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Does anyone know why the band Fleetwood Mac might have been an expert in medical communication?
Physicians and other medical providers have multiple roles; one obvious task is to provide advice. And for this advice to be valuable, we need to be good listeners; we need to absorb data from multiple sources, which include journals, textbooks and patients; and we need to synthesize data and observations to create a plan. Perhaps most important, we need to communicate. Most commonly this communication is with patients, but it can also be with staff, friends, family or colleagues. And for many of us, it takes the form of lectures or written communication.
Recently a peer asked me to share with other faculty advice on how to give a lecture. At first, I was a bit intimidated to portray myself as a role model. But once I accepted the task, I confess that I enjoyed formulating some observations I have made during four decades in academia. I call the advice Rosenbaum’s “Rules,” and if you are patient enough to read to the end, you will appreciate why “Rules” is written in quotation marks.
The 5 “Rules”
Rule number 1: The only time you have the audience’s full attention is when you begin; consequently, the first words out of your mouth are also the most important.
I tested this nearly 30 years ago, when my daughter asked me for advice about what to say for a speech at her bat mitzvah. We hit upon starting with a riddle: “How is my bat mitzvah related to my Torah portion, my Uncle Ricky and the Metropolitan Opera?” I guess it does not exactly compare to “It was the best of times. It was the worst of times,” but to have stayed in my memory for three decades suggests that at least it did create some interest (for me if for no one else) in what was to follow. (I defer to readers as to whether I have fulfilled this goal in this essay. And don’t ask me to solve the riddle; neither my daughter nor I remember her Torah portion.)
Rule number 2: Tell the audience what you are going to say, tell it and then tell them what you said.
Almost always when I give a talk, an early slide is labeled Outline or Agenda. This helps provide structure for me and for the listener.
We deceive ourselves if we think that anyone in the audience will retain all that we have shared. You will have achieved success if the audience absorbs one or two key points. Don’t be shy about stating and restating what you perceive to be the most important information.
Rule number 3: Know your audience.
If you are lecturing in North Dakota, say something to show that you recognize and appreciate North Dakota. If you are lecturing about polychondritis and an audience member has published an important paper on polychondritis, give that audience member a shoutout. Acknowledging the experience, wisdom and expertise of your peers is simply good behavior. Showing that you admire your hosts will make your audience more accepting of any advice you share.
Rule number 4: Active learning is always more effective than passive learning.
One solution to ensure your audience is paying attention is to have a quiz at the start of the talk and guarantee the answers will be embedded in the lecture. Another solution is to make use of audience response devices. And another gambit is simply to ask such rhetorical questions as, “How would you approach this problem?” The more the audience feels engaged and empowered, the more likely they will retain at least a portion of your message.
Rule number 5: Fashion your own unique style.
This rule is exemplified by a behavioral science experiment conducted at the Boston Museum of Science with preschool children.1 Cognitive science faculty from Massachusetts Institute of Technology created a toy with four colored tubes: red, purple, black and blue. The gadget was capable of four actions: it could squeak, it could play music, it could illuminate itself, and it could act like a mirror. If the experimenter demonstrated one of those attributes and then handed the toy to the child, most children focused on that one function, repeatedly triggered the action and soon got bored. But if the experimenter just handed the toy to the child, most children explored the toy, rapidly learned all four functions and spent more time in play than when the show-and-tell teaching approach was used.
You can interpret this study many ways. But to me, the lesson is that telling someone what to do or how to behave is constraining. It is far better to allow someone to explore and find the path that best fits their personality, interests and skills. That is why I placed rules in quotation marks in my title. The only rule for optimal communication, be it with a patient, in a scholarly paper or in a medical lecture, is to find your own style. Find what works for you. And try your best to assess objectively if you have succeeded with your own unique approach.
So, ironically, my advice is that the best advice is to ignore my advice. Rules are indeed made to be broken. Or, in the words of Fleetwood Mac, “Go your own way.”
James T. Rosenbaum, MD, MACR, is the Richard Chenoweth Chair Emeritus, Legacy Devers Eye Institute, Portland, Ore.
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