Reticence, Red Flags, and the Real Work

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In the world of patient advocacy, in the world of healthcare, in matters of communication, and even in life, when there is a problem, our focus often goes straight to solving it. In times that we cannot we go about creating a workaround, to go around the problem or we commence to building a bridge.

Not so today. Not on this topic. This one we must meet, and work through.

Our topic is one you likely know. Have seen. Felt.

I am talking today about reticence.

Reticence is an unwillingness to do something or talk about something.

Reticence: that of another person or it may be your own. You know it when you see, hear, or feel it.

Ever observed it, reticence? Those of you who have been in any kind of caregiving likely have. Reticence can range from levels of (shoulders shrugging)a vague “I dunno” to “Nope” to “Hell no, we won’t go!”

Y’all know I love examining the peculiar-but-important intersections in healthcare and in communication. Those points where it may be best to stop and take a look. Stop before opposition is created that grinds you to a halt, or a line in the sand is drawn. Pausing is an opportunity to better understand and navigate. Today is no different.

It is in meeting with reticence where folks screw up. It then makes it hard to repair mistakes they made.

They push and push and try their logic upon another. The ‘another’ has other logic and emotions, and the other soon senses an unwanted something-or-other coming its way or being forced upon them. It is time to stand their ground. Head butt. Sometimes irreparable damage occurs.

Its origin may not matter. Let’s talk about how to meet it and how to diffuse and dissolve it.

Have you ever seen that image of a mule with his heels dug in?  How do you change that?

Let’s look at reticence, our own or that of others. Let’s examine the causes for it. Then we’ll talk about how to get past it.

Reticence is an unwillingness to do something or talk about something. An older adult’s reticence can stem from various factors, including fear of losing independence, a desire not to be a burden, and concerns about the impact of aging on their dignity and quality of life. It may be fear-based, or the result of a previous experience or an imprint.

For instance:

“I’m not going to talk about moving from my town of 60 years now. This is all I have known.”

“I’m not going to sign over my power!” (thinking designating someone as agent with Power of Attorney is “giving away power” and their right to self-determination).

“Yeah, when Clara’s children wanted her to move and be closer to them, they found an apartment for her, alright. They put her in a home!  I heard from her once, and she was unhappy. Haven’t heard from her since. Hear me when I say NO to that.”

Fear of unknown, previous experiences, or imprints made upon you during your lifetime can be good reasons for reticence. But reticence is not the end of the conversation(s). I just [said] wrote ‘conversations.’ That’s conversations – with an “s”!”

Other ways reticence is displayed is when someone’s being reserved, not forthcoming, playing one’s cards close to the chest. Perhaps they do not reveal their thoughts readily (and by doing so they can maintain their stance, perceived power, or at least upset the applecart).

Other times reticence can be painfully obvious. It can bring things to a halt and can set up contention.

Recently a care manager consulted with me about the best approach for her client and family dilemma. It seemed plans had been made for an older couple, John and Jenny, to enter a senior living community. Because of their varying physical and now the mother’s cognitive changes they were to enter assisted living, together. That alone was hard to orchestrate, not all assisted livings can accept couples without splitting them up (Why didn’t senior communities plan for this in their models??).  

Daughter and son-in-law arrive from out of state to finalize the move with all concerned. That is when John announces ”We are not going. We’ve decided to stay put.” Might have been a Hell No – We Won't Go” or whatever, but reticence was undeniably present.

It did not matter to John that his doctor had recommended that the move be made and ASAP -and that John had agreed. Didn't matter that this was what the care manager had advised. Didn't matter that this is what the states-away daughter wanted for her aging parents, to live in community, and it didn't matter what was safe and seemingly best for this couple with their respective medical and cognitive changes. There had already been a couple of incidences of falls, and with injury. 

This intersection is what I want to talk about. The point of resistance to the plans,  those Best Laid Plans, the logic, the agreement... and now there is a giant barrier to moving forward. Reticence is an intersection where avoidance does not work. Detours do not work. It must be entered.

Many of us have been here ourselves, or with loved ones. What do we do?

Pause, assess, and acknowledge is what you’re gonna do.

If you push or press you will make it worse. If you do not address the matter, or gloss over it and continue, it will resurface. And with the excess baggage of hard feelings.

Whether it is another’s reticence or maybe your own, the process we are going over today works in both instances.

Pause, assess, and acknowledge

This is an opportunity, for conversations (remember my oft-used phrase “That’s conversations, with an s”?). Something needs airing -and - something needs hearing. Here’s your chance.

Here is a chance to come alongside rather than to face in opposition. And there is stuff to be learned, gained, like intel (my fav part)! The intel is about the other party’s position, emotions, reasons, or experiences that have influenced the stance. Let’s find out what make the other tick. From that will likely come inroads and common ground.

After we recognize reticence, pause, and assess. Then we acknowledge where all the parties are coming from. In this case with John and Jenny 

§  The doctor may be coming from a place of care and treatment, and safety.

§  A patient advocate like myself comes from that place too as does a care manager but also of a desire to educate and inform toward arriving at the best decisions.

§  Daughter and son-in-law are coming from that also, but they may carry more: there could be fear, guilt (from distance or lessened availability drives fear – it’s all so volatile with them states away).

§  Also presenting, for everyone, is the uncertainty of the future. John and Jenny, their daughter and SIL, and to some degree the care manager.

Time to acknowledge. Go there. It’s time to respect and talk, to ask for more information about the other’s thoughts. Restate what you hear the other person saying, narratively:

”Dad, (John) it seems there is different thinking since we last talked. I am interested in your line of thinking. Tell me more about that. I‘d like to understand.” 

(One of the best phrases I know to extend a conversation is ”Tell me more about that.” Try it, on everything).

Now, you may not get anything definitive from John first shot outta the gate. But I can tell you with certainty that no amount of logic, haranguing, or even railroading will change John then and there.

Tip, and really important: When talking, minimize or eliminate the use of “You.” It makes folks defensive and sets up further divide. Can you narrate it, speak in third person, to avoid any verbal finger-pointing? Simply state “what is”?

“On one hand there is a plan for helping John and Jenny to move into an assisted living community; on the other hand, there is a wish to remain in and modify the home. Those are different and we should talk about it. There is common ground here, and that is caring for Dad and Mom and working together to find what is the best fit for Dad and Mom/John and Jenny.”

Sometimes last-minute, 11th-hour reticence is often fear in disguise. It must be acknowledged and consensus regained. There is no glossing over and hoping no one will notice.

This cannot NOT be dealt with, aired, acknowledged, the reticence respected and discussed. Solution may not immediately follow but it needs airing -and hearing. Things won’t proceed toward or meet with solution until it is aired. Plus, you will learn more, gain insights, and likely garner other important stuff, so hear it.

The whole idea that something needs airing Is not always obstinance or a roadblock. It is opportunity. The pause, assess, and acknowledge can get us out of the quagmire.

Instead of butting heads, can you come alongside that other party (physically if you are able) and acknowledge? Simply restate, or stop and ask for more information and clarity? Show interest, and respect?

The goal here is to find the common ground, find agreement, even in the short term. Break the steps  to change down even further. (Conversations with a “s”!”).  Make a modified plan, a step by (tiny) step plan. Act, even if only finding some agreement in the short term.

In John and Jenny’s case the couple still had capacity to make decisions and to determine their outcome even if it is not the outcome wanted by several members of the team. There was airing and there was hearing. There was plan and a timeline modification, and safety was a big part of all of it. Some compromises were found, because they addressed the reticence. The family moved on, in agreement, with a similar plan.

I see so many people get tripped up when they find themselves at an intersection where something needs airing and someone needs to be heard (even if that someone is yourself!). Don't let it derail you. Simply see it as the opportunity for conversations and step into it, ensuring that all can be on the table, for and from everyone.

If we're smart, we will consider these kinds of intersections as a normal occurrence, a rest stop or a roadmap check on our journey and a way to make the journey even better.

Are you caught in the quagmire? Stuck, or stagnant? I do some of my best work with folks who find themselves inside these intersections o’ life. We will talk about yours when you schedule a consultation.

Nancy Ruffner is a patient advocate who provides strategy for aging, healthcare navigation, and solo aging. Nancy consults with clients in a triage fashion, offering one-hour consultations to find a path, gain a deeper understanding of “how stuff works” in eldercare, or to specifically problem-solve. Schedule your 1-Hour session now, without obligation of commitment or continuing costs. nancyruffner.com.