I have had 3 conversations today with various doctors at the referral hospital which basically sum up the very limited range of capacity building techniques I possess.
Conversation 1 - Semi-informal general chat with senior management doctor regarding my role and work plan. Style adopted - personable, informal & honest. The subject evolved on to how we can motivate, engage & train staff. There is always a lot of "I completely agree with you", "Can I be completely frank/honest with you?" from me and you don't have to have a degree in psychology to know that this is then often mirrored in return. He suggested to me that a technique for enabling co-operation from the staff would be to sack them if they don't do their job properly & engage in training. Oh how we laughed - it's funny because in a system of patronage, hierarchy and corruption, people just don't get sacked for failing to meet their contractual requirements, breaking rules (what rules?) or even being completely incompetent & negligent. It was a wild flight of fantasy here yet in at home it would be normal working procedure. As far as relationship building goes these are the conversations that mean the most to me but are by far the hardest to have.
Conversation 2 - Any one who has ever worked with me will recognize this well used technique of communication - the 'joking when you really mean every word' conversation. I am so well rehearsed at this technique that once whilst working in psychiatry my boss after asking me about something serious and listening to my response said to me "Esther - I think that humour is an incredibly sophisticated and intelligent defense mechanism but could you please just answer my original question?" Today when I saw one of the paediatric all stars I pretended to avoid him so he grabbed me by the hand, preventing my escape, then we had a long conversation about Vitamin A deficiency, team based learning modules & the paediatric ward renovations. When I suggested - smiling, laughing and leaning in a casual relaxed manner against the nearest wall - that the newly renovated clean, shiny & glazed Paediatric ER had remain empty for 2 weeks now not as he suggested because there had been no children sick enough to warrant it being occupied but more because "the patients were all too dirty and poor to put in to such a lovely new room" he may have got that I wasn't completely joking. He then told us he was on duty and had to go now to see some patients, J (the straight-man) added "so you can finally put some patients in your new ER" - much hilarity - oh how we all laughed (again - capacity building is just so much fun).
Conversation 3 - I like to call the final style of conversing - 'capacity building by flirtation' but I think the term 'prostituting ones-self' may also be used. This technique can only work with people who have initiated the flirtation that you can then reciprocate and use to your cunning capacity building intentions. After alienating myself from the whole surgical department for asking "whose patient is this?" (see 'why today my head hurts....') I had feared that this particular form of conversation was no longer available to me. But walking from conversation 2 to conversation 3 I did pretended to throw myself into the path of one of the surgeons driving his massive Lexus 4x4 to much waving & smiling (by both of us I hasten to add - if it had just been me doing the waving & smiling that would just be a bit odd) - so there was already hope that the thaw had began. My first day back I had barely received a nod of recognition from HS and then in khmer (he has more than reasonable english and french) he gruffly asked my VA "Has she come here because she wants to speak to me?", churlishly I had replied "No, non, o'tey!" But after the conversation 1 it had become apparent to me that HS was the person I really needed to speak to regarding a heading on my to-do list - 'surgery'.
So with B (URC nurse), as chaperone & not as it turned out translator, I went to the surgical changing room - the main stage for most of the important surgical conversations at the hospital. HS as you can imagine was hardly thrilled to see me but when I pulled my joker card that the Deputy Director had said I must speak with him he looked fairly resigned.
What ensued was a conversation regarding burns patients mismanagement, analgesia with dressing changes & trauma care. It was agreed that I would draw up a draft burns protocol, we would have further discussions regarding analgesia (I had previously succeeded in getting a post-operative analgesia protocol written by him using that little known technique 'reverse psychology'. I really hope that I'm not giving too many of my complexed and highly successful techniques away here) and there was even a forced/semi-genuine apology from him for giving me the 'cold shoulder' previously.
All this however required me to have my legs pinned in between one of his thighs & the table leg and having my hand held whilst B watched Karaoke on TV. Now as I have previously mentioned this physical contact is normal for a man-man interaction and my inclusion in this 'bromance' can mainly be put done to my curious 'half man-half woman' status as a foreign female doctor. The hair flicking (mine not theirs) is however just plain flirtation. B was impressed by the effectiveness of my type 3 conversation & quoted that all in all it had been "a very fruitful conversation".
I say - show me the fruit!
Conversation 1 - Semi-informal general chat with senior management doctor regarding my role and work plan. Style adopted - personable, informal & honest. The subject evolved on to how we can motivate, engage & train staff. There is always a lot of "I completely agree with you", "Can I be completely frank/honest with you?" from me and you don't have to have a degree in psychology to know that this is then often mirrored in return. He suggested to me that a technique for enabling co-operation from the staff would be to sack them if they don't do their job properly & engage in training. Oh how we laughed - it's funny because in a system of patronage, hierarchy and corruption, people just don't get sacked for failing to meet their contractual requirements, breaking rules (what rules?) or even being completely incompetent & negligent. It was a wild flight of fantasy here yet in at home it would be normal working procedure. As far as relationship building goes these are the conversations that mean the most to me but are by far the hardest to have.
Conversation 2 - Any one who has ever worked with me will recognize this well used technique of communication - the 'joking when you really mean every word' conversation. I am so well rehearsed at this technique that once whilst working in psychiatry my boss after asking me about something serious and listening to my response said to me "Esther - I think that humour is an incredibly sophisticated and intelligent defense mechanism but could you please just answer my original question?" Today when I saw one of the paediatric all stars I pretended to avoid him so he grabbed me by the hand, preventing my escape, then we had a long conversation about Vitamin A deficiency, team based learning modules & the paediatric ward renovations. When I suggested - smiling, laughing and leaning in a casual relaxed manner against the nearest wall - that the newly renovated clean, shiny & glazed Paediatric ER had remain empty for 2 weeks now not as he suggested because there had been no children sick enough to warrant it being occupied but more because "the patients were all too dirty and poor to put in to such a lovely new room" he may have got that I wasn't completely joking. He then told us he was on duty and had to go now to see some patients, J (the straight-man) added "so you can finally put some patients in your new ER" - much hilarity - oh how we all laughed (again - capacity building is just so much fun).
Conversation 3 - I like to call the final style of conversing - 'capacity building by flirtation' but I think the term 'prostituting ones-self' may also be used. This technique can only work with people who have initiated the flirtation that you can then reciprocate and use to your cunning capacity building intentions. After alienating myself from the whole surgical department for asking "whose patient is this?" (see 'why today my head hurts....') I had feared that this particular form of conversation was no longer available to me. But walking from conversation 2 to conversation 3 I did pretended to throw myself into the path of one of the surgeons driving his massive Lexus 4x4 to much waving & smiling (by both of us I hasten to add - if it had just been me doing the waving & smiling that would just be a bit odd) - so there was already hope that the thaw had began. My first day back I had barely received a nod of recognition from HS and then in khmer (he has more than reasonable english and french) he gruffly asked my VA "Has she come here because she wants to speak to me?", churlishly I had replied "No, non, o'tey!" But after the conversation 1 it had become apparent to me that HS was the person I really needed to speak to regarding a heading on my to-do list - 'surgery'.
So with B (URC nurse), as chaperone & not as it turned out translator, I went to the surgical changing room - the main stage for most of the important surgical conversations at the hospital. HS as you can imagine was hardly thrilled to see me but when I pulled my joker card that the Deputy Director had said I must speak with him he looked fairly resigned.
What ensued was a conversation regarding burns patients mismanagement, analgesia with dressing changes & trauma care. It was agreed that I would draw up a draft burns protocol, we would have further discussions regarding analgesia (I had previously succeeded in getting a post-operative analgesia protocol written by him using that little known technique 'reverse psychology'. I really hope that I'm not giving too many of my complexed and highly successful techniques away here) and there was even a forced/semi-genuine apology from him for giving me the 'cold shoulder' previously.
All this however required me to have my legs pinned in between one of his thighs & the table leg and having my hand held whilst B watched Karaoke on TV. Now as I have previously mentioned this physical contact is normal for a man-man interaction and my inclusion in this 'bromance' can mainly be put done to my curious 'half man-half woman' status as a foreign female doctor. The hair flicking (mine not theirs) is however just plain flirtation. B was impressed by the effectiveness of my type 3 conversation & quoted that all in all it had been "a very fruitful conversation".
I say - show me the fruit!
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