Featured topic and speakers
Neha Sangwan, MD, internal medicine physician and founder of Intuitive Intelligence, shares practical strategies for navigating conflict, miscommunication, and the most challenging personalities in your life.
- Neha Sangwan, MD, internal medicine physician, founder and CEO of Intuitive Intelligence
- Kevin Hopkins, MD, family physician, Cleveland Clinic
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Speaker: Hello and welcome to the AMA STEPS Forward® podcast series. We'll hear from health care leaders nationwide about real-world solutions to the challenges that practices are confronting today. Solutions that help put the joy back into medicine. AMA STEPS Forward® program is open access and free to all at stepsforward.org.
Dr. Hopkins: Hello, my name is Kevin Hopkins. I'm a family physician from the Cleveland Clinic and a senior physician advisor for practice transformation at the AMA. Today on our podcast, we're joined by our guest, Dr. Neha Sangwan, founder and CEO of Intuitive Intelligence, an internal medicine physician, international speaker and corporate communication expert. Dr. Sangwan, thank you so much for being with us today. Could we start by you telling our listeners a little about yourself and your background?
Dr. Sangwan: Sure. It's an honor to be here. My background, I first became a mechanical and biomedical engineer. I worked for Motorola as a manufacturing engineer back when Motorola was a thing. I went on to medical school and studied internal medicine and moved on to being a hospitalist after that. I burned out in 2004, and that really changed how I thought about our jobs and our roles in medicine and in health care. At the time, I thought it was the worst thing that could have ever happened to me. I now realize that it is precisely the reason that I'm talking to you today. So the lessons I've learned, the importance of communication, how that relates to our energy levels, our enthusiasm, the meaning in medicine, all of it came through these experiences. And so I just feel really excited and happy to hear what you'd like to know and share with everybody hopefully some tools that can help them.
Dr. Hopkins: Great, certainly we're all a product of our past experiences, right? And so good, bad or indifferent, they shape and mold us into the people that we are today and certainly who we will be in the future. So our main topic of conversation today is to discuss strategies for communicating with the most challenging personalities in our lives. There are a lot of people in our world, probably in each of our lives that have some challenging personalities. If you can't think of somebody in your life that has a challenging personality, you're probably that person. How did this topic of thinking about how to handle and communicate with people with challenging personalities, how did that become an area of interest for you?
Dr. Sangwan: You're exactly right in our personal experience really changes us and influences us and shapes us. And growing up, I had a really difficult time communicating and emotions were tough for me. I got bullied. There were all sorts of ways in my life. What I did was turn that into academic and athletic endeavor and achievement. So I took that thing that was hard for me and I moved it into a way that the world would appreciate and honor and give me accolades. And so in that experience, when I was about 30 years old, graduating from residency and heading out into the world, I happened to go to Australia and I did a rotation in my residency with the flying doctors and learning how they heal and help do Aboriginal medicine. And while I was there, I went to a communication workshop and it just opened my world.
It opened my world to seeing how little I understood about communication, how stifled I felt, how I didn't learn this with 12, 13 years of higher education, right? I didn't learn it in my family. Society doesn't really revere us for being vulnerable, for being honest, for showing up authentically as who we are. We're in fact, revered for looking perfect, putting the best highlight reel of our life on social media, looking like we're the ones behind the white coats that... we've got it together. And that wasn't my experience. My experience was more that I'm imperfect, that I struggle just like my patients do. When I would give them a diagnosis, whether it's of cancer or something else, I was the doctor that sat on their bed and held their hand when I did it. And other people would say to me, "You can't get so emotional because if you care that much, you're going to burn out. You aren't going to last here."
Well, what I realized around this is no, it was just that I didn't know how to process my emotions. I didn't know how to communicate in a way that I could ask for what I needed, be open to what other people wanted, and find a win, win, win, win in the middle. And because I didn't understand that, I was really losing a lot of energy and feeling quite depleted. So the moment I discovered that this could be one of the keys, I did what all of us do, I put my head down, I learned this, I learned everything about it. I put my energy and effort and time to saying, "we can do this." We are smart, we are dedicated, we are strong. And if there's something we don't know, boy, one thing we don't lack is determination and hard work. So I set off to learn everything I could about it.
Dr. Hopkins: Well, I think we do live in a world where often there's sort of this suspension of reality, right? And so whether, like you said, it's the best highlight reel of your life on social media or something else entirely, we all know and understand that that's not reality. That's not real life. It's totally different. We all have ups and downs, we all have imperfections, and we're all work in progress.
Dr. Sangwan: And you know what though? Kevin, to get here, to get here, we had to get an A. To get here, we had to get the score on our board exams. To get here, we had to beat everybody else. But to succeed here, we have to collaborate. And when we find ourselves in the autonomous mode of how we did it or how we got here, it can be a really difficult and draining experience to change how we were programmed in order to succeed in a very different way of being than what got us here.
Dr. Hopkins: I love what you said just a little bit ago about how we emotionally connect with our patients. And some people do think that that's going to burn us out, and yet we know that it can actually engage us and keep us engaged. I feel like how we handle our emotions as physicians especially could be a topic of a whole separate podcast. But I wanted to ask you about communication is hard for a lot of people. We'll set aside the complicated or difficult personality for a moment, but why do you think interpersonal communication and mastering it to the best of our ability is so important for physicians and other health care workers?
Dr. Sangwan: Well, we interact with each other and with our patients at oftentimes milestones and the highest stress of their lives. They're the most scared that they've ever been. We are guiding them through something so unknown and foreign to them. It brings up all of their greatest fears. They must face certain items that they were saying someday when, "Oh, I'll do that in the future," all of a sudden it's in front of them. So our ability to communicate not only with them, but with ourselves and with them, allows us to become incredibly not just efficient, which we all hope to be, but effective. And so it allows us to be able to influence other people when change is necessary. It allows us to forge bonds of trust and connection.
We are the ones that are paving a path for the future, for the unknown for our patients. And we're enlisting our colleagues to please help us as we do it. If we are not masterful communicators, our job just got a lot harder. And the thing we never talk about is, listen, at work, we've got positional power. We wear a lab coat. I call you Joe, you call me Dr. Sangwan. You speak in regular speak and ask questions and I use fancy language like that's idiopathic hypertension. "Your idiopathic hypertension is elevated," right? So there's a way in which at work, there's this power in hierarchy that goes on and a way that we have been schooled and trained that gives us this positional power. Sometimes many of us hide behind it because we haven't developed our own personal power. And what communication, clear, effective, compassionate communication with yourself and with others gives you, is it gives you personal power such that your positional power becomes a beautiful add-on and synergistically makes you powerful. But it is not what we hide behind "Because I said so. Because I'm the doctor."
Any of you that are parents out there that are listening, the moment you say, "Because I'm your mother or I'm your father," you know that the other person feels defeated, is rolling their eyes. And in the moment, you may have won. But long term you don't win because you are distancing your relationship from that person. So if we want to be happy, if we want to be satisfied, if we want to be on fire in our careers without burning out, learning how to communicate clearly and effectively is the key
Dr. Hopkins: So you just reminded me of myself on multiple occasions where I've heard myself say to my kids, "Because I said so. Because I'm the dad." And usually you're right, it's because I've run out of good reasons or I can't think and articulate my thoughts and feelings in the moment. But it really is sort of a cop out answer. A lot of us do that all the time. No matter how hard we fight genetics, it's hard to overcome. We tend to turn into our parents at least some version of them. Thinking about people with difficult personalities, and that could be patience, it could also be family members, friends, acquaintances, it could be somebody that I'm having dinner with tonight, what advice or tips could you give me as far as some practical strategies for communicating with people who maybe have challenging or difficult personalities at least from our perspective?
Dr. Sangwan: I'd say the title of this is a little bit enticing and all of us can think of someone else. That's the easiest way to think about it. But I'd say that there's somebody in this person who's challenging life, who is their best friend, who is their partner, who really gets them. So I'm not sure that there's actually other challenging personalities. I would say it's a little bit more like people with whom I have a challenge communicating with because there's some people in their lives that don't find them challenging at all. And so I think the first thing to think through is let's just think about medicine and how we all ended up in different disciplines of medicine. The way that I like to think about this is let's just break it into four main categories, different work styles that people have and different ways in which they operate. Because once we understand our own work style and our own way that we operate, it will become clear how other people operate in a different way and how that might have us not feeling able to communicate with them.
So the first one, the first one are the doers. So doers are the ones that love checking things off their to-do list, a sense of accomplishment, getting tasks done. The most amazing thing about the doers is they are the ones who are going to get it done on time and under budget. They're the ones who round really fast. Sometimes stereotypically, it could be the surgeons, looks good from the door, right? They are getting it done and their check marks, there are their adrenaline, right? There's many of us that work this way. So it's not just stereotypically that, but just kind of putting that into your psyche, your thought process.
If they had a motto, it would be "Nike, Just Do It." If they were at the gym, they'd be on the treadmill listening to the latest podcast, getting caught up on the newspaper or magazine. They're getting it all to done. So they're incredible. And sometimes they are very, very, very, very busy without progress because they're just do and do and they forgot about something and now they got to go back and they got to do it again, right? So they're very busy. They're very good about getting something over the finish line, but sometimes not with the details that need to happen alongside it. So if they were a vehicle, what vehicle would you guess that they would be?
Dr. Hopkins: Probably, maybe a sports car.
Dr. Sangwan: Yes, it could be a sports car. I call them a Hummer because if they're going to get from point A to point B and you're in their way, listen, they're going to go right over you. Like, it's getting done, right? And that car, it can go kind of fast too. It's solid, right? They're willing to go out and get it done. So here's the kicker, the doers amongst us that... Listen, all of us have all four of these in us. That's how we got here. But some of them are our core that when we're under stress, we default to this way of getting things done. So I want to kind of say it and then say like, "Hey, you might find more than one of these in yourself." What are the doers most afraid of? Now, this is really important to understand maybe in a consultant. The doers are most afraid of vulnerability. They like staying really busy because then they don't have to feel. "That takes too much time. By the way, that's messy. And by the way, then I wouldn't get things done on time and I can't do that," right?
And so doers are going to be much more engaged when it's like, "Okay, this is how we execute. This is what we need to do. You're going to be quick." You're not giving them the paragraph. You might not even be talking to them in bullets. They just want the headline. They want the headline of what's happening. So when you're communicating with them, you want to know who you're speaking to and meet them in their style of communication.
Okay. Second one type here is going to be a thinker. A thinker, their currency is details, numbers, complicated, complex. If they were a surgeon, they'd want to be the oncologic reconstructive plastic surgeon. They're ID often takes on infectious disease, takes on the most complicated cases, right? Where the rest of us are like, "Oh no, thank you," they are walking into the building, like, "Yep, that's where I want to go. That's going to be a challenge today." So whereas the doers are "Nike Just Do It," these people are like, "Hey, let's do it once and let's do it right." And so they're going to move a little slower and they know that that's important in order to do it once, do it right, think, put everything into place.
At the gym, not only are they keeping track of their weights and how many reps, and this is chest and upper body today, and Tuesdays and Thursdays are legs, whatever it is, they care very much that things are done in a sequential order. So if somebody's on the machine that they need to do next, they'll wait. Okay. That would make the doers crazy. "There could be so much you could get done. Skip to doing legs. Do something else."
Dr. Hopkins: Move on to the next machine, right? But these people are into the process it sounds like, yep.
Dr. Sangwan: They love the process. They love making sure everything fits. They're putting all the pieces together, right? And we love them because they really do shed light in an area that we may not have thought of when we were zipping all around, okay? So you can see how the doers and thinkers will be really annoying when they're in a meeting because one of them's like, "Okay, are we going to get doing? Are we going to get going on that?" And the other one's like, "Hey, hey, hey, wait, what about this and what about this? And what about..." Okay? So I'm hoping that in this experience you're starting to open your thinking about, first of all, noticing which one sounds more like you or sounds like a colleague or whatever that is. Just allow that to kind of simmer and go through here. So let's talk about what car would the thinker, what would represent the thinker?
Dr. Hopkins: Probably that's something that's very reliable, a Volvo or a Subaru. Very safe, very cautious.
Dr. Sangwan: Yes. And I just chose a Prius. There's not a right or wrong answer here. I'm telling you what I chose because they've thought through the impact on the environment, the price, the utility, the space, and oh yes, the carpool sticker, right? So they've thought through it all and they're going to make sure that this is the best for every aspect.
Now, the greatest fear of the thinker is of looking foolish. And so they don't want to make a mistake. They tend to be much more soft-spoken. They listen more than they speak. Once they've got it all accumulated, then they will share whatever it's, right? So just noticing, oh, if this is your colleague, if this is that challenging personality for you, wanting to honor that there's a part of them that really wants to be valuable, be someone who contributes something that other people haven't thought of and doesn't want to feel foolish. And so when you can honor that, slowing down a little bit to allow them to give you some shed light on something you may not have thought of, your curiosity would be really helpful with them.
Dr. Hopkins: Sure. So if I'm a doer, being able to slow down and maybe give them a beat or two to respond rather than bulldozing would be beneficial to everybody.
Dr. Sangwan: Exactly. And knowing, valuing that if you do that, if you do that, they may pick up something that you didn't really want to sit down and think about. You weren't really interested in doing it. So allow them the time to do that and be your superpower where together, you don't miss something.
So the third work style is the seer, the seer's currency is of innovation, possibility, new ideas. These are the health care providers who were the ones first thinking about "How we could do an EKG on the iPhone and connect technology" and how they were the ones running towards electronic medical record records, not away. They're the ones who love robotics, the next technology to do surgery, right? They're very forward-thinking. They look at policy of government, how that intersects insurance, how the newest trials, right? They're the ones that are expanding us from where we are into the future. They like to brainstorm. They like to have ideas, right?
Now you can see in a meeting with the doer, the doer's like, "When are we going to get going?" And the thinker's like, "Come on, that's not even realistic. How are we going to do what you just said? There's no way." So the seers are enjoying the possibility, being a possibilian, like the world of possibilities and everybody else is like, "Come on. We have patience to see. We've got things to do."
So what's interesting is at the gym, okay, listen, they're not going to be at the gym, not at a conventional gym anyway. They're going to be on the latest carbon fiber bike, blazing new trails that only years from now other people will use. So the seers are very interesting because they're the ones that keep moving us forward when we want to stay where we are. So there's something exciting about them, they're a little bit aesthetic. They will have a pop of color, they might have a really nice watch, they might have cool socks. They're like the fun life of the party. Now here's the kicker. They love all this newness and possibilities so much that they might not show up at your party because they're waiting to see if something better might come along. So what car do you think the seers might be? And by the way, the motto of the seers is If "You Can Dream It, You Can Be It," Walt Disney.
Dr. Hopkins: Well, as you were talking about it, I was thinking of Tesla or whatever the newest electric vehicle is.
Dr. Sangwan: So I made him a red cyber Tesla truck, because you know why? They don't come in red. That's a custom paint job, right? So it's the newest, coolest, fanciest thing, right? And they've made it their own. They put their own signature on it.
Now the challenge with your seer colleague will be that their greatest fear is of being trapped. They love possibilities. So when you're asking them to commit to one way, to one path, they're not going to like that and they're going to be wanting to work around things or maybe, yeah, you're trying to make an agreement with them like, "Hey, can we have that by tomorrow at four o'clock? We're going to decide the next path of which way we're going to go with this client" and they're like, "Hey, well, we'll see. We need to get this and I need to talk to this." they're doing this thing and you might not like that.
If you're a thinker, you want to know when. When you're a doer, you want to know how fast, right? And the thing the seers got another way of being. And if you understand that they're fear of being trapped, what you can do when you communicate with them is brainstorm with them. Allow them to share their ideas and creativity. And then when you come down to this space, say, "Hey, listen, let's try this. How about if we regroup afterwards and we'll see how it's working?" So give them a little bit of leeway, allow them to not feel trapped and they will serve you because you will be current, you be cutting edge, you will be on the front lines of what's happening.
The last and final one is the feeler. The feeler's currency is people, connection relationships. And so they move a little bit slower than the doers and the seers, right? The thinkers and the feelers move a little slower because they know how that create relationships and solid connection takes time to build. Their motto is if you want to go fast, go alone. If you want to go far, go together. And at the gym, let's be honest, they're pretty obvious to spot because they care more about socializing than sweating because it's all about connection. And so what car do you think they might be?
Dr. Hopkins: Well, I don't know. I was thinking of a Jeep or a Harley Davidson motorcycle, a part of a community that's like a club.
Dr. Sangwan: Okay. I never even thought about the Harley. What I love about that is they even get a hug, right? They're on it with someone else, they're getting a hug while they're doing it. That is an excellent one.
So a minivan is what I chose because they don't really care how we get there as long as we all go together, right? So understanding what they value is really important. What is their greatest fear? Their greatest fear is of rejection. And so if they're taking too long, if you're irritated by how they're trying to get consensus with everyone, the patient, the family, everyone's got to get... Well, their greatest fear is rejection, and that's what is motivating them. The greatest part about the feelers, they're the glue of the team. They would be saying this, "Hey Kevin, you aren't quite yourself. Is everything okay?" And you're like, "Oh my gosh, you're right. I got that disturbing email this morning. I didn't even realize that it showed." They're going to notice things for you before you even notice things. But they're going to want to spend the first five minutes chatting, "How was your weekend?" and the doers are like, "Please." The thinkers are like, "How is this going to get us to the answer? This isn't going to help." The seers are like, "Can we talk about where we're headed?"
So when you're connecting with a feeler, what they want to know is that you care about them, that you care about the patient, that you care about their family and what's going to happen. Have you thought about the nurses and the staff in the changes that you're proposing? So once we start to identify ourselves and understand ourselves better, we start to understand that in fact the doers aren't right and the thinkers, feelers, seers wrong, and any other combination. In fact, the best teams have at least one of each of these strengths and work styles on them. We aren't judging each other for how the other person does it differently and doesn't do it right and doesn't do it the way we do it. We value their strengths and we know that they bring something to the table that is not what we want to do.
And so we allow them the time, we become curious, we ask what they're thinking, we share the possibilities. And then we keep them on time, we keep them on budget as we are gentle and care about them and do it once and do it right. And we have the most cutting edge options available for our patients and for our community.
Dr. Hopkins: So it sounds like I'm going to have to change my paradigm that it's not people that are difficult or challenging or even their personalities, it's the interaction of their personality with mine that is challenging and difficult.
Dr. Sangwan: Yeah, and do I care to know who this is and do I want to adjust my communication so I can meet them and not trigger that part of them that's their greatest fear? And do I know what they value and can I come to them with a proposal or a communication that honors what they value and what I value? It's our job. Our world is moving faster and faster every day. If we don't learn how to do this, we're going to keep getting passive aggressive with one another, being frustrated, losing our connection to our meaning in medicine and in health care.
Dr. Hopkins: So identifying and being aware of the style of others, the communication style, personality style, work style of others as well as what they fear or what they are concerned about or worried about, what bothers them the most, sounds like those are important things for us to consider in our interactions with people with whom we work, with whom we live, with whom we do life. Last question I have for you on this topic is any tips or tricks that you have for how we can practice these skills and get better at them over time?
Dr. Sangwan: I feel like we've done so much hard learning in our lives and been through a lot and endured a lot. I think it's time now to make this fun. And so I would say if there's anyone that you love and lead and you've noticed something about yourself and you don't know what their highest values are, share this with them. Share the four different work styles. And ask them, be curious. This should be fun now. We are done with accomplishment. It is time for fulfillment. We have climbed the ladder we needed to be here. What if we did this together? So I would say have fun with it. Don't try to use what you've learned just now and then start acting different with other people.
The people you love and lead know you, and they're going to be like, "What are you doing? What's wrong with you?" So I would say the tip I'd give you is share with them that you learned something about yourself. Share these four work styles. Ask them which one they are. And then ask how you can partner even better so that you can be stronger colleagues, stronger partners. And just be curious. When things don't go your way, just ask yourself like, "Oh, maybe I just kind of hit that thing that the seer felt trapped or the feeler felt rejected or the thinker looked foolish because I called on them before they were ready to answer, or the doer didn't want to be vulnerable about what's happening, making a mistake or something else." So just get curious and make this fun. I don't want this to be hard work. You all work hard enough. Let's have some fun together and let's bring more meaning into medicine, nursing, and health care.
Dr. Hopkins: Well, thank you for sharing the valuable information and tips that you share today. We'll probably all be on the lookout for the doers, the thinkers, the seers, and the feelers in our lives and hopefully be interacting and communicating with them much more effectively. Thank you for joining us today, Dr. Sangwan. For our listeners, if you'd like to learn more about Dr. Sangwan and her work, you can visit her website at doctorneha, that's D-O-C-T-O-R-N-E-H-A.com. Be sure to check out stepsforward.org for more resources on this topic. Neha, did I get the website correct?
Dr. Sangwan: You did. The one thing I didn't tell them is in 2023, I am releasing a book on burnout and how to assess it in yourselves and those you love and lead and it will have these tools in it. So if they want to learn more there, they can also look for that.
Dr. Hopkins: Fantastic. Well, thanks for sharing that. And I know your website is filled with other resources, links. You've written and spoken a ton about these types of topics so thank you for sharing your wisdom and knowledge and experience with us today. And thank you all for listening.
Speaker: Thank you for listening to this episode from the AMA STEPS Forward® Series. AMA STEPS Forward® program is open access and free to all at stepsforward.org. STEPS Forward® can help put the joy back into medicine by offering real world solutions to the challenges that your practice is confronting today. We look forward to you joining us next time on the AMA STEPS Forward® Series, stepsforward.org.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.