Subscribe to The Podcast by KevinMD. Catch up on old episodes!

We’re joined by Jill Wener, an internal medicine physician, as we delve into the transformative concept of dialectics. Join us for an exploration of how dialectical thinking can help you navigate complex emotions, foster better health care practices, and promote constructive dialogue on contentious issues.

Jill Wener is an internal medicine physician.

She discusses the KevinMD article, “An approach to conflict resolution: More than one thing can be true.”

Our presenting sponsor is Nuance, a Microsoft company.

Together, Microsoft and Nuance are leveraging their rich digital technology and advanced AI capabilities to tackle some of health care’s biggest challenges. AI-driven technology promises to revolutionize patient and provider experiences with clinical documentation that writes itself.

The Nuance Dragon Ambient eXperience, or DAX for short, is a voice-enabled solution that automatically captures patient encounters securely and accurately at the point of care. DAX Copilot combines proven conversational and ambient AI with the most advanced generative AI in a mobile application that integrates directly with your existing workflows.

Physicians who use DAX have reported a 50 percent decrease in documentation time and a 70 percent reduction in feelings of burnout, and 85 percent of patients say their physician is more personable and conversational.

Discover AI-powered clinical documentation that writes itself. Visit https://nuance.com/daxinaction to see a 12-minute DAX Copilot demo.

VISIT SPONSOR → https://nuance.com/daxinaction

SUBSCRIBE TO THE PODCAST → https://kevinmd.com/podcast

RECOMMENDED BY KEVINMD → https://kevinmd.com/recommended

GET CME FOR THIS EPISODE → https://earnc.me/hS7Jb8

Powered by CMEfy. 

Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Jill Wener. She’s an internal medicine physician. Today’s KevinMD article is “An approach to conflict resolution: More than one thing can be true.” Jill, welcome back to the show.

Jill Wener: Thanks so much for having me.

Kevin Pho: So Jill’s been on several times. Go to KevinMD.com/podcast to hear her prior episodes and her story. But today let’s jump right into this topic, which I think is very relevant in a lot of the situations that we physicians find ourselves in, “An approach to conflict resolution: More than one thing can be true.” So tell us about this article.

Jill Wener: So for anyone who has read the article, I kind of came at it from the approach of current politics, international news, something that’s really been consuming a lot of my emotional energy, I guess even before October 7th. But I realized that a lot of people are having a hard time with the situation in Israel and Palestine, because we’re very polarized. It’s either one thing or the other.

And I’m a Jewish woman and I support the liberation of Palestine, and people have accused me of being anti-Semitic or not caring enough about Jewish people because of that. And so what has been very helpful, and a lot of people have responded to in my social media posts, is the concept of dialectics, which is the notion that more than one thing can be true at the same time even if they oppose each other. And so I wanted to bring that into the KevinMD space and apply it toward a lot of the stuff that we see in health care and health equity spaces as well.

Kevin Pho: So tell us exactly what dialectics is, and how have you used that, especially with the current political environment? Just give us a story, an example, about some of the criticism that you faced and what you did to address that.

Jill Wener: Sure. So dialectics are the idea, I sort of mentioned it, but the idea that more than one thing can be true at the same time, even when they seem to be opposing. And they have been used for dialectical behavioral therapy, which people may have heard of as really great for patients with borderline personality disorder. But they’re also used outside of therapy spaces completely, so dialectics have nothing to do with borderline personality disorder. And they’re also used in therapy, like I use it with my therapist. So it can be used in spaces that are not just borderline personality disorder.

And basically, I am opposed to anti-Semitism, I have experienced anti-Semitism, and I also oppose Islamophobia, and I also oppose the way that the Israeli government has been treating Palestine and continues to treat them. So the idea that I care about other people as much as I care about my own experience seems to be hard for people. And me caring for the liberation of Palestine doesn’t take away from me wanting the world to be a safe place for everybody, including Jewish people.

Kevin Pho: So how difficult is it to hold on to that notion that more than one idea, or more than one opposing idea, can be true at once? Because it seems like we read newspapers and there’s a certain absolutism in terms of how people feel. It’s only one thing or the other. We seem to be living in a world where there are binary choices. So how can one get from our current state, which is binary choices, to what you’re describing in terms of holding more than one opposing idea at once? How difficult is that? How does one get to that place?

Jill Wener: I would say that’s like the million-dollar question, Kevin, and I’m really glad you asked it, and I may not have a great answer, but I’ll try.

I think first off, particularly when trauma is involved, people go into their habitual trauma responses around things that have happened to them in their lives. And for Jewish folks that could be carrying Holocaust trauma, that could be carrying other trauma that Jewish people have experienced, or their own personal anti-Semitism. For physicians it could be some of the trauma of training that’s happened, or a bad patient experience, or something like that.

So when we bring our own trauma and we go into the trauma response, our rational thinking brain goes offline for, I think, a minimum like 17 to 24 minutes. So we’re kind of in survival mode and threat detection mode, and we’re not thinking rationally. And that’s great if we’re actually in a threat in that moment, and people in the Middle East, actually right now in Palestine, are in actual physical threat right now. But me right now as a Jewish person, I’m not in physical threat. So if someone says something that kind of activates that threat response, I’m not communicating with them in a way that’s open. I’m getting defensive, and I’m not looking to communicate or to listen or to hear anything other than what I’m feeling.

So I think what’s important is for us to recognize when our own trauma responses come up, recognize that all the experiences we’ve had in our lives follow us everywhere we go unless we’ve really worked to heal those, recognize when we’re starting to get defensive, recognize when we’re listening only to correct somebody, being very conscious and intentional about honoring someone else’s point of view, especially if we don’t agree with it. We can listen, we can say, I understand what you’re sharing with me, thank you for sharing your opinion, and I feel, instead of but, and. So we can use both-and thinking instead of kind of either-or thinking. So those are just a few of the ways that we can start to do it.

But I had this moment, someone was telling me about an experience they had over the holidays, and they were talking about their grandfather who has passed away. And they were like, I feel so bad, because my grandfather, who I loved so much, looking back he was really, really racist. And he thought that he wasn’t, he thought he was helping out some of the black folks in his community, but he was actually super, super racist. And this person was sharing with me that it made them feel kind of sad about, and also a little guilty, that they loved their grandfather so much.

And I actually really liked that, because it helped to remind me that even people who do these racist things or say these racist things, they’re humans too. And I don’t want to justify it, but if we can try to see the humanity, because this man was extremely important to my friend who was telling me about it. This man did take those actions, he was a product of his environment. So if we can understand that we’re products of our environment, and learn and change and grow, then we can also still remember that we’re all human beings, and we all brush our teeth hopefully at least once a day, a couple times a day, and we all have family, and we laugh at jokes, and we have fears and anxieties.

And it’s really hard to do. It’s really hard for me to do, because I see people sometimes who are, I’m an anti-racism educator, and so I hold space for people and I’m compassionate for people when I’m working with them. But when I hear some of the stuff that’s out there, it’s very hard for me to remember that they’re humans, and it’s really hard for me to remember that dehumanizing people doesn’t bring us to understanding and progress.

Kevin Pho: So what kind of techniques do you do in those situations when you are talking or meeting with someone with opposing viewpoints, or even extremely opposing viewpoints? How do you take that time to think and acknowledge the fact that, hey, they too are human?

Jill Wener: Oh, that’s a good question. I mean, I think as much as possible, to create a container, to create expectations, guidelines, around having these types of conversations. Not everyone wants to learn, not everyone wants to grow. And so knowing that if I’m engaging with someone who actually wants to learn or have a discussion, let’s set aside time and come in so we are going to minimize our getting defensive, or when someone says something we don’t agree with or that causes harm, there’s a way for us to talk about that. That’s not always realistic in the real world.

So I think that recognizing my own physiologic response as I start to get upset or triggered by what they’re saying, giving myself space to breathe, setting boundaries, knowing that there are certain things that I’m not going to fall into, a certain trap I’m not going to go there, if they start to get belligerent I’m not going to go there, self-compassion when I’m not reacting in a way that I’m proud of, or compassion for that person when they’re not reacting in a way, recognizing that they’re bringing their own traumas in as well.

And I think, yeah, I don’t know that, it is very difficult. In situations right now around Israel and Palestine, it’s really hard for me to engage in those conversations right now with people who are not addressing the fact that an entire people are being demolished, and without acknowledging the political circumstances that led to that. So for myself, I’m pulling away from some of that. I’m speaking out, I’m writing this article, reaching out in other ways, putting out social media posts, and calling my congresspeople. But right now I don’t want that to get in the way of my relationships with people, so I’m avoiding that as much as possible. I have had very deep conversations with my parents about it, who don’t agree with me, but we did agree that our relationship is important, and so we heard each other out. And I think that sometimes is all we can really ask for.

Kevin Pho: How about in the exam room as physicians? How can dialectical thinking foster better connections and communication with our patients?

Jill Wener: I think in health care, and I got to this a little bit in the article, in health care, especially as allopathic doctors, we are trained to know everything, and everything else is wrong. Chiropractors are dangerous because they cause dissections of the vertebral artery, but we don’t acknowledge our own things that we do that cause problems, like contrast nephropathy, all sorts of things that we do that can be harmful, but we don’t really see that. So we point our fingers at all these other things that aren’t what we do, that we think aren’t right.

And I think in doing that we set ourselves up for almost confrontation with our patients, when we don’t know the answer, when we can’t figure it out, or they have a symptom that is maybe stress related but we’re not equipped to help them deal with that stress. We can get defensive, and we can find the patient annoying, we can kind of be like, oh, they’re one of those annoying patients, or we can do extra tests and medications that maybe aren’t needed.

So if we’re able to acknowledge, there’s things that I don’t know, there’s things I have not been taught, I’m not trained to do, and there are also a lot of other people out in this world who can do certain things, who can fill in the gaps in a way that I can’t, I think that can allow us to have more collaborative conversations with our patients, and have it be less oppositional when patients come in with Google articles.

We get threatened by that. I think it’s frustrating in a lot of ways, but it’s sort of like, who do you think you are? Well, really, we should trust our patients to know their bodies best. And yes, we offer advice as experts, but can this patient be sharing something, and can we also have a lot of knowledge? Can those both be true at the same time?

Kevin Pho: So are you seeing a trend towards that ideal? Whenever you coach or talk to other physicians, do you still feel that physicians today are taking that paternalistic approach, my way or the highway, I’m right and I’m the physician, I have more knowledge? Or do you feel that there’s a trend more towards this dialectical approach, where we can assume that we don’t know everything and sometimes we have to let the patients guide us?

Jill Wener: That’s a great question. I love that you use the word paternalistic, because that’s absolutely perfectly descriptive. I don’t have a good answer to that, because I’m actually not in practice, I left clinical practice in 2015. I will say that my experiences as a patient in the health care system, I feel like people are starting to become more open to other modalities.

And I think there’s also, when you’re stressed out and we have 10 minutes, 15 minutes per patient, and you have your private equity firm breathing down your neck to be productive, it’s stressful and it’s really toxic. So anything that’s going to push you out of what you normally do, out of your normal routine, is going to feel threatening, and I understand that. It’s really hard to be a health care professional right now. So I think that sometimes it’s still seen as an interruption or like a nuisance.

But I am hearing more and more physicians saying, OK, well, I don’t know about this, but you could try acupuncture, or go to the pelvic floor physical therapist, or try these other things, knowing that they don’t have all the answers. And I think that helps a lot for physician well-being as well, not having to carry that whole weight of knowing everything, trying to fix everything, because that doesn’t make any sense, that we should have to do that for people.

Kevin Pho: Now, to shift that mindset on behalf of physicians, is that something that they could do themselves, really just taking a deep breath, as we talked about, and acknowledging that we may not have all the answers? Does this require some formal therapy, as you alluded to earlier? What does it take for physicians to integrate more of this dialectical thinking?

Jill Wener: I don’t know. I mean, for me, I was so in that mindset until I broke down with burnout in 2011 and learned this meditation practice, that I was like, holy crap, how is this even real, how is this something that has been out there that I kind of had my blinders on, that I didn’t even know that things like that existed? And so that for me was a huge thing. Well, what else is out there that I don’t know about? What else have I been missing, because I’ve been kind of indoctrinated to think that this one thing is true, or the only truth?

So that for me was something. And then I learned about tapping, and tapping was amazing for me, and I know that acupuncture has really great data and results. And just kind of, I mean, just trying things out, hearing what people have to say, just allowing ourselves to be open and shifting the mindset.

I don’t think it requires any therapy or anything other than a willingness to not have to be right all the time, to let go that mantle of carrying the weight of the world, all that responsibility on our shoulders, and being open to being wrong. And that can be really hard, but it’s also honestly a big relief, not having to be in charge all the time. For me it was like, oh, when I surrender a little bit of the control, things kind of happen the way they’re meant to happen, and usually it’s better than I even thought should happen. Like there’s an answer that’s even better for the patient, that I was so focused on my mindset that I was missing out on. So it’s just like a willingness to shift our mindset a little bit, and I think then that brings in more experiences and more exposure.

Kevin Pho: We’re talking to Jill Wener. She’s an internal medicine physician. Today’s KevinMD article is “An approach to conflict resolution: More than one thing can be true.” Jill, let’s end with some of your take-home messages to the KevinMD audience.

Jill Wener: It’s OK to be wrong, it’s OK to ask for help. And I think until we acknowledge that someone else’s lived experience is just as important as our lived experience, we’re going to keep running into the same issues over and over again, the frustration with communication problems, with health equity, political issues. So we have to start to really, really recognize that there are other experiences and truths that are just as important to other people as our truths are to us.

Kevin Pho: Jill, thank you so much for sharing your time and insight, and thanks again for coming back on the show.

Jill Wener: Thanks for having me.