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Crucial Conversations: Tools for Talking When Stakes Are High

Kerry Patterson, Joseph Grenny, Ron McMillan, Al Switzler

New York, McGraw-Hill, 2012, 244 pp., including index, $13, paperback

What is a crucial conversation, and how does one excel when in the midst of such a conversation? Crucial Conversations strives to answer these questions. A crucial conversation is identified as one in which opinions vary, stakes are high, and emotions run strong. Such conversations occur daily and may significantly affect our lives. This book details tools and skills to help the reader learn the art of communication during difficult situations. Over 11 easily read chapters, the authors discuss preparing for crucial conversations, creating safety during crucial conversations, effectively having a crucial conversation, and closing a crucial conversation. Using the online resources, readers can access role-playing scenarios, print a dialogue model for the office, watch videos of cases and training, and download a study guide for faculty development or a reading group.

The second chapter introduces the goal of communication: to contribute to the pool of shared meaning. When a person notices she is in a crucial conversation, by being mindful, she can stay out of automatic scripts and contribute to the pool of shared meaning. In the third chapter, the authors encourage starting with heart to prepare for a conversation: focusing on ourselves and our true intent, thus avoiding sucker’s choices in conversations such as insulting or baiting. In chapter four, the authors give techniques for staying out of silence and violence, the two main detractors from dialogue. Withdrawing, avoiding, or masking can lead to silence (withholding information from the pool of meaning) while controlling, labeling, or attacking can lead to violence (trying to force meaning into the pool). There is also a helpful test to learn one’s own style under stress.

Chapter five details methods for creating a safe environment for all parties during a crucial conversation. In the sixth chapter, the authors describe mastering the story, a technique similar to cognitive behavior therapy, using a helpful visual aid. In chapters seven and eight, the authors explain several tools for use during a crucial conversation to add to the pool of shared meaning. Chapter nine discusses next action steps, such as deciding how to decide, making assignments, and documenting.

The reader can benefit from reading the entire book from start to finish or reviewing it in a piecemeal fashion. I recommend reading Chapter 11 (Putting it all together) first as it integrates the concepts put forth in the book using a table and then deciding on how best to use the book. Chapter 10 (Yeah, but) is particularly helpful, outlining solutions for specific difficult conversations and is applicable in the work setting. Chapter 6’s description of cognitive behavioral therapy was particularly helpful to me as a physician and educator. The reader stories throughout the book were also helpful, demonstrating further application of skills in real-life situations, including physician-physician and mother-bipolar daughter interactions. The final chapter highlights specific ideas for incorporating the concepts of the book into daily life.

For future revisions, I would recommend a basic introduction chapter paralleling the final summary chapter, so that readers might have a visual framework around which to organize and better learn the methods described in the book. I would also recommend creating a visual representation relating the concepts in the book or adding other concepts and expanding on the “Path to Action” visual model used in chapter six. By highlighting each chapter’s contents on such a model, visual and linear learners would be more engaged. Being a visual, ordered learner, as I read the book, I needed to create my own diagram to understand where each tool was being used in a crucial conversation. With this type of addition to structure, the outstanding content of the book would shine through, and the book would be more appealing and useful to all types of learners.

This book has empowered me to participate successfully in crucial conversations with colleagues, supervisors, staff, students, and patients. Using the book, I created agendas and personal guides for several meetings in which crucial conversations occurred. I had been avoiding having a difficult conversation with a colleague, but with the tools of this book, I was able to effectively work through this challenging situation. I have been asked by my division chair to give faculty development to the department on the book’s contents. Our department has purchased several copies, which are constantly in use. The book may also be helpful in teaching cognitive behavioral therapy, communication skills, and interprofessional teamwork to medical students. This is an excellent book, entirely applicable on a daily basis for physicians, educators, and students. I enthusiastically recommend Crucial Conversations for physicians and educators.

Suzanne Minor, MD

Florida International University

Miami, FL


Copyright 2018 by Society of Teachers of Family Medicine