186 The Inner Consultation

‘Your knees have a problem. Their problem is, you aren’t listening to what
they’re trying to tell you. They’re trying to tell you, by hurting, that you’re asking
too much of them. You’re asking them to carry more weight than they can stand,
and they don’t like it. What they would like is for you to take some of the load off
them. The only way you can lessen the load is to weigh less. So in order to weigh
less you’re going to have to diet. Now I know you find dieting difficult; but
difficulties are there to be solved . . .’
The shingles technique gives an argument the persuasive feel of inevitable logic
leading one short step at a time to the only possible conclusion. It is a good way
to counter red herrings. It is also a useful manoeuvre in response to patients who
can think of a dozen reasons why anything you suggest won’t work.

Don’t say ‘don’t’ (unless you mean ‘do’)

There you are, sitting in a railway carriage minding your own business, not a care
in the world. Then a total stranger on the opposite seat sighs deeply, leans
forward, and says to you, ‘Don’t talk to me about traffic wardens.’ Well, you hadn’t
been going to. Nothing was further from your thoughts – until then. But from
then on you can’t think about anything but traffic wardens, and how they would
have featured in the conversation you’re not going to have. There is nothing
more guaranteed to make me brace myself rigid in the dentist’s chair than being
told, ‘This won’t hurt.’ Until then, I might have managed to convince myself that
modern dentistry was a pleasure, and then – wham! – what’s ‘hurt’ doing in the
dentist’s mind?
As we’ve found already, most thought is figurative rather than logical. We (or
at least our right hemispheres) think in pictures, imaginery conversations, and
feelings. All of these are positive experiences; how do you convey their opposites?
Whereas in the logical left hemisphere realm of grammar and syntax, negation is
easy – you just stick ‘not’ into the sentence – in figurative language, you can’t see
a ‘not’ picture, or feel a ‘not’ sensation. The opposite of an image or a feeling is
another different one, not the absence of any image or feeling at all.
Earlier in this chapter I quoted the maxim ‘the meaning of any communica-
tion is the effect it produces’. The right hemisphere doesn’t understand negation.
It responds to negatives as if they weren’t there. To the right hemisphere:

don’t means do,

won’t means might,
can’t means could, and
shouldn’t means probably will.

‘Don’t worry,’ means worrying is an option. ‘This won’t hurt,’ means it might.
‘I can’t get you seen any earlier,’ means that somebody else could. ‘Don’t forget,
you shouldn’t stop the course of tablets until they’ve all gone,’ is a clear challenge.
If you want to tell someone’s right hemisphere something, put it positively.
Instead of these examples, you could say, ‘Relax’. ‘You’ll just feel me touching
you.’ ‘That’s the earliest appointment.’ ‘Remember to finish all the tablets.’
A pub bore was telling his favourite ‘what I did in the war’ story. ‘There I
was, flying over the desert, miles and miles of sand. Can you imagine, nothing
 B5 Checkpoint 3 (handover): communication skills 187

but sand?’ ‘Right, got you,’ said the little fellow listening to him. ‘No trees,
nothing,’ the bore confirmed.
‘Ah,’ said the little fellow, ‘sorry. Just give me a moment.’ A lone palm tree had
appeared in this imaginary scene, bottom left. It just wouldn’t vanish, so in his
mind’s eye he had two Arabs ride up on camels, dismount, unpack a saw, saw
down the tree, and exit stage right, dragging the tree behind them. ‘Okay, nothing
but sand,’ he said. ‘Carry on.’
‘Suddenly both engines failed. We were going to have to make an emergency
landing. The sand of the desert was firm and level, so I made a perfect approach
and landed. But while we were still rolling, the airplane struck an obstacle, cart-
wheeled, and landed on her back. You’ll never guess what we’d hit.’
‘The sawn-off stump of the only palm tree for miles,’ said the little fellow.
Without a word, the bore turned on his heel and left.
It is possible to turn this inability to think in negatives to your advantage,
and induce your patient to consider doing something out of keeping with nor-
mal habits and attitudes. By disguising your suggestion as a negative, you can
‘smuggle’ it in past the logically-minded sentry which is fooled by the correct-
ness of your grammar. Imagine how patients might respond to the following
examples, bearing in mind that what you are seeking is behavioural acceptance
of your wishes. Verbal agreement or disagreement matters less than the practical
outcome.

‘You couldn’t get your husband to come and see me, I don’t suppose.’ (I could
ask him.)
‘I shouldn’t think you’d find it easy to cut down your smoking.’ (I’m not that
hooked, you’ll see.)
‘Not everybody can understand why we are cautious about prescribing sleeping
tablets.’ (So tell me.)
‘I wasn’t really thinking of asking a surgeon to see you at the moment.’ (When,
then?)
‘You don’t just have to take my word for it.’ (No, I do believe you.)

Questions make good statements

I reminded you in Chapter B3, on eliciting skills, how statements can make good
questions because they don’t give too much away about the response you’re
hoping for, and the patient doesn’t have to commit himself to a particular answer.
The corollary is also true: questions can make good statements. Having to make a
reply produces a commitment to the answer given. Here are some examples.

Statement: ‘I think you drink too much.’

‘Stone-wall’ response: ‘No I don’t.’
In question form: ‘Have you ever thought you might be drinking
too much?’
Possible replies: ‘Yes,’ or ‘No.’
Your responses: (to ‘yes’) ‘I think so too. Let’s discuss that.’
(to ‘no’) ‘Well, let’s see, how much are you
drinking, exactly?’