Last week the very last episode of Game of Thrones was broadcast. I was surrounded by friends and loved ones all doing everything they could to avoid hearing the ending before they’d seen it; even it this meant fingers in the ears and loud singing. I’ve only ever seen one episode so don’t worry I won’t spoil the ending for you. But actually that wouldn’t be as bad as you think. Spoiler alert: we actually love spoilers. And knowing this improves we way we communicate.
For all we complain if someone ‘spoils the ending’ of something the opposite is true. In 2011 a series of experiments explored the effect of spoilers on the enjoyment of a story. Subjects were given twelve stories from a variety of genres. One group were told the plot twist as part of a separate introduction. In the second the outcome was given away in the opening paragraph and the third group had no spoilers. The groups receiving the spoilers reported enjoying the story more than the group without spoilers. The group where the spoiler was a separate introduction actually enjoyed the story the most. This is known as the spoiler paradox.
Understanding the spoiler paradox is to understand how human beings find meaning. This is known as ‘theory of mind’. This means we like giving meaning and intentions to other people and even inanimate objects. As a result we love stories. A lot. Therefore we find stories a better way of sharing a message. The message “don’t tell lies” is an important one we’ve tried to teach others for generations. But one of the best ways to teach it was to give it a story: ‘The Boy Who Cried Wolf’. Consider Aesop’s fables or the parables of Jesus. Stories have a power.
Therefore, if we know where the story is going it becomes easier for us to follow. We don’t have to waste cognitive energy wondering where the story is taking us. Instead we can focus on the information as it comes. Knowing the final point makes the ‘journey’ easier.
Think how often we’ll watch a favourite movie or read a favourite book even though we know the end. We all know the story of Romeo and Juliet but will still watch it in the theatre. We’ll still go to see a film based on a book we’ve read. Knowing the ending doesn’t detract at all. In fact, I’d argue that focusing on twists and spoilers actually detracts from telling a good story. If you’re relying on spoilers to keep your audience’s attention then your story isn’t going to stand up to much. As a fan of BBC’s Sherlock I think the series went downhill fast in Series 3 when the writers focused on plot twists rather than just telling a decent updated version of the classic stories.
So, how can knowing about the spoiler paradox shape the way we communicate?
In healthcare we’re encouraged to user the ‘SBAR’ model to communicate about a patient. SBAR (Situation, Background, Assessment and Recommendation) was originally used by the military in the early 21st century before becoming widely adopted in healthcare where it has been shown to improve patient safety. In order to standardise communication about a patient SBAR proformas are often included by phones. There’s clear guidance about the content for each section of SBAR.
Why I’m calling
What led to me seeing this patient
What I’ve found and done
What I need from you
Handing over a patient on the phone to a senior is regularly included as a core skill to be assessed in examinations.
You’ll notice that right at the very beginning of the proforma in this photo (taken by me in the Resus room at Queens Medical Centre, Nottingham) it says ‘Presenting Complaint’. In other proformas I’ve seen this is also written as ‘Reason for call’. This makes a big impact on how easy the handover is for the other person. For example:
“Hi, is that the surgical registrar on call? My name is Jamie I’m one of the doctors in the Emergency Department. I’ve got a 20 year old man called John Smith down here who’s got lower right abdominal pain. He’s normally well and takes no medications. The pain started yesterday near his belly button and has moved to his right lower abdomen. He’s been vomiting and has a fever. His inflammatory markers are raised. I think he has appendicitis and would like to refer him to you for assessment.”
“Hi, is that the surgical registrar on call? My name is Jamie I’m one of the doctors in the Emergency Department. I’d like to refer a patient for assessment who I think has appendicitis. He’s a 20 year old man called John Smith who’s got lower right abdominal pain. He’s normally well and takes no medications. The pain started yesterday near his belly button and has moved to his right lower abdomen. He’s been vomiting and has a fever. His inflammatory markers are raised. Could I please send him for assessment?”
Both are the same story with the same intended message - I’ve got a patient with appendicitis I’d like to refer. But which one would be easier for a tired, stress surgeon on call to follow?
We can use this simple hack to make our presenting more effective as well. Rather than our audience sitting their trying to formulate their own ideas and meaning, which risks them either taking the wrong message home or just giving up, we must be explicit from the beginning.
“Hello my name is Jamie. I’m going to talk about diabetic ketoacidosis which affects 4% of our patients with Type 1 Diabetes. In particular I’m going to focus on three key points: what causes DKA, the three features we need to make a diagnosis and how the treatment for DKA is different from other diabetic emergencies and why we that it is important.”
Your audience immediately knows what is coming and what to look out for without any ambiguity. Communication is based on stories. Knowing what is coming actually helps us follow that story. The real spoiler is that we love spoilers. Don’t try and pull a rabbit from the hat. Punchlines are for jokes. Be clear with what you want.
Thanks for reading