Managing Difficult Conversations Without a Neuralyzer

I think I was the last lone ranger Chief Resident in Psychiatry, meaning doing the job solo. After that, there were always at least two senior residents managing that. One of the things I did was to give lectures on various topics that were not strictly related to how to work on the wards and clinics, but how to communicate with other professionals and with patients.

The other big task was fielding outside telephone calls from doctors in other hospitals trying to transfer patients to The University of Iowa Hospital psychiatric units. That’s right, that was a resident’s duty. I had some pretty difficult conversations. I couldn’t just accept every referral.

The hospital didn’t issue neuralyzers, so it was impossible to make difficult conversations go away.

I used a couple of books as guides: “Getting to Yes” by Fisher and Ury, and Difficult Conversations by Stone, Patton, and Heen. I should seriously have reread those books during my entire career and even now. Nobody’s perfect. I encountered racism from patients, so I was no stranger to a variety of difficult conversations in many different situations.

Anyhow those two books are on the short list at the University of Iowa Conflict Management web page. There’s a ton of resources there available for learning about how to manage conflict and recognize what implicit bias is and what it is not.

Implicit bias gets a lot of press. I think it can tend to set people on edge before and during seminars on equity, diversity, and inclusion. Not everybody is a racist. But our brains are wired for implicit biases. I think we all need to get busy, and I mean everybody, including me. A good place to start is understanding implicit bias.

Dr. Feranmi Okanlami MLK Distinguished Lecture

Today, Dr. Feranmi Okanlami, MD, MS, director of student accessibility and accommodation services at the University of Michigan, delivered the Martin Luther King Jr. Distinguished Lecture: Disabusing Disabilities.” It was sponsored by the University of Iowa.

I attended Dr. Okanlami’s lecture by Zoom. I noticed he was wearing a handsomely carved wooden bow tie, which I don’t have an image for, but you can order them on Amazon, if you’re interested. I’m not the only attendee who noticed it. I used to wear cloth bow ties when I was a much younger man. I gave up wearing any cloth ties shortly after the Covid-19 pandemic began because, as everyone knows, fabric neckties of any kind generally almost never get laundered and carry all kinds of germs. The wooden bow tie is easily wiped down with sanitizers.

But this post is not about wooden bow ties. It’s about what Dr. Okanlami called “ableism” which naturally brings to mind other terms like “racism.” He showed a few images on his slides which showed another point he expanded on, which is the difference between equality and equity. The quick way for me to explain this is to quote the Milken Institute School of Public Health definition:

“Equality means each individual or group of people is given the same resources or opportunities. Equity recognizes that each person has different circumstances and allocates the exact resources and opportunities needed to reach an equal outcome.” — MPH@GW, the George Washington University online Master of Public Health program.

Dr. Okanlami impressed me in many ways, but one of them is his ability to give unrehearsed presentations. He hates to “give talks” as he put it, but likes to talk. 

I should explain the reason for this post’s featured image, which might seem puzzling. It’s a photo of the curb ramp connected to the sidewalk outside our home. The city requires homeowners to clear the snow from curb ramps, which, ironically, the city plows plug with snow after every snowstorm. These used to be called “handicap ramps.” I suspect Dr. Okanlami would object to the use of this label and in general it’s probably insulting, but that is what they were called for years. They are an accommodation for those who use wheelchairs.

The word accommodation can have a negative connotation, which Dr. Okanlami clarified. Many believe accommodations give an “unfair” advantage to some people. Actually, they provide opportunities for those with a different set of abilities or altered abilities to participate in society in ways that allow them to contribute to society, and even change it—sometimes in major ways.

Our curb ramp is interesting. The short length of sidewalk beyond it leads to a pile of construction rubble because there is no sidewalk extending beyond our property line on that side. I call it the sidewalk to nowhere, which is now a misnomer. There is a new subdivision under development leading north of our neighborhood. There are houses being built and many have moved in. But for now, you have to walk in the street, which is often muddy and blocked. It’s difficult to walk through it because of heavy equipment and trucks parked along the street. But that doesn’t stop people from walking there. I have never seen anyone in a wheelchair attempt to use the curb ramp. But many people use it who don’t have a visible disability. But it’s there if someone needs it, and we keep it clear of snow on principle.

Dr. Okanlami mentioned those with invisible disabilities. There was not enough time to discuss this in detail, but they include those with mental health challenges. As a consulting psychiatrist working in the general hospital, I saw many of them. They deserve a seat at the table, too.

And I remember one of my medical school classmates who did need to use a wheelchair. There was a special ramp made for him that allowed him to participate in gross anatomy class. Dr. Lance Goetz, MD, graduated with our class and has been a practicing physiatrist in Richmond, Virginia for the last 21 years.

Although Dr. Okanlami’s lecture was recorded today and will, I hope, soon be available for public view, I’m including a YouTube recording of a presentation he gave in 2018 which has the same title and very similar content as the talk he delivered today.

I think his talk evolves every time he gives it. The environment in 2018 was very different than it is now because there was no pandemic and there was a live audience which interacts in a very different way than Zoom allows. That said, the slides were essentially the same today on equity and equality, as were his essential points. He shared a lot about himself in 2018, maybe a little less today mainly because of time constraints and the difficulties inherent to virtual lectures. But he has a great sense of humor.

And he does wear very handsomely carved wooden bow ties.

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