Crucial Conversation & Accountability

Talks About Hard Hitting Issues

Crucial Accountability

Crucial initialization

Crucial accountability comes where the accountability system is weak. The ones who see the problem don’t actually address it because they think that they don’t have the power to raise the issue; neither do have skills to do so. Crucial accountability helps in bridging the gaps that has trapped you and kept you stuck. It is like a maze in which you are lost and can’t find an appropriate way out. Crucial accountability is the way that will get you out of the web and will lead you to your destination.

Motivations & abilities

While you share your story, describe the gap between what did you observe and what were your expectations. Is it motivation, ability or both that has worked as a hindrance. The best tool to be used here is the six sources of influence. Asking questions will also extend help to others to share their point of view. It is very important to make the whole process safe. Before the Crucial accountability starts pin point all the possible limitations and keep in mind that don’t let your ideas come up at front, rather ask the other person to share his ideas.

Patients efforts

Interestingly the blood sugar chart shows that the patient has done a good job and has managed his sugar levels very well, but HBA1C reflects that the patient is lying. Here is where the doctor needs to do the Crucial accountability of the patient. The doctor will indicate that the report maintained by him (patient) indicates a totally different story as compared to HBA1C report.

Critical Accountability

Before you start doing the crucial accountability it is very important to be sure to select the right one. In case when crucial accountability turns critical, stay focused and never let the dialogue die. An element of respect should be maintained throughout the conversation even if one is hurt, angry or scared. Tell your part of story and let the other person know how you validate your behavior. Be emotionally strong and don’t practice any criminal, victim or helpless stories.


It is your duty to help the other person come up with the ways to overcome ability barriers while he looks into the personal, social and structural solutions. Element of motivation should not be left aside and let the other person realize the natural as well as invisible consequences. Motivation moreover should be looked under the limelight of personal, social and structural sources. Lastly, solutions found should be turned into actions in such a way that it permanently bridges the gap. For example a diabetologist asks the patient for his HBA1C report and his 3 months blood sugar maintenance chart (Provided earlier to the patient by doctor on his last visit).

Doctors Advice

As the doctor puts the real picture in front of a patient, he also indicates him the consequences he will face if he continued following the same not so acceptable routine. The doctor enlightens the patient that his behaviour can result fatal as well. This generates realization in patient that no matter one day everyone has to die but dyeing with pain is our own choice. The meeting ends up while setting new goals.

Crucial Conversation

The word Crucial Conversation itself hears to be heavily loaded and brings in mind the image of top-notch highly influential people discussing the future of the world. But in fact, these heavily loaded words belong to each and every one of us and have a very important significance in our lives. Crucial conversations are actually those conversations that take place on daily basis and have a greater impact on our lives.

Crucial conversations are all about hard-hitting issues. It’s human nature to avoid conversations that are thought to result in either hurting someone or in simple words that make things worse. The crucial conversation takes place when stakes are high, opinions vary and emotions run strong. In our usual life whenever we are in the middle of a crucial conversation there are three possible solutions from which we choose the one that suits us. The commonly adopted one is to avoid that conversation, Second choice is to face the matter that results in poor consequences while the third one is to face the matter which results favorable.

Crucial conversations help in spotting those conversations that are keeping you away from what you desire and thus break the silence. Violence is highly not advisable during crucial conversations. Always share your feelings, opinions, ideas, and facts honestly and openly. It is very important to be clear about how you are going to manage your stress when in a crucial conversation. Listen carefully and be clear about what results are you looking for, maintain a proper dialogue. It is always important to understand the motives that can twist the conversation crucial. Always tell your story, so that a proper link generates between your story and your behavior. An important point to be noted at this stage is that the stories should be free of any criminal, victim, and helpless tags. Speak believably while putting your point of view in front of the other person. Always give a proper margin to help other communicate his mind to you

In any case, if you feel threatened and you find your safety at risk, Stop the conversation right away and see how to let it continue while looking for a feasible solution. Once the safety is done return back to the conversation. Always do crucial conversations on mutual grounds and put skills and principles together to make it work and end up with a desirable result.

For example, in the case of diabetes, the doctor and the patient get into a crucial conversation where a doctor diagnosis patient with diabetes mellitus and breaks the news to him. The patient is in denial and also under grief. He does not believe that he has become the victim of this lifelong disease and thinks that he is on the verge to die. Then the diabetologist starts the crucial conversation with him letting him realize that he is not going to die rather he needs to start living a healthy life. He needs to take a proper diet, need to do walk or exercise regularly, should learn skills for stress management and willpower, and lastly, timely intake of insulin should be regularly followed. One of the questions that the patient asks the doctor, that my willpower ability is low and I have always been bad at it. The doctor tells the patient that willpower ability can be increased by learning some very effective skills, it is something from nature that we nurture. Finally, the meeting ends at mutually deciding some goals in order to manage Diabetes Mellitus. The doctor also refers the patient to counselors to help him learn some important skills in order to manage his disease.

Around the world, many health professionals get banned because of the medical mistakes done by them. Interestingly the research has shown the other sides of the picture where patients often do not share their concerns with their health professionals and thus the professionals alone have to face the music afterward. The major reason for this is that patient doesn’t want to offend their health professional and thus they don’t speak up.

Interestingly there are some very effective communication skills that if adopted can result in reduced medical errors and at the patients’ end, it would become easy to share medical history and the current symptoms.

Whenever you are in a crucial conversation with your Diabetologist, always follow the following guidelines that can help make the communication smoother and easier:

  • It is a myth that our doctor knows each and everything about us (patients) and hence he/she is responsible for helping us get rid of our disease. In actual it is totally wrong because you are the expert on yourself and no one else on earth could better explain you than you yourself. So point to be noticed here is, whenever you visit your doctor always explain your medical history so that whenever he/she starts treating you they are in a better position to take accurate decisions about your treatment. Even in between a treatment if you face any undesirable symptoms always share that with your diabetologist at your earliest.

For example, you are visiting your diabetologist in order to take help, manage your diabetes. It is your first and foremost duty to share your medical history with your diabetologist as if you are a heart patient or you have stents placed in your heart or you have some kidney problem always inform your diabetologist well before the treatment starts. This will result in an informed decision and a chance of success drastically rises.

  • It is always recommended to speak before the situation becomes crucial. Getting angry, worried, or upset results negatively and thus should be avoided. Before these harsh behaviors attack you, talk to your doctor. We (Patients) often take doctors for granted without realizing that it is a hassled profession and doctor always tries his/her level best to treat a patient under any circumstances.

For example, if you have observed a pattern of getting angry on regular basis, talks to your diabetologist as this could be one of the symptoms that your sugar levels are not maintained well. Not giving importance to your increased anger pattern can have horrific results.

  •  Being respectful to others is not only a good habit but also in return you are being respected by others. It is a give-and-take relationship and it always results in a healthy association. The same rule applies to being respectful to your doctor, which shows your trust over your doctor’s potential and position.

For example, visiting your diabetologist for the very first time you can always say a word of praise to him/her, ‘Doctor, I am lucky to come under your supervision and I know that I am in good hands’

  • Always share the true facts with your doctor. Never present yourself with a vague statement. Presenting facts helps your doctor dig to the real root cause of your problem and thus helps recommend the best possible treatment for you.

For example, if you are a heart patient and you have been through a serious surgery and you have not shared this fact with your diabetologist then there is a high possibility that some medicine recommended by your diabetologist unknowingly that you are a heart patient could have a negative effect on your management of heart disease.

  • When the diabetologists end informing you about the disease and its management now it’s your chance to ask a question. This helps in two ways, first, if you have any doubt regarding treatment you can always ask and remove them; secondly, it shows your interest and seriousness towards treatment hence helps in strengthening the relationship between you and the diabetologist.

For example ‘Doctor, the skills you have taught me to control diabetes, will it really work for me?’

In a nutshell, the above mentioned points would work immensely if practiced properly and is an antidote to crucial conversations