Small talk is a big deal.
Small talk is the oil that keeps the machinery of interpersonal relationships running smoothly.
Small talk even has its own name. It’s called “phatic chat”.
Phatic chat has been described as “A type of speech in which ties of union are created by a mere exchange of words” by Bronislaw Malinowski (no relation to Barry Manilow). This is why I think it’s important that us health professionals be intentional about phatic chat.
Every, “Hello. My name is…” and “How are you today?” serves to create a working relationship between people. Health professionals rely on working, therapeutic relationships.
Academics (god bless their cotton socks) have even gone to the effort of researching and naming 12 functions of phatic communication (source):
(1) breaking the silence
(2) starting a conversation
(3) making small talk
(4) making gossip
(5) keeping talking
(6) expressing solidarity
(7) creating harmony
(8) creating comfort
(9) expressing empathy
(10) expressing friendship
(11) expressing respect
(12) expressing politeness
When we think about phatic chat in the health care setting, it’s not just a social lubricant, we can also see it as a stand-alone form of therapy. Think of phatic chat as the nonspecific factors of psychotherapy
BTW: “nonspecific factors of psychotherapy” an actual thing, let me google that for you: here
Phatic chat/the nonspecific factors of psychotherapy show the person that there is someone who is interested in them and their concerns. It helps people feel understood, accepted and respected. In my current gig – providing mental health support in the general hospital – I often get told by patients how good it is to be nursed by someone who is good at phatic chat.
It’s easy to imagine, isn’t it? Who would you rather attend to your vital signs, IV antbiotics, wound dressings, and pain relief in hospital: a friendly person who chats and listens, or someone unfriendly and officious who just goes about the tasks at hand? There’s more than one way to prime an IV line.
It sounds simple, and (to my ear anyway) pretty patronising. However, it’s clear that many clinicians do not routinely engage in phatic chat.
You may already know the story of Kate Grainger. Briefly, for those who don’t, Kate was a doctor in the UK who tweeted her experience of living with a terminal illness. One of the many observations she made was that it was refreshing, but actually pretty unusual, for hospital staff to introduce themselves by name and role when they came to see you in your hospital bed. That observation lead to this tweet:
That simple idea has been one of Kate’s greatest legacies (she died in 2016).
If you’re not familiar with the #hellomynameis story, I urge you to visit the hellomynameis.org.uk website for more info.
#hellomynameis = a very successful campaign promoting phatic chat in healthcare
I live and work a long way from the UK. Although I don’t wear a #hellomynameis badge, I borrow heavily from the idea that phatic chat is important, and toss-in a few more Aussie-fied ways to go about using it in the hospital setting. As argued above, phatic chat is important for building relationships and can be therapeutic in and of itself. Sometimes to be culturally safe you need to try a little harder to facilitate trust and rapport. With that in mind. here’s 4 ideas that usually (not always) work for me:
“Are you Cyril? G’day my name is Paul McNamara, I’m a nurse with the psych team here at the hospital. Is it OK if we sit down and have a bit of yarn?”
Shaking hands is a respectful thing to do. I always offer a handshake when introducing myself to patients (they’re often surprised!).
Don’t worry infection control peeps, I’ve got that covered: meta4RN.com/hygiene
Three (this is my second favourite: I stole it from Professor Ernest Hunter)
Make a cup of tea for the patient. Even if they say “no thanks”, let them know that you’re making one for yourself anyway, so are happy to make them one while you’re at it. Take instructions on how the person likes it . Apologise if you make it too hot/strong/weak or spill it. Sip yours when they’re talking: if for no other reason, it let’s them know you’re not about to interrupt.
This might be the best journal article ever written by a psychiatrist:
Hunter, E (2008) The Aboriginal tea ceremony: its relevance to psychiatric practice. Australasian Psychiatry, 16:2, doi: 10.1080/10398560701616221
Despite the paper’s title, the same demonstrations of humbleness, politeness and respect work for whitefellas too.
Four (this is my favourite: I made this one up myself)
I nearly always use when Google Maps when introducing myself to people who have come to the hospital from out of town. “Oh you’re from Aurukun? I’ve been to Wujal Wujal, Laura and Hope Vale, but I’ve never been there. Do you mind if we use this map on my phone to see where you live?” It’s nearly always a great way to break the ice, especially when meeting with someone from a different culture. It sets the right tone of showing that you’re interested and approachable.
I’m lucky to work in a place where I meet with Aboriginal and Torres Strait Islander people all the time. By getting the Aboriginal/Torres Strait Islander person to show me around their community on a map, I’m acknowledging/demonstrating that they know stuff that I don’t know, and I’m prepared to learn from them. Sometimes I’m a bit more skilled at using the Google map app on my phone, so I get to show the person how I can be helpful, in a kind and respectful way. It probably doesn’t hurt that we’re both looking at the map together and working on the same task (it demonstrates that we can work together, and you don’t want to rush into making a heap of eye contact with someone you’ve just met). While we’re using the app to find their house, the local school, favourite fishing or camping spot, and other landmarks we’re getting to know each other a bit. I’m not left in that clumsy position of being accidentally too pushy, too intrusive, too task-orientated.
Spending a few minutes establishing rapport is what phatic chat is all about. The phone/map app is just a prop, but it’s a great prop.
A while back I had a gig educating uni students. One of the best tricks-of-the-trade when in a uni lecturer role is to introduce people to words they have not heard before. This makes you look cleverer than you really are, and lends an illusion of credibility.
So, with that in mind, my call-to arms for health professionals is this:
Let’s embiggen phatic chat!
It’s a perfectly cromulent thing to do. 🙂
The phrase/notion of “phatic chat” as a defence against the forces that seek to turn nurses into unempathetic box-ticking robots came to my attention via Professor Eimear Muir-Cochrane’s keynote presentation at the ACMHN 39th International Mental Health Nursing Conference, held in Perth, Western Australia, 22nd-24th October 2013.
Storify of the keynote here: storify.com/meta4RN/zero
Follow Professor Eimear Muir-Cochrane on Twitter here: @eimearmuirc
As always your thoughts/feedback is welcome in the comments section below.
Paul McNamara, 12th October 2017
Short URL meta4RN.com/phatic