure that I know the points that I want to get across and to give me purpose in my messaging. As the interim chief of the division, I spend a lot of my days going from meeting to meeting with faculty, fellow deans, administrators, and I found that writing a list of priorities or writing a list of asks for each helps me to deliver my key issues in a much more clear and concise manner. I make sure that the points that I need to get across get across because I know that I've got a list of them. I don't take them with me, but I have them in my head. Writing them down even the day before helps me to establish clarity and purpose. Next slide. Tip number 10, slow down, shut up, and listen. Very early on in my career, I was asked to speak at a luncheon session during DDW's postgraduate course. It was an incredible honor for me. I was so young, but I was incredibly nervous. I will tell you that when I get really nervous, I speak really quickly. After about five minutes of the talk, an older gentleman in the front of the room just raised his hand and he said, can you please slow down? Point taken. Slow down, listen when you're giving these talks. Next slide. As I said earlier, when I'm stressed out or in a stressful meeting, I tend to talk faster. My pitch rises. In my notes for this talk, I will tell you I have slow written in capital letters several times just so that I make sure that I don't speak too quickly. Yoga has been really helpful for me as well. I think the mindfulness practices have helped me when I'm in a contentious meeting or if I have to give a lecture to deep breathe, to slow down, to relax, to be mindful. Those are all important ways to help us to make sure that we're getting ourselves relaxed so that we make sure we get that right message across. Next slide. I also want to talk to you about non-verbal communication, effective email communication. I am a huge email offender. I will tell you that before I took this position as interim chief, I would send out these super long emails that were lots and lots of things. I've really learned in the last three months how to communicate better by email. It's important to have a concise message. Also remember that email is never, ever, ever confidential. If you never want that stuff to get out there, don't put it in an email. Definitely proofread your email. Spell check it. Grammar check it. Avoid reply all. Look at the font and the point size. Definitely don't type in all caps. It makes it look like you're yelling, but don't type in all lower case either because it makes you look too juvenile. Don't spam your readers. Definitely do not send funny YouTube videos of cats. Not good. Not cool. The things that I do want to point out that I do that I think I've learned a lot about in emailing are to think about it and to use your draft folder. For me, and I've given this advice to some of my other faculty as well. For me, if I have an email that I have to send back that I need to think about for a while, I put it into my draft folder. My draft folder is actually pretty big at times. I erase the two, who it goes to, because I don't want to, if any chance that I happen to hit send, it will at least tell me that it's not going to go to anybody. I erase the two and I keep it in my draft folder. It gives me a time to think about it. Sometimes it's only ten minutes, but sometimes it's two days before I actually send it or sometimes I actually just delete it altogether because it's not the way it should be sent. I think particularly if you're angry, then you should leave it in that draft folder for a while and sit back and think about it. That leads me to the next, if things become heated, abandon email and discuss things in person. It's really, really important not to send these nasty RAM emails to each other. If you need to talk about it, sit down and make the effort to talk about it. I didn't put this in my slide, but the other thing to remember is that you don't have to answer all emails right away. Silence is a really useful tool. It allows both parties some time to think. If you don't want to answer, then they kind of get your message. Silence can be an important tool as well. I also want to talk to you a little bit about nonverbal communication. I hope some of you have read about Amy Cuddy. She's a social psychologist at Harvard. A lot of these issues with these power poses have been written about in Time Magazine and Newsweek. Maybe you have read about them. Amy Cuddy and her colleagues first published these experiments with power posing in 2010. They showed the benefits of doing these expansive, bold poses, even just having good upright posture, as well as even vocal expansiveness, speaking slowly. Carrying yourself in a powerful way directs your feelings and your thoughts and your behaviors. It's been shown to increase testosterone levels and decrease cortisol levels. Your body feels more powerful, you're more present, and you're going to perform better. I will tell you, and pay attention to this, see if you do any of these things. It's interesting to me that if you look at her book cover jacket, in her pose, she doesn't have a power pose at all, but she makes a point in her book of saying that women, particularly when they are feeling nervous, will touch their face, their neck, they'll play with their hair, or they'll cross and uncross their legs a lot. I think it's important for you to be attentive to your nonverbal communication and what you're saying by your body position. Can this improve your performance in a measurable way? She did a study where they told subjects that they were going to be participating in an intense mock interview for their dream job. They had only five minutes to prepare a response to the question, why should we hire you? They told that they were going to be videotaped, they were going to be judged by a panel of experts, and they had to speak for a full five minutes. The judges that were evaluating them wore white coats, they had clipboards, and they gave absolutely no feedback. While these participants were preparing their speech, they had some of the subjects adopt a high power or a low power pose before the interview. It's not during the interview, obviously. That would not go well. Before the interview, for two minutes, while they were preparing, they took one of those poses that I showed you earlier, the Wonder Woman pose, as you can see here. Those who did the power poses had better evaluations, they were more strongly recommended for hire, and really because presence mattered to the judges because it signaled genuineness, it signaled believability, and it told the judges that they could trust the person, that they were observing what was authentic. Amy Cuddy says, your body shapes your mind, your mind shapes your behavior, and your behavior shapes your future. So let your body tell you that you're powerful, that you're deserving, and you'll become more present, you'll become more enthusiastic, and you'll become more authentically yourself. Next slide. So what happens if you don't do a good job with communication? It leads to unhappiness and frustration, and it destroys the doctor-patient relationship, it destroys loyalty and progress, and the same is true if there's miscommunication with your nurses or your colleagues or even your spouse, right? Next slide. So my final tip here is, what do you do if you're not doing it well? Get help. If your communication style is hurting your practice, don't believe it's just my personality and I can't change. You can improve your communication style and your communication approach. You can become more effective, you can become more successful, and you can become more empowered. Believe me, business leaders do this all the time. They seek out help and coaches to help them improve. Doctors, we don't do this enough. Next slide. So here's a few ways that you can improve your communication skills. Do it like business leaders. You can hire an executive coach. But for many of us, we're not going to take that route. So practice. Really, practice communicating and think about how you're communicating. Ask for feedback. There's plenty of things out there for you to read from things like Forbes, business magazines. Look in the business sector of things, Forbes, or the Harvard Business Weekly. Remember that you could take a course or you could actually find a mentor. I think that it's important for you to pay attention to your communication skills because it impacts so many aspects of your practice in your career. So I know you have a lot on your plate, taking care of patients, reading up on the latest endoscopy practice, getting your MOCs, but it's really important to consider your communication style because it impacts so much in your life. So thank you so much for listening and good luck. Thank you very much, Dr. Yoshida. Yes. I'm just going to tell you, I'm putting these power pulses up at the very end so that you can see them while we're answering questions. Okay. Well, thank you very much. At this time, Dr. Yoshida and the lead directors will address questions received from the audience. As a reminder, you can submit a question through the question box. If you do not see the question box, please click the white arrow in the orange box located on the right side of your screen. It's towards the bottom. So the first question we have for this webinar, number one, in situations such as open access endoscopy where you have little to no relationship with the patient and family, how should you approach them if there is an adverse event? These are situations where trust has not been established. So this is my everyday life and I think this is really important. You have to establish trust at the very beginning and I think that has a lot to do with the way that you first approach the patient. For me, it's really important that I meet the patient before the procedure and that I make a very concerted effort to let them know that I know about their last colonoscopy, for instance, if they had a colonoscopy even by some other person, that I know why they're there and I know what we're doing and what they've had done in the past. I make it a point to, when I speak about consent, I make it a point to slow down when I talk about consent and to speak to them in language that they can definitely understand. And I think, finally, one of the things that I do is I talk to the family member in the room and I will say something like, your wife will be with us for 45 minutes, we'll take great care of her, and you're in charge of lunch when we get back. And I think that, I think the communication there is helpful at the top when you are, they need to understand that you know them, you care about them, and that you're going to take good care of them. And I think that if you come out and there is an adverse event, which will happen and we can't always prevent, that they know that you were prepared beforehand. I think that's really key. Yeah, I would, I agree with everything that you said, Cindy, and I, you know, the other thing you mentioned during the presentation is just honesty, you know, about what happened, you know, whether you anticipated that it was going to happen or you did not, but this is what we think happened, this is what we're going to do now, and, you know, I think that honesty is really important, because, you know, patients know, they know by your body language, by your voice, whether something doesn't sound right, and so, you know, just being honest and just like you, I deal with this all the time, and most of the time I would say patients understand and they want you to continue to take care of them. Okay, the second question we have here, are there certain courses nationally that you are aware of that would be helpful in this arena of communication? So I talked to you guys about taking a course or getting an executive coach. I think probably the best way to do this would be doing something locally. So at University of Virginia, we have a business school, we have a Darden business school, and Darden has a, if you look at the business school website, they definitely have ways that you can find a mentor, or they have executive coaches that you can hire, but they also have great courses. They have courses specifically for teaching communication. So if you were really interested in a course, I think I would look towards a business school, and you can do this online too. Even business schools online have communication courses. But don't, I would also say, don't discount the idea of having an executive coach, especially as you are moving up in your career, things like becoming a chief. I think taking this job on is something that if you need to lead, you need people who are unbiased to help you in your, all aspects of that next job, but also in communication skills. So I think we don't do this enough as physicians. We don't use coaches, but it can be very useful. Yeah, I would, Marty, I'll just add also, this is Jennifer, that Harvard Business School has several programs that are available to everyone. They're pretty costly, but particularly if you're moving up in leadership, your department may oftentimes fund you to go if you're obviously interested and you're taking on a leadership position, but, and specifically around healthcare. So if you go on their website, they have a program where you go, I think it's for six months, and maybe go four times in that six months and meet with your class. And so I've been told, I think I'm going to sign up for that soon, but I've been told that was really good. And then also this ELOM program, and I forget what it stands for. I don't know, Dr. Sheen, if you've heard of that, but it's this executive leadership program specifically for women and it's out of Drexel University as well. Sounds great. Yeah. Okay, the next question we have, if we are perceived as too pushy, are there certain body postures you recommend when talking? You described postures of confidence. However, if overconfidence is an issue, is there a better pose to assume? That's a great question. You know, I guess I would have to say, Vanessa and Jennifer chime in here. I don't think that's the problem with most women. I don't think, I mean, we definitely have women that we know of, right, who are ball busters. But I think that for the most part, right, for the most part, women tend to have more trouble being confident. So I wouldn't say that there is a pose that we should try to take or something. It's about reading your audience, too. I think if you're getting too aggressive, you need to probably tone it down. I agree. This is Vanessa, Cindy wholeheartedly. The other thing that I know sounds sort of simple, but I like to be comfortable in what I'm wearing when I'm giving a talk, because if you're uncomfortable or you feel self-conscious, That's another added stress, being up there. So just something that I tend to do. That's good input, because I tend to like, you know, wear high heels and I'm uncomfortable. So I'm going to start to follow that, Vanessa. But the other thing I would say about, and so I'm tall. I think all of you all know that. And so I'm actually very conscious of that. And I try not to kind of tower over or lean into people's space. And I know that's sort of counter to what you just told us. But I don't want to make the other person feel uncomfortable. So I tend to be very conscious of that and just sort of give them my space, give them their space. But I don't fold my body in. That I will not do. But I will just kind of pull back, particularly with a guy. I feel that men get intimidated when I'm looking down. So that's sort of another issue that I deal with. I don't have that problem, Jennifer. Okay. Neither do I. And you mentioned that reading people or groups is very important. Can you give examples of cues we should be picking up on? Oh, I think there's a ton of cues that you can look at. I mean, particularly if people are not looking at you. For me, when I give, it's super difficult on a webinar, I'll tell you, because I have no idea whether or not you guys are just muting me and watching YouTube videos. But I think that when you're with an audience and you have people in front of you, if people start fidgeting or looking away or if they are not looking at you or paying attention to your slides, you've got a problem. And you have to reengage. You really have to try to get their attention back. The other thing, too, is I don't like it when people read off their slides. It's really important for you to have a conversation, particularly if you're giving a presentation to the audience. So practice. I mean, do the presentation a bunch of times at home with notes and then without notes and see if you can give it. And I think that if you have it written down at the beginning, you'll be able to give it over and over and engage your audience a lot better. Cindy, one thing I tend to do is if somebody's, you know, we all have situations where there's that member in the audience who's falling asleep in the front row. And if that sort of deflates me in any way, I just concentrate on the folks that are actually engaged and looking. I mean, obviously, it's a problem for the whole audience who's asleep and snoring. But, you know, to sort of build your confidence back, I tend to look at the people who are engaged and try to eliminate that one person who's sleeping out of my head. That's good advice. Yeah, it's perfect. The next question I have, I have noticed some patients or family members recording conversations on their phone after the endoscopy procedure or in the clinic. How do you approach this? And is there a particular hospital policy you follow in your institution? So we don't. So I don't know anything about our hospital policy, but I will tell you, I work at an ASC and they definitely have a no recording, no phone policy. So we keep phones out of the procedure room. We don't even allow the phones to be in the procedure room. They take everything away and make sure that the phones are not there. And they don't allow that afterwards. I'm super, I've not had that happen. I think I would probably ask the person if we could just have a discussion without it. And many times they probably would say that they want to make sure that they're going to remember everything that, I can understand this now, because they want to make sure that they hear everything that you said because they're sedated and they want to make sure that they get it all down. And my response to that would say, please call me tomorrow. I'm happy to talk to you anytime if there's something that you didn't get. I want you to hear this. But yeah. Jennifer? Yeah, I agree with that. Yeah, I have had a patient's son recording the conversation. We came as a team rounding. And, you know, the challenge I have with that, if they ask me, can I record this? Because I want to make sure my sister-in-law gets, you know, gets the same information because they're going to ask me. You know, I may say, I may say, okay. And then obviously I'm very cautious. I'm always cautious about what I say, but I'm even more cautious. But it's when they like this, this one particular patient or the patient's son just kind of had the phone kind of hiding it and recording the conversation. But I saw him and I didn't say anything because I wasn't sure about the policy. When I asked the nurse manager, then, you know, he told me that patients can do it. They have every right to do it. It's just courteous for them to ask you, can I record this? And then you may respond, you know, the way in which you mentioned, Cindy, or you may say yes, whatever you're comfortable with. But they really should ask your permission to do that. Otherwise, it does seem like they have some ulterior motivation and it makes, it made me uncomfortable. So, you know, I think if I had to do it again, I would say, are you recording that? Can I ask you why? Blah, blah, blah. And then maybe say call me tomorrow based on what you just said, Cindy. But, you know, it's a tough situation because I don't think that they, that there's a policy like you said. I agree, yeah. You know, the majority of the time for us is when it's exactly what Jennifer said. It's so that a family member that's not present can hear what the results showed and what the findings are. And I kind of agree with both of you. I prefer that they not, but if they really insist, I am very cautious about what I say. But we've got to really be mindful that any time and anywhere we are in the procedure, out of the procedure, we have to really act like we are being recorded. Yeah. Because, you know, and not say anything inappropriate and, you know, sometimes we're tired and we make jokes, but got to be mindful that anywhere and anytime we may actually be recorded. Yeah. And that's just important, too. There have been a number of instances at our institution, and Vanessa can confirm this, but where there has been communication that's been taken wrong by maybe a physician to a staff member. And I think professionalism is very important. And if somebody questions your professionalism, communicating that and making sure that they understand what you said was not meant to be derogatory or that everybody understands the way that the communication was happening is really, really important to not getting into trouble. Okay. And the final question for this webinar is, often if you are a woman and you are direct and honest in a situation, it is labeled as aggressive or inappropriate. There is a gender divide on acceptable language. I am told by my mentors, unless it's a male colleague's idea, it is not a good idea. How do we overcome this in 2017? Go find a different place to have a job. My goodness, I will tell you that really, that's, I get the beginning part of the question because I think that is true. There's definitely times where there's a double standard. But if a male colleague is telling you that your opinion is not valuable because you're the wrong sex, that's not acceptable. I think we have, I have many male colleagues who are very, very supportive of what I say and are very respect, and respect me for what I say as well. It's tough because just like Sheryl Sandberg said, and please read her book. I mean, Lena is a very, very important book. One of the things it'll do, it'll help you find people who are like you and help you to look for people in your organization who have the same goals as you. And you can work together to help to solve some of these problems, like I said, because it could be mostly in your area or your division or, and it might be helpful to have other people that you can talk to about this. But read Sheryl Sandberg's book. I think she has really good ideas about that whole issue of that delicate honesty. It's important for you to be honest, like Jennifer said earlier, but we don't have to be brutally honest. Sometimes that is going to get you into trouble. You have to make sure that the way you approach things, and even maybe that's a deal about practicing, is if you can practice the way that you deliver your message, and even deliver it to a colleague before you deliver it to the person that you need to be honest with, you can get feedback from that person as to the way that you might be able to do it better. And I think that might be the most helpful advice I can give you. All right. Thank you all for joining us. We hope that this information is useful to you and your practice. Following tonight's webinar, you will receive a short survey. Please take a moment to complete it. This concludes our webinar. Have a great evening and thank you again.

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