“Let me tell you a story...”
I bet those six words got your attention just now — as they have done countless times before. People love stories. People have always loved stories. You are familiar with stories that have been repeated since at least the Bronze Age. If you have even a passing familiarity with a major religion, it would be hard to avoid encountering at least some of the elements of these stories.
Even older stories have been used by the entertainment industry. In an episode of the television show Star Trek: The Next Generation, Captain John Luc Picard refers to the story of Gilgamesh (2750 BC, Akkad).(1) Marvel Entertainment has reincarnated the gods of Norse, Greek, and Egyptian mythology. Star Wars: A New Hope incorporated a story arc from Homer’s Odyssey: Telemachus’ search for his father.
My wife and I recently took our family to Ireland. As we traveled around, stopping at Neolithic and Mesolithic stone forts and stone circles, I could not help but imagine generation after generation of families and clans gathering after sunset by the fireside to recount stories from their youth. Certainly, they told tales of their ancestors and legends of their heroes and gods.
In Myths to Live By, Joseph Campbell refers to myths as public dreams. I can remember stories my great-grandmother told me 50 years ago because they tapped into that public dream. The stories, novels, and movies that are etched into our memories tap into that dream as well.
Steve Persall says that “stories speak to something inside us that wants to know how our world lives, that wants to make order of it and find some meaning. [They do that] in a way that science and facts do not always do, because science and facts do not always give us meaning.”(1) With storytelling wrapped in our DNA, why are there so many dry, forgettable presentations and soul-sucking meetings?
PRESENTER AS STORYTELLER
For thousands of years, meetings were the highlight of anyone’s day: conversations, lectures, sermons, storytelling, plays, and festivals. We still look forward to almost all of these gatherings — except for the work meeting. A meeting is any phone call, video call, or occasion where two or more people get together to discuss or work through office topics.(2)
Look at your calendar and note how much of your day is filled with meetings. How much of your employees’ days are relegated to meetings? Multiply that by their hourly compensation. Are meetings the best use of their time and the organization’s money?
If you are the leader of the meeting or speaking on a topic, you are the presenter. Your presentations constitute a portion of the mental image most people have of you because it is the sum of your intellect, experience, confidence, and personality. It is how you come to live in their minds. That cannot be overstated. We do not always appreciate that, and certainly not as much as our forebears did.
The Greeks and Romans valued rhetoric. It was considered the highest achievement of a Roman citizen to be a good man well spoken, according to Quintilian. Even a political and military figure such as Julius Caesar spent a year learning rhetoric, diverting himself from his ambitious drive to “bestride the world.”(3) He knew that a well-researched, well-constructed, and expertly delivered presentation was as essential to motivate his followers as any military or political success.
When was the last time staff members left your hospital committee meeting energized, hearts filled with purpose, and ready to take on the world? No matter the presentation or the size of the audience, whether it is to one person or hundreds, formal or informal, sharing information or making a request, follow the time-honored canons of classic rhetoric: invention, arrangement, style, memory, and delivery.
But first, it is critical to understand two things: your audience and the purpose of the meeting.
AUDIENCE, PURPOSE, PRESENTATION
Is your audience one person? As clinicians, we have experience with one-on-one conversations, asking questions, taking a history, relaying findings and diagnoses, giving advice, counseling, and persuading. This does not always translate into being adept at one-on-one conversations with peers, bosses, and subordinates because the power dynamic and the settings are quite different. In a larger group, matters grow even more complicated. Is the group clinical? Are they laypeople, board members, or stakeholders from the community? All the canons will need to be adjusted for each scenario.
What are you trying to say? Why are you talking? To share data? Can that be done by email? Do you even need to have a meeting? Is it to gain consensus for a decision? Is it to bring together experts to make decisions? Is it to persuade? What is the key message you want everyone to walk away with? What is your medium — in-person, phone call, conference call, virtual meeting, asynchronous, or group email?
Aristotle wrote that there are two kinds of arguments. The first kind is technical, including proofs, laws, witnesses, contracts, and oaths. This specialized information is for a limited audience and is supposed to be objective, neutral, and true. The modern variety would be data presentations with pivot tables and run charts. These presentations supply facts and figures, charts and graphs. (Of course, we know that statistics and science can be debated and colored with emotion and bias.)
The second type of rhetoric is artistic. This is where the audience is persuaded in three areas: logos, pathos, and ethos — roughly a rational argument, an emotional bond with your listeners, and your own credibility. We tend to focus overwhelmingly on logos — the facts and figures — but countless studies show that facts don’t change our minds.(4 )As social animals, we instinctively want to fit in with the group, even if that means sacrificing reason.
You still need to base your presentation on solid data, but do not think that data alone will be persuasive. That is where you need pathos, the emotional appeal. Ethos is everything you are: your professional degree, your reputation, your training, and your gravitas — your presence and demeanor.
Invention
This is the brainstorming part. What ideas will you introduce? What are the details that will support them? How do you want your audience to visualize what you are presenting? How will you classify and define your topics? What sources of information will you use? You need to address the audience’s assumptions. This is where you identify and highlight the specific points you want to make as you build your case.
Arrangement
Your statements and proofs should fit into an introduction, body, and conclusion. Many presentations start and end without any structure. The arc is key for storytelling, persuasion, or explanation.
I assumed the chair of the quality council at our hospital a few years ago. Month after month, I watched the various managers deliver updates on their areas of expertise. In the room were about 30 managers and directors. The combined cost of their compensation for that 90-minute meeting exceeded $10,000. I had to wonder what value we were getting for it. The presenters were well-intentioned, and the data was well-researched, but there was no structure, no story. Were the presentations registering?
One day I conducted an experiment. I took careful notes during the meeting and then afterward asked the group some simple questions. All the answers had been projected on a screen or spoken aloud moments before. I ask such things as” Which medication was most prone to be involved in dosage errors?” “What was the falls rate this past month?” “What was the trend for C-sections?”
Folks struggled to answer. In fact, even the presenters struggled to answer questions about their own topics. The group grew uncomfortable, as I had caught them off guard. Then I explained that the human brain can only process data at about 60 bits per second.(5) Running through two or three dozen PowerPoint slides in a few minutes is simply overwhelming. Presentations needed to be arranged more thoughtfully.
I asked them to limit their presentations to just a few slides from now on. I also asked them to tell the audience at the very start three things they wanted them to remember. After the presentation, they were to highlight those three things again.
The purpose of any presentation is to have folks remember something when they walk out of the room. Too many of us go to a meeting with the feeling we must do a giant data dump. We have forgotten how or why we tell stories. Perhaps because we are assaulted by information all day long, we think we need to compete with our own deluge of data. We need to remember we are dealing with other human beings with a limited capacity for attention and processing. Memories are best formed when emotion and engagement are built into the presentation.
I learned this lesson when I appeared on a local weekend morning news TV show some years before. My topic was to be heat-related emergencies and the dangers of too much sun exposure. I wanted to fit as much as I could into the five minutes allotted.
I came in prepared to talk about the different wavelengths of ultraviolet light and all the acute and chronic conditions they could cause. I was prepared to reference songs and poems about the sun for literary allusion. I wound up sounding rushed and unorganized.
Brevity and focus are key to arrangement. Introduce the topic, state what you aim to say, tell the story, and wrap it up. The story should incorporate the examples or proofs (data, research) that you gathered in the invention stage.
Style
This may be the canon that gets a great speech quoted or placed into the history books. Once you know why you are saying something and have selected the content, it is time to pick the words, the quotes, the phrasing. This is where we use tropes such as metaphor or irony (we had to destroy the village in order to save it), hyperbole, understatement, or such things as polysyndeton (lions and tigers and bears, oh my!). These are the phrases that stick in people’s minds or become memes on SnapChat. There are dozens of schemes and tropes.(6) Salt your presentation with a few well-chosen images to catch the listeners’ attention and linger in their memory.
Style is often best when simple and direct. The most memorable presentations often are. Lincoln’s Gettysburg Address is 272 words. Franklin Roosevelt’s fireside chats galvanized the nation and provided inspiration throughout the Great Depression and World War II. Eighty percent of the words he used were drawn from the list of the thousand most common English words.(7)
It is tempting as a medical professional to want to dazzle folks with your intelligence, wordplay, jargon, or nuance. When we switch from addressing fellow medical professionals, we need to be careful about using technical or scientific terms.
Early in my tenure as CMO, I made presentations to the board of directors, advising on policy or actions, and I thought I would impress them by quoting case law, statutes, regulations, and historical precedents. I was convinced I had constructed iron-clad logical arguments. Later I learned that members of the committee thought I was showing off or trying to talk above them. That was the opposite of my intent. I had used the wrong style. The point was to communicate and persuade. I let my passion for wordsmithing take a front seat to the detriment of the message.
You need to know your audience. Is it appropriate to use jargon? Contractions? Mild curse words? Imagery? Evocative language? Speak in the local patois? We all have experience with code-switching — alternating between language varieties consistent with the syntax and phonology of each. “Great leaders are almost always great simplifiers who can cut through argument, debate, and doubt to offer a solution everybody can understand.”(8) That means using the style that will best resonate with the audience.
Back to my quality committee example: I gave the group latitude to be creative and to do anything they thought would enhance their presentation. I even told them they could use sock puppet props or set their presentations to music. In fact, our infectious disease coordinator did just that. She brought in a guitar and sang a song. That certainly got everyone’s attention. For once, nobody was engaged in sidebar conversations or looking down at their phones. And everyone felt energized when they walked out of the meeting.
So why not do that when it is appropriate? Why do we feel we need to be boring and act like Babbitt, the eponymous character in Sinclair Lewis’s novel about vacuity and conformity?(9) Certainly, there are times and circumstances when an informal presentation, no matter how engaging, would be inappropriate. But there are more times than not when it would be welcomed.
At our Medical Executive Committee, I have recognized the Physician of the Month. On one occasion, I presented in iambic pentameter. I was not sure if that would fly, but afterward, I was asked for copies of my verse. I do not think it would compete with Yeats for space in a poetry anthology, but it set out what I intended: the audience was engaged and the message was transmitted. Keep it simple, keep it short, make it memorable, and have fun whenever you can.
Memory and Delivery
Before teleprompters, presenters needed to memorize their speeches. While an entire presentation need not be committed to memory, it is beneficial to rehearse or do a dry run. Consider how the audience will see it. If there is too much information a slide, get rid of it. How often have you heard a presenter say, “Since you can’t read this, let me go over it for you”? Your slides should enhance your presentation, not detract from it.
Test drive the presentation technology. If there are AV technicians, make their acquaintance before the presentation and learn the controls for sound, lighting, and controlling the screen. If on a virtual conference, check out the lighting and sound in advance. Always do your own check; don’t leave it to someone else. Recently we had a grand rounds that was broadcast to the medical staff. Despite having a media person set it up, it was not until 15 minutes into the presentation that the speaker realized no one online could hear him.
Ask a friend or trusted colleague about your pacing, clarity, and delivery. While presenting, will you stay behind the podium or in one corner of the room? I have found that I look better and sound more confident if I stand up, even in a virtual meeting. Consider walking around. If you are up to it, on occasion, sit next to someone for a few seconds and look them in the eye. People will pay way more attention if they think you may single them out. Do not let the audience get so comfortable that they tune out by scrolling through their phone.
Do not use just slides; use props as well. They do not need to be elaborate. I gave a presentation on robotic surgery to ask donors for funding. To demonstrate the traditional kind of surgery, I used a fork and knife from the cafeteria; I used a grabber stick for laparoscopic; and I used a slide for the robotic surgery. While I didn’t bring in a robot, the props helped the audience easily grasp what I was presenting and gave them a way to explain it to their constituencies.
If you are talking about a 3D printer, bring small models that the audience can keep. Or hand out prizes or candy for the right answers if you are asking questions. Mirror what your audience is doing — lean in, use open gestures, and make yourself look big.
It is ok to wear high heels or boots or a brightly colored shirt. First impressions matter. Start with a big smile, or a joke, or a story, and establish your presence. Make an impression. A psychologist named Nalini Ambady gave students three 10-second soundless videotapes of a teacher lecturing. Then she asked the students to rate the teacher. Their ratings matched the ratings of students who had taken the teacher’s course for an entire semester. Then she cut the videotape back to two seconds and showed it to a new group. The ratings still matched those of the students who had sat through the entire term.(10)
Should you wear a lab coat? Suit and tie? Again, you need to know your audience. Recall President George W. Bush wearing a casual jacket, holding a bullhorn at Ground Zero right after 9/11.(11) That is where he gave a very short epigram, but perhaps the most memorable of his two terms.
Despite all the work you put into invention, arrangement, and style, it is the actual delivery that will carry the most meaning. Albert Mehrabian’s 7-38-55 Communication model says that 7% of the meaning of feelings and attitudes takes place through the words we use in spoken communications, while 38% takes place through tone and voice, and the remaining 55% of communication of these factors takes place through our body language (specifically our facial expressions).(12)
Take time to rehearse and practice. Although it is humbling, videotape yourself. You may detect some unconscious and distracting habits, such as leaning on a podium, tapping your foot, keeping your eyes closed, swallowing your words. Ask for feedback. Speechmaking, storytelling, and presenting are sports — practice and coaching will make you better. Always concentrate on the fundamentals.
LISTENING IS AS HARD AS PRESENTING
Much of the time, you will be part of the audience. There is an art to that as well. This applies to large groups as much as to small ones.
One day, while a boss and I were chatting, she asked how I thought I was received by my peers. I was noncommittal, knowing she had something to share. She showed me a photo she surreptitiously took of me during an executive meeting. I was clearly focused on my mobile device. She said I was perceived as smart but borderline arrogant because I did not pay attention when others presented. In my mind, I said, “Yes, because many of these presentations do not pertain to me, drone on, or are not well done.” That did not matter.
A few keys to being a great listener: pay attention, watch for nonverbal communications, paraphrase and repeat back, make no assumptions, encourage the communicator to speak (can be done nonverbally), and visualize the message you are receiving.(13)
As I said in the beginning of this article, we are social animals. We want to be understood. We look to our audiences for a connection. If you lean in and appear interested, the speaker knows. Eye contact and mirroring their gestures, however subtle, conveys empathy. We have neurons dedicated to that sole function.(14) Tell stories, listen closely, and engage!
Excerpted from The Chief Medical Officer’s Essential Guidebook by Mark D. Olszyk, MD, MBA, CPE.
REFERENCES
Persall S. Move Over, Odysseus. Here Comes Luke Skywalker. Mythology in Star Wars. Center for Story and Symbol. https://folkstory.com/articles/petersburg.html .
Petz J. Boring Meetings Suck. New York: John Wiley & Sons; 2011.
Shakespeare W. Julius Caesar, Act I, Scene II.
Kolbert E. Why Facts Don’t Change Our Minds. The New Yorker. February 19, 2017. https://www.newyorker.com/magazine/2017/02/27/why-facts-dont-change-our-minds .
Emerging Technology from arXiv. New Measure of Human Brain Processing Speed. MIT Technology Review. August 25, 2009. www.technologyreview.com/2009/08/25/210267/new-measure-of-human-brain-processing-speed/#:~:text=A%20new%20way%20to%20analyze,than%2060%20bits%20per%20second .
Contributors to Wikimedia projects. Figure of Speech. Wikipedia, the Free Encyclopedia. August 29, 2002. https://en.wikipedia.org/wiki/Figure_of_speech .
Phadnis V, Sridhar S. Franklin D. Roosevelt: A New Dealer in Hope. Thesis. http://fdranewdealerinhope.weebly.com/conclusion.html .
Powell C. BrainyQuote. www.brainyquote.com/quotes/colin_powell_144992 .
Lewis S. Babbitt. New York: Bantam Classics; 2007.
Gladwell M. Blink: The Power of Thinking Without Thinking. Boston: Back Bay Books; 2007.
Williams A. ‘I Can Hear You! The Rest of the World Hears You’: George W. Bush’s Bullhorn Speech Still Echoes. Fox 10 Phoenix. September 11, 2019. www.fox10phoenix.com/news/i-can-hear-you-the-rest-of-the-world-hears-you-george-w-bushs-bullhorn-speech-still-echoes .
Belludi N. Albert Mehrabian’s 7-38-55 Rule of Personal Communication — Right Attitudes. October 4, 2008. www.rightattitudes.com/2008/10/04/7-38-55-rule-personal-communication .
World of Work Project. Six Facets of Effective Listening for Better Connection. The World of Work Project. July 8, 2019. https://worldofwork.io/2019/07/six-facets-of-effective-listening .
Marsh J. Do Mirror Neurons Give Us Empathy? Greater Good. March 29, 2012. https://greatergood.berkeley.edu/article/item/do_mirror_neurons_give_empathy .