Comparison of Oliceridine and Hydromorphone for Postoperative Analgesia in Adults Undergoing Lower Limb Fracture Surgery: A Randomized Controlled Non-Inferiority Trial.

“He who has learned to disagree without being disagreeable has discovered the most valuable secret of negotiation.” is a book written by Chris Voss, a former international hostage negotiator with the Federal Bureau of Investigation. Voss draws from his personal experience to equip readers with valuable tools to negotiate various circumstances both personally and professionally. For example, he teaches the readers how to ask calibrated questions, learn tactile empathy, label emotions, and mirror the key words of the counterpart to create a safe negotiation environment. While the target audience is not medical professionals, the toolset still applies. As physicians, we find ourselves engaged in numerous negotiations, whether labeled as such or not. These include more obvious forms of negotiation such as contract negotiation. Less obvious forms include shared medical decision making with patients and families, coverage discussions with colleagues, and borrowing resources from colleagues and hospital organizations. Voss has a unique way of teaching the readers his negotiation techniques and executing them by creating captivating and memorable plotlines. He begins each chapter with a hostage negotiation that he encountered. He describes how he handled hostage situations, both successes and failures, encountered through conversations with the adversary. By the end of each chapter, he draws out a tangible skill that can be learned and implemented by the reader. For example, in chapter four, Voss describes the psychology behind the word “no.” He suggests that hearing “no” from the adversary is actually the beginning of “getting to yes.” The “no” opens a deeper discussion about the adversary's true goals and intentions. When “no” is given as a response, it provides the opportunity to ask the adversary “why?” or “what are your reservations?” In a medical environment, “no” can be a way that someone expresses their boundaries and often their goals. As providers, realizing the meaning of “no” in these interactions can turn a potentially negative situation into a positive and proactive environment where we learn more about what the patient or colleague finds important. For instance, when a family declines a treatment option instead of stopping the conversation there, the physician has the opportunity to engage with the family's questions, concerns, hesitancies, and overall perspective. The response of “no” allows the provider to ask questions to better understand the family's goals and uncover underlying needs. While many of the negotiation tactics that Voss describes can be quite fruitful, caution is also recommended when applying them to the medical context. There are moments in medicine when getting to “no” can end a conversation and lead to loss of trust. Valuable rapport could potentially be lost in this context.