89. The Drunk Whisperer
Highlights
- DEF CON 5 - I'm Chill, You're Chill
Summary:
It's just being nice, acknowledging that no agitated patient chose this as plan A. And any sort of minor bribery, like we've had the conversation of the number of milligrams of Larazapam equivalent to a turkey sandwich. Just being nice and knowing when you can bend while still keeping things safe.
Transcript:
Speaker 2
It's just being nice, acknowledging that no agitated patient chose this as plan A. It's really all about having that empathy, preserving the relationship, and just checking out and making sure things are okay. And any sort of minor bribery, like we've had the conversation of the number of milligrams of Larazapam equivalent to a turkey sandwich. It's probably pretty good. Just being nice and knowing when you can bend while still keeping things safe. And then as you go down towards DEF CON 4, you're really looking a lot more the active verbal judo type activities. Being a lot more clear that, yes, if you continue that behavior, things will get worse. How is it that we can work together to avoid that situation? Because neither of us want that. DEF CON 3 would often be taking the edge off, honestly, with a lot of oral medications is usually what I like to go here. So we're not wrestling with people and using needles. So I like to use a lot of oral Larazapam or Adivan to sort of take the edge off. And a specific phrase I really like to use is, you seem a bit anxious. Would you like something to help calm you down? And a lot of folks are actively looking for this. They want to be a little bit more chill because they recognize that they're agitated and upset. (Time 0:10:12)
- Empathy in Judo
Summary:
I think that your de-escalation totally fits with this philosophy, staying calm in the midst of conflict. And to that point, verbal judo, there's a lot of specific techniques and frankly, it's hard to remember them. It really is amazing how as long as you have that empathy, it becomes more of a mirror of sort of seeing that, yes, I can put myself in your shoes"
Transcript:
Speaker 1
crash. And I think that your de-escalation totally fits with this philosophy, staying calm in the midst of conflict, deflecting verbal abuse, and offering empathy in the face of antagonism. And the phrasing of, hey, you look stressed, can I get you something to help you relax? When I heard you say that and just how you phrased it the first time and even just this time, I said, oh, that is a different way to model my behavior on managing distressed patients with that calm demeanor because I found myself pretty agitated myself.
Speaker 2
It really is amazing how as long as you have that empathy, it becomes more of a mirror of sort of seeing that, yes, I can put myself in your shoes as opposed to this antagonistic wrestling match that honestly was my previous approach before really reflecting on what we were doing.
Speaker 1
And to that point, verbal judo, there's a lot of specific techniques and frankly, it's hard to remember them. It's like, oh, here's the five steps to do this, a six steps to do this, the eight steps to do that, this mnemonic for that. It's hard to remember. Actually, the author says, you know, it'd probably be hard for me to remember all of these things. But in one of the final chapters of the book after George Thompson, the author describes all of these very exacting steps on how to diffuse or cajole. He gives this single unifying principle and it's so skillfully phrased. And it's this empathy absorbs tension. If you walk into a conflict and try to bludgeon the person by force (Time 0:14:32)
- You Look Real Upset, Hey, Tell Me What's Going On
Summary:
The universal upset patient protocol, there are six steps of this. It's a little bit like the DEF CON thing, but it walks the person through acknowledging their hostility and then hopefully to resolution. Before I walk into the room, I steal myself. And maybe I'll hold these breaths or exhale, exhale slowly just to become a little bit more parasympathetic so that I'm not in an escalated state as they are. "I need to be calm, I need to be like Jose"
Transcript:
Speaker 2
And Rob, I'll go ahead and say that if you believe that you don't have any upset patients and you work in the emergency department, you've got a serious denial problem. All right.
Speaker 1
So the universal upset patient protocol, there are six steps of this. And it's, it's a little bit like the DEF CON thing, but it walks the person through acknowledging their hostility and then hopefully to resolution. So here we go. So the six steps, before I walk into the room, I steal myself. And it's not that like, okay, here we go for battle. But I take a couple deep breaths. And maybe I'll hold these breaths or exhale, exhale slowly just to become a little bit more parasympathetic, so that I'm not in an escalated state as they are, I need to be calm, I need to be like Jose. So step one, walk in the room and say, you seem really upset, or you look really upset. And usually I've been told by the nurse like, Hey, this patient is really pissed. So I kind of know it's a fixed game. Let's just be clear on that. So that validates that they're upset. And that goes a long way, validating what's going on with them, rather saying like, you have no right to be (Time 0:25:27)
- You Look Real Upset, Hey, Tell Me What's Going On
Summary:
The universal upset patient protocol, there are six steps of this. It's a little bit like the DEF CON thing, but it walks the person through acknowledging their hostility and then hopefully to resolution. So step one, walk in the room and say, you seem really upset, or you look real upset. Step two, hey, tell me about it, tell me what's going on. Now this gives them permission to vent. And sometimes it ends at step two because people just want to be heard. But often goes to step three, ham so sorry this is happening to you. Take any ego out of it. Even if you think that their emotional upset is absolutely ridiculous, take any ego
Transcript:
Speaker 1
So the universal upset patient protocol, there are six steps of this. And it's, it's a little bit like the DEF CON thing, but it walks the person through acknowledging their hostility and then hopefully to resolution. So here we go. So the six steps, before I walk into the room, I steal myself. And it's not that like, okay, here we go for battle. But I take a couple deep breaths. And maybe I'll hold these breaths or exhale, exhale slowly just to become a little bit more parasympathetic, so that I'm not in an escalated state as they are, I need to be calm, I need to be like Jose. So step one, walk in the room and say, you seem really upset, or you look really upset. And usually I've been told by the nurse like, Hey, this patient is really pissed. So I kind of know it's a fixed game. Let's just be clear on that. So that validates that they're upset. And that goes a long way, validating what's going on with them, rather saying like, you have no right to be upset. That's step one, you look real upset. Step two, hey, tell me about it, tell me what's going on. Now this gives them permission to vent. And at this point, our job is to listen to just actively taken what they're saying, process what they're saying, not just, all right, I'm going to give them one minute and after that, I'll stop thinking about what I'm going to do after work and I'll get back to listening them. No, you're actively listening, kind of problem-solving in your mind. And you're just listening, not interrupting. And sometimes it ends at step two because people just want to be heard. But often goes to step three, ham so sorry this is happening to you. And regardless of what's happening, even if you think that their emotional upset is absolutely ridiculous, take any ego out of it. (Time 0:25:40)
- The Stoic Philosophers
Summary:
When we're dealing with human beings, it's super easy for us to get angry in these confrontations. How we respond here says just as much about us as it does the other person. We treat people as ladies and gentlemen, not because they are, but because we are. And I think right below or maybe along with empathy absorbs tension.
Transcript:
Speaker 2
I've been a few jugular veins that I was like, how dare you get so close to the carotid? I'm really upset with you. Yeah.
Speaker 1
But when we're dealing with human beings, it's super easy for us to get angry in these confrontations. But how we respond here says just as much about us as it does the other person. And I think right below or maybe along with empathy absorbs tension. There's another verbal judo principle that if you forget all of the micro steps, here is the boldface. We treat people as ladies and gentlemen, not because they are, but because we are. Now, that's not a specific strategy. It's more of something to internalize in these situations. It sounds like it goes a little bit against the empathy like, oh, well, they're not a ladies and gentlemen. Well, yes, they are. But the reason that you are responding this way is because you are. This is coming from you. Now, you will feel the animalistic response of anger or defensiveness or fear and want to lash out. I mean, that's natural when you are being attacked. But take a pause. Take a breath. And remember that you probably don't have a choice about that (Time 0:35:15)