• Rob Orman

1. Verbal Judo

In this first episode of Stimulus, we learn from two masters in the art of de-escalating those who are agitated and upset.  Jose Pacheco, RN, known affectionately to his co-workers as ‘The Drunk Whisperer’, has a specific sequence to this approach, which he’s going to walk us through, step by step. The good news is that verbal de-escalation is a tool that can be learned by almost anyone. To that end, we’re also joined by Dan McCollum, emergency physician at Augusta University, to talk about conflict resolution that evolved from the martial arts principal of using your opponent's energy to resolve conflict, rather than simply butting heads. The name for this method? Verbal Judo.

We discuss:

Ways to de-escalate and defuse people who are belligerent or intoxicated.  Just see what happens when you offer them a burger with a side of bacon. [00:50]  

“Verbal Judo” is a term coined by George Thompson, PhD and the title of his book.  It refers to the ability to stay calm in the midst of conflict, deflecting verbal abuse and offering empathy in the face of antagonism.  It is teachable and learnable. [03:31]

McCollum’s de-escalation sequence is a graduated response to agitated patients based on the military system of DEFCON 1-5. [06:35] 

How crucial it is to be nice, have empathy, speak quietly, know when you can bend (while still keeping things safe), and offer anxiolytics as needed. [08:10]

The notion that empathy can absorb tension and be a strategic tool for conflict de-escalation. [14:18]

The 6 steps of Dike Drummond’s Universal Upset Patient Protocol to defuse the situation when a patient is angry:  1) validate that the patient is upset, 2) ask why they’re upset, giving them permission to vent, 3) empathize, telling them how sorry you are what whatever they’re experiencing, 4) ask how you can help to resolve the situation, 5) suggest your own plan for resolving the conflict, 6) close the deal, thanking them for sharing their thoughts. [22:30]

The importance of being organized and having a plan before starting a difficult conversation.  'Winging it' doesn’t have as good an outcome. [29:43]

The fact that how we respond to confrontation says just as much about us as it does about the other person.  A verbal judo principle is, “We treat people as ladies and gentleman not because they are, but because we are.” [32:52]

How the stoic idea of the dichotomy of control applies in these situations.  Some things are within our control and others are outside our control. While you can’t control how an upset person is going to respond to conflict, you can control how you respond. [34:43]

The value of seeing a situation from the other person’s eyes. Through this, we can have empathy and understand what it is that they’re needing. [35:40]

The “Sword of Insertion” technique is a tool for ensuring you understand the other person’s point of view.  This permits you to interrupt, saying, “Let me be sure I heard what you said,” and then you paraphrase. [36:58]

The importance of active listening in conflict resolution. [38:38]

Jose Pacheco’s tips for interacting with difficult patients in the ED:  1) ask permission to enter the room, 2) approach with compassion, kindness, respect and humility, 3) use body language to show that you want to help (hands open, palms up, leaning forward, empathetic facial expression, maintain eye contact, positioned at eye level), 4) adjust your tone of voice of voice (if they’re yelling, speak quietly), 5) try to find out what they need right now, 6) always have an exit plan and security guard back-up, should things escalate. [41:15]

Non-verbal cues are the majority of our communication. Content is 10%, voice is 35%, and nonverbals are 55%.[51:46]

Show Notes by Melissa Orman, MD

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