Difficult Conversations

Maria C. Savoia, M.D., F.A.C.P
March 13, 2013
• A discussion between two people where
– Stakes are high
– Opinions vary
– Emotions run strong
» Paterson, K., et. al., Crucial Conversations, 2011
• A difficult conversation is anything you find
hard to talk about
» Stone D., et. al., Difficult Conversations
• When opinions are congruent
• When delivering good news
• When the stakes aren’t high
When behaviors need to improve
When disappointment is involved
When standards need to be enforced
When advocating for your own interests
When you have to say no but want to say yes
– Or, when you have to say yes but want to say no
• Fight
• Flight
Know your heart and stay focused on your goals
Foster open dialogue
Establish a mutual purpose
Work from facts and not from “stories”
What are you trying to accomplish?
What is the real problem?
What do you really want?
Can you state your goal or the problem in one
• No one likes to feel attacked
• No one likes to be blindsided
• Everyone wants to feel respected
• What do you want to have happen with the
• Where is there common ground?
• Where are your goals and interests aligned?
• Don’t assume
• Don’t assign motivations
• Don’t assume others know
• Don’t be afraid of a “no”
• And don’t put it off
Avoid unplanned encounters
Prepare and be prepared
Set the agenda or at least know it
Before opinions, give facts
Test the conclusions from the facts
Try for agreement
Test for understanding
• How you start has a strong influence on
whether you will be successful
• A positive tone sets a positive climate for
• Why would a reasonable, rational person do
what the person did?
• Try putting yourself in the other person’s shoes
• Anticipate his/her emotions
• Anticipate his/her responses
– Yes
– Maybe
– No
• But don’t presume to know the answer
• Be prepared for each response
Something “pushes your buttons”
It is the last straw
You see villains
You feel victimized
You are ambivalent or feel guilty
“Show me a woman who doesn’t feel guilty, and
I’ll show you a man.”
Erica Jong
“Time wounds all heels.”
Groucho Marx

similar documents