Imagine you’ve just come out of an observed clinical encounter with a patient. You are eager to hear the positive feedback and constructive criticism from a supervisor. You sit down with your staff and they say:
“You did a great job, but -”
How would you feel?
Let’s imagine instead they say:
“You did a great job, and -”
How would you feel now? On paper, the difference between “and” or “but” seems insignificant. They’re both 3 letters, one syllable, and are used to connect thoughts together. However, when used in conversation, the difference can be substantial. In the first example, when the supervising staff uses “but”, you might feel like “maybe I didn’t actually do a great job?”. Here the “but” means that whatever follows will have much more weight than what has come before, and that likely, you’re expecting whatever comes after to be negative. In the second example, when they use “and”, maybe constructive criticism will come after, and yet you’re much more inclined to believe they think you did a great job.
We use “but” in the place of “and” all the time: “I’m sorry I said that thing, but I’m tired and I wasn’t thinking straight”, “I felt so good about that exam, but I totally messed up on that one question”, or “I know you’re upset, but we have lots to think about right now”. Any of these sound like something you’d say or think? Notice how in all the examples, the phrase that comes before “but” is almost nullified by what follows? Are we sorry? Did we actually feel good about that exam? Do we recognize they’re upset?
Now let’s say we put “and” in the place of “but”: “I’m sorry I said that thing, and I’m tired and I wasn’t thinking straight”, “I felt so good about that exam, and I totally messed up on that one question”, or “I know you’re upset, and we have lots to think about right now”. The first part of the phrase gets much more validation this way. It doesn’t feel like it’s been outshined by whatever comes after “and”. The two phrases are equals and can hold the same weight – multiple things can be true at the same time: we can be sorry and be tired and not thinking straight all at the same time while properly acknowledging that we’re sorry.
How might this translate to a healthcare learning environment? Or in conversations with patients or colleagues? When we use “but”, we are providing a subtle value judgement of two things, when in reality they can co-exist and do not need comparison. Whether it’s in a clinical encounter, discussing difficult news with a patient, or giving feedback to a colleague, using “and” allows us to be more validating of others and we can also be more validating of ourselves. When we are mindful of language, simple changes such as this can allow for more compassion and validation for both ourselves and others.
References : https://michaelssorensen.com/use-and-instead-of-but-for-more-effective-communication/
This article was written by Ana Clouatre, a medical student at McGill University and member of the Mindful Medical Learner initiative