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May 18, 2020

The good news is that verbal de-escalation is a tool that can be learned by almost anyone. In this episode, 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. We are 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.

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We discuss:

  • Ways to de-escalate and defuse people who are belligerent or intoxicated [00:50];  
  • The origin of “Verbal Judo”, a term coined by George Thompson, PhD and the title of his book [03:31];
  • McCollum’s de-escalation sequence which 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  [22:30];
  • The importance of being organized and having a plan before starting a difficult conversation [29:43];
  • How your response to confrontation says just as much about you as it does about the other person [32:52];
  • How the stoic idea of the dichotomy of control applies in these situations [34:43];
  • The value of seeing a situation from the other person’s eyes  [35:40];
  • The “Sword of Insertion” technique [36:58];
  • The importance of active listening in conflict resolution [38:38];
  • Jose Pacheco’s tips for interacting with difficult patients in the ED [41:15];
  • Non-verbal cues and why they are the majority of our communication [51:46]; and
  • More.