What Your Doctor Doesn’t Tell You & How to Unlock Your True Voice

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Speaker 1 Today, on something you should know, what happens to all the things you buy online, but then return? Probably not what you think.

Speaker 1 Then you can get a lot of medical tests when you're sick, but it's not always a good idea.

Speaker 2 Very often, time is a better answer to medical problems than bunches of scans and loads of blood tests.

Speaker 2 You can be overdiagnosed very, very easily if a doctor sends you for a scan every time you go and see them.

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Speaker 1 Something you should know, fascinating intel, the world's top experts, and practical advice you can use in your life. Today, something you should know.
Click Mike Carruthers.

Speaker 1 What do you think happens to the items you buy online or in the store? What happens to those items when you return them for whatever reason? Probably not what you think.

Speaker 1 Hi, and welcome to this episode of Something You Should Know.

Speaker 1 If you've been shopping online for any length of time, you know that most online sellers make it pretty easy to return items that you don't want. They even pay for the return shipping sometimes.

Speaker 1 And you might think those items are just repackaged and resold to someone else. And that does happen sometimes.

Speaker 1 To be sure, Amazon, Target, and Walmart resell a portion of returned products themselves. Amazon has Amazon Warehouse, a marketplace for used and refurbished products.

Speaker 1 Similarly, Walmart lists refurbished electronics on its website and sometimes resells returned products in its store's clearance section.

Speaker 1 But in many cases, the math just doesn't make sense to repackage and relist those items. So a lot of those items are sent to liquidation warehouses, which then resell those items to smaller retailers.

Speaker 1 to resell to other consumers. But what surprised me is that a lot of stuff just gets thrown out and ends up in a landfill.
There are some interesting reasons for that.

Speaker 1 For example, the product might be discontinued. The store doesn't even sell that product anymore.
Or it isn't cost-effective to repackage and resell it to anyone.

Speaker 1 One estimate is that 25% or more of returned items get tossed out and end up in a landfill. And stuff like inexpensive clothes and returned underwear all fall in that category.

Speaker 1 And that is something you should know. know.

Speaker 1 There is an assumption, I think, when it comes to your health care that if something seems wrong, you should have it looked at so you can get a diagnosis, because early diagnosis of an illness is a good thing.

Speaker 1 It allows you to treat something early, and just generally getting an early diagnosis is always better. Well, Maybe, but there is another side to that coin, as you're about to hear, from Dr.

Speaker 1 Suzanne O'Sullivan. She is a consultant neurologist and clinical neurophysiologist and author of three previous books.

Speaker 1 She has a new one out called The Age of Diagnosis, How Our Obsession with Medical Labels Is Making Us Sicker. Hey, doctor, welcome to Something You Should Know.

Speaker 2 Thanks for having me.

Speaker 1 So I think it's widely believed, it's conventional wisdom, that early diagnosis is a good thing. So explain this alternate view you have.

Speaker 2 Yeah, so I think that there's some fairly sort of there's some received wisdom, which is that earlier diagnosis are always for the better.

Speaker 2 If you catch a diagnosis early, you'll promote long-term health.

Speaker 2 You know, that the more health conditions you recognize, the more treatment you give, the more you promote long-term health of the population.

Speaker 2 And those assumptions, you know, they make a huge amount of sense. One can understand why we think that way.

Speaker 2 However, when we look at the statistics of diagnosis, we see something that suggests those assumptions may may actually be quite problematic.

Speaker 2 So, for several decades now, we've really been focused on diagnosing lots of things at earlier stages. So, for example, we have screening programs for cancer that detect very early cancers.

Speaker 2 We have screening programs for learning problems that are detecting milder forms of problems like autism and ADHD.

Speaker 2 Now, if the assumption that early diagnosis and recognizing mild conditions was to our benefit was correct, we should be seeing the downstream effects of all that improved diagnosis.

Speaker 2 We should be seeing fewer late-stage cancers, fewer deaths from cancer. We should see children with better mental health going into adulthood, better able to progress through life.

Speaker 2 But we are actually seeing the opposite of all of those things. We are diagnosing lots of conditions earlier, so we've got lots of people becoming patients earlier than they would have before,

Speaker 2 and we have just as many people with late-stage problems.

Speaker 1 So, I'm surprised to hear you say that because my perception is, and I'm certainly no doctor, but

Speaker 1 my perception is that there are fewer deaths from cancer, that we are catching cancer earlier and that that is has proven to be a good thing, that people are not dying and they are getting their cancer cured.

Speaker 1 No?

Speaker 2 If you look at people who have been diagnosed with early cancers on screening, you will see fewer deaths from cancers in those groups. But if you look at the overall mortality from cancer,

Speaker 2 we have a gradually increasing amount of cancer diagnosis with late-stage cancer also.

Speaker 2 And the reason that happens is because if you diagnose lots of people with early cancer cells, what people don't realize is that not every abnormal cell that looks cancerous will actually grow and cause long-term health problems.

Speaker 2 Only certain cancer cells grow to become malignant, life-threatening cancers.

Speaker 2 If you catch lots and lots lots of early cancer cells and treat them all as if they are potentially going to be life-threatening in the future, you'll be treating a lot of those people unnecessarily.

Speaker 2 But if you look at the survival rates for cancer in those people, they'll look fantastic because a lot of those people didn't need to be treated. In the long run,

Speaker 2 they'll be very healthy. They'll attribute that to their cancer treatment, not knowing that the treatment was never necessary.

Speaker 1 Well, you know, I have heard that before, or something like that before, that, you know, if you looked at any of us with a you know a microscope we all have cancer in us somewhere probably or something that looks like cancer but it doesn't mean that we necessarily need to treat it but why don't we need to treat it

Speaker 2 yeah so what I always say to people is you know that you have to remember that a lot of the technology we have now to look inside the healthy body has only been available to us for a couple of decades you know the MRI scan came into regular use in the 1990s but the really good MRI scanners have only been around for a couple of decades now.

Speaker 2 So we did not know for a very, very long time what the inside of the healthy body looked like. You know, we were not able to genetically test, you know, mass numbers of people until the last 10 years.

Speaker 2 So what we have is

Speaker 2 a sort of, we've got all these new types of technology that allow us look inside the healthy body in a way that we never have before.

Speaker 2 And we're detecting things that were always there that we didn't know were there.

Speaker 2 So for example, if you look at autism studies of people, you will often find that they have small abnormal cells that didn't progress.

Speaker 2 There was a study in Detroit of men and they found that 45% of men in their 50s had prostate cancer at the time of death.

Speaker 2 Their deaths were for things other than prostate cancer and that those those numbers were substantially higher as men got older.

Speaker 2 So huge numbers of men have early cancer cells that never cause them in their prostate, that never cause them health problems.

Speaker 2 We didn't know about them because we didn't have the means to look for them.

Speaker 2 So now that we're finding them, we're kind of acting on the assumption that all of them will progress because we simply don't have the knowledge base yet to know what factors make cancer cells grow in some people, but they don't grow in other people.

Speaker 2 How do you tell a serious cell that will progress from one that doesn't? So these cells have always been there. And the difference now is we have the technology and the ability to see them.

Speaker 1 So I get that. That's really interesting.

Speaker 1 And I've heard, too, that, you know, there are many men as they age, get prostate cancer, and that many men die with it, but far fewer men die of it, that it's just there because you live long enough, you're going to get it.

Speaker 2 Precisely. And, you know, a lot of countries don't do prostate screening because of the problems of overdiagnosis of prostate cancer.

Speaker 2 So some estimates would be that if you screen a thousand men for prostate cancer, you won't save any lives, but you will over-treat 10 to 20 men for prostate cancer who didn't need treatment because these abnormal cells in the prostate are so common.

Speaker 2 And the difficulty is that if a man presents for screening of his prostate and abnormal cells are found, how is he to react to that?

Speaker 2 Because it's very frightening to learn that you have abnormal cells. And there are watchful waiting programs that suggest we don't have to overreact when this sort of thing is found.

Speaker 2 But that can be very hard to do on an individual level if you don't know ahead of time that these things exist.

Speaker 1 So I get what you're saying about cancer, but what about something like heart disease, where it's reversible in many cases?

Speaker 1 So it would seem the earlier you catch it, the less reversing you have to do. So why not catch it early?

Speaker 2 So a lot of focus at the moment with regards to something like heart disease is on identifying the risk factors that might put you

Speaker 2 at higher risk of heart disease going down the line. So for example, something like diabetes or something like hypertension.

Speaker 2 So over the years, you know, there's no point at which a blood sugar suddenly turns into diabetes. There's no right point.

Speaker 2 At some point, too much glucose on your blood means you're diabetic, but no one can say what that exact point is. And similarly, you know, what is normal blood pressure? You know, is it 140 over 80?

Speaker 2 Is it 130 over 80? Nobody knows.

Speaker 2 So what has been happening over the years, in order to reduce the risk of something like heart disease or strokes down the line, committees of specialists have been gradually changing the parameters required to be diagnosed with something like pre-diabetes or hypertension with the idea that if you address these issues, you'll prevent heart disease at a later date.

Speaker 2 Now,

Speaker 2 this runs into the same difficulties as the early cancer diagnosis. If you

Speaker 2 adjust the parameters of blood pressure to identify more people as hypertensive, as happened not that very long ago,

Speaker 2 you can

Speaker 2 identify huge numbers of people as being potentially hypertensive and potentially at risk of heart disease or stroke.

Speaker 2 But actually, of those huge number of people, you will certainly be helping a percentage of them. Maybe 20% of them will genuinely be at risk of stroke.

Speaker 2 But you are inevitably going to be over-treating maybe 80% of them who are never at risk because they didn't have other high risk factors.

Speaker 2 And similarly, if you identify lots of people with pre-diabetes, only a percentage of those people would actually develop diabetes if you didn't identify them.

Speaker 2 So you've always got this health economics going on where you're saying, I identify 100 people,

Speaker 2 10 of them might benefit. but 90 of them will probably not benefit from this intervention.
And the assumption all the time is that the intervention doesn't do any harm, so that's okay.

Speaker 2 You've saved 10 people and the other 90 people have just gotten some good advice in health monitoring. But of course, it's not as simple as that.
Health monitoring in itself has problems.

Speaker 1 We are discussing a very important change in healthcare and my guest is Suzanne O'Sullivan.

Speaker 1 She is a neurologist and author of the book, The Age of Diagnosis, How Our Obsession with Medical Labels is Making Us Sicker.

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Speaker 1 So, doctor, I think there's this general perception that if you have something wrong, if something doesn't seem right or you see something or feel something, the advice is go to the doctor, get it checked out.

Speaker 1 And the underlying assumption there is, so you know what it is, what the diagnosis is, and therefore you can treat it.

Speaker 1 But then you also hear doctors say things,

Speaker 1 I've had doctors say things like,

Speaker 1 well, we'll keep our eye on it. And I don't like that.

Speaker 1 That sounds very non-committal, very vague. I don't want to keep my eye on it.
I want to fix it.

Speaker 2 Well, I mean, with regard to sort of if somebody notices a symptom and goes to their doctor, we do, you know, I'm certainly not advocating that they don't do that.

Speaker 2 The distinction I'm making is between us

Speaker 2 as a scientific and medical community seeking out patients who are asymptomatic. So I'm talking about asymptomatic cancers and asymptomatic hypertension and asymptomatic prediabetes.

Speaker 2 If we work really hard to try and find loads of asymptomatic people at risk of problems, we overdiagnose.

Speaker 2 But obviously symptomatic disease is a completely different thing that does need to be taken more seriously. However, when it comes to

Speaker 2 things that come to a doctor and how one should approach that, very often

Speaker 1 their

Speaker 2 time is a better answer to medical problems than bunches of scans and loads of blood tests. You know, medicine and diagnosis is still a clinical art.
Tests need to be put into a clinical perspective.

Speaker 2 You will get a better and more reliable diagnosis from a good doctor who takes time listening to you and examining you than you will from a scan.

Speaker 2 Because again, the problem is that scans and blood tests, they pick up irregularities all the time.

Speaker 2 You can be overdiagnosed very, very easily if a doctor sends you for a scan every time you go and see them.

Speaker 1 Well, what about something like pancreatic cancer, which is asymptomatic for a long time and then it's too late? And so, wouldn't it have been nice if we had been able to find this earlier?

Speaker 1 But that seems to be impossible or close to impossible.

Speaker 2 I mean, obviously,

Speaker 2 finding progressive cancer early is the aim. But the difficulty is that

Speaker 2 our science isn't very good at doing it yet so i'm not suggesting this won't be a wonderful strategy in the future and but unfortunately there are some cancers and pancreatic cancer would be one of those that spreads very quickly and therefore screening programs don't work very well for those so for example ovarian cancer spreads very quickly so you don't have a screening program for that because by the time it's found it's it's often already spread and that can be a difficulty.

Speaker 2 So other cancers spread spread very slowly or grow or don't grow at all. And that's where overdiagos.

Speaker 2 So underdiagnosis occurs in some cancers because they're hard to detect or they spread very quickly. Overdiagnosis occurs in other cancers because some don't grow at all.

Speaker 2 So there's absolutely no doubt that the logic that we should try and find them early is the correct one. But the point is, we're not very good at doing that yet.
We just have not mastered that yet.

Speaker 1 Well, you just use the term progressive cancer. The only way you can tell if something something is progressing is to look at it at least two points in time.

Speaker 1 You can't look at something once and say it's progressing. You don't know.

Speaker 2 Well, that's precisely the point. So of how one could perhaps think about how one deals differently with this issue of screened cancers.
So again, I'm talking a cancer that

Speaker 2 presents with symptoms is completely different, but let's say a cancer found on screening.

Speaker 2 You can actually consider a watchful waiting program for those cancers.

Speaker 2 So a lot of abnormal breast cancer cells and a lot of abnormal prostate cancer cells don't necessarily progress to be life-threatening. And what you can do in those situations is

Speaker 2 do exactly what you're suggesting, which is monitor them with scans over time to look to see is this one that's progressing or is it staying the same.

Speaker 2 At the moment, because the word cancer is such a frightening one, you know, we feel a bit compelled into action. People need to know that, you know, these cancer, cancers are not all equal.

Speaker 2 A screen cancer is not exactly the same as a symptomatic cancer. And you do have time to think.
But to be able to have time to think, you need to understand that these cancers don't all grow.

Speaker 2 And you also need to have a good doctor by your side supporting you while you have serial testing to see whether you are one of the lucky ones who has just cells that aren't going to grow or if you're one of the unlucky ones.

Speaker 1 but you just use that, you know, the word frightening. But

Speaker 1 when I hear, if I were to hear that I have cancer cells, if I have early stage cancer, and I think it's just human nature,

Speaker 1 I don't want that. I want you to get rid of that.
You're the doctor. Get rid of my early stage cancer so it doesn't.

Speaker 1 It's an emotional knee-jerk reaction, but it's certainly understandable.

Speaker 2 I guarantee you, Mike, I would be exactly the same. You know, if I, you know, I do have cancer screening because in the UK it's recommended on a regular basis.
I have the standard screening.

Speaker 2 And if something is found, even with the knowledge that I have now, I would be just as frightened as anybody else. And I would also feel compelled to act.

Speaker 2 And I think probably one of the issues there is we're calling all of these things cancers. but they're not necessarily that's not necessarily representative of what is being found.

Speaker 2 So what some people would argue is that we should name, give these kind of abnormal cells found on screening a different name to cancer.

Speaker 2 Because the minute we kind of hear, oh, it's a cancer, well, you just want it out and you'll be subjecting yourself to treatment which could be harmful in itself.

Speaker 2 So, you know, to solve that problem of fear, because fear compels us into doing things that aren't necessarily the best thing for us.

Speaker 2 And perhaps to solve the problem of fear, we should give these screened abnormal cells a name that is less frightening than cancer.

Speaker 1 You would almost think, I mean, you could imagine one course of action might be, if a doctor knows that this isn't something to worry about yet,

Speaker 1 to stay quiet. But you can't do that as a doctor.
You can't not tell people they have cancer.

Speaker 2 No, obviously you can't withhold those kind of findings. Although, you know, I don't want to frighten your listeners in any way.

Speaker 2 But, you know, doctors to a certain degree withhold things all the time, you know, because it's quite unusual, not things of the magnitude of cancer, I should add, but, you you know, it's quite unusual.

Speaker 2 If you see a patient and you do a bunch of blood tests and a couple of scans and a chest x-ray and a few things, you know, the likelihood that every one of those tests is going to come back, saying, giving a 100% clean bill of health is actually quite unusual because every single blood test is open to a range of different results.

Speaker 2 And scans constantly show little white spots and cysts and things. You know, they are just incredibly common.
And it's a doctor's job all the time to decide what is important and what is unimportant.

Speaker 2 You know, we could frighten the living daylights out of our patients if we kind of made a big deal of everything abnormal we found on tests. Medicine is an art.
Diagnosis is an art.

Speaker 2 So a doctor is constantly sort of weighing up little irregularities that they found on tests against their patient's story and deciding whether those irregularities are worth a mention or not.

Speaker 2 But of course, screen cancer, well, that's a whole nother story. But it is part of the art of medicine to decide what is important and what isn't.

Speaker 2 And there is an argument for some tests, not cancer per se, but some tests that, you know, not everything needs to be passed on to the patient if it's judged to be likely to cause them more anxiety instead of putting their minds at ease.

Speaker 1 What about other medical conditions? It seems people go to the doctor for a lot of things that might just go away by themselves. I mean, muscle pain, for example.

Speaker 1 I mean, sometimes it really can be very painful, but it does seem like it eventually goes away and that it didn't need medical intervention. But if you go to the doctor, you want medical intervention.

Speaker 2 Yeah, I mean, you know, there's surprisingly few real emergency situations. Unless you're working in a big trauma center where you're constantly seeing road traffic accidents, et you know a lot of

Speaker 2 a lot of medicine isn't an emergency situation and a lot of time a better diagnosis is made and the treat patient is better treated if you take a little bit of time to think and most problems are not rapidly progressive and usually you know a patient working in concert with the doctor where the doctor has a few meetings so that you can kind of really get a sense of the story and that you can kind of understand the person you're speaking to that's how you make an accurate diagnosis.

Speaker 2 Feeling a need to label things immediately to satisfy the patient isn't necessarily the best type of medicine. And very often

Speaker 2 things disappear. And you know, I'm sure you already know this, but you know, doctors don't have the answer to everything.
We don't know what causes every ache and pain.

Speaker 2 We don't know why people go through various transient symptoms.

Speaker 2 Once we've ruled out through the history and examination anything serious, often the safest strategy is just a series of meetings and time to think.

Speaker 1 Well, this is a part of medicine that I don't think people think much about, that sometimes having too much information is a problem, and that and a lot of this we're just not that good at yet.

Speaker 1 I've been speaking with Dr. Suzanne O'Sullivan.
She is a neurologist and author of the book, The Age of Diagnosis, How Our Obsession with Medical Labels is Making Us Sicker.

Speaker 1 And there's a link to her book at Amazon in the show notes.

Speaker 1 Dr. O'Sullivan, thank you for explaining all this, making it much clearer.

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Speaker 1 It's hard to imagine a day going by when you don't talk to someone. I mean, that's what we humans do.
We talk. Most of us talk all day long.

Speaker 1 And you probably don't think a whole lot about how you speak. Are you being effective in how and what you say? Do other people enjoy speaking with you?

Speaker 1 All these things are important because others are certainly making judgments about you based on how you speak.

Speaker 1 Here with some great advice on how to speak for maximum effectiveness is Michael Chad Heppner. He's coached presidential candidates, prominent CEOs, and Ivy League deans on their communication skills.

Speaker 1 He's author of a book called Don't Say Um, How to Communicate Effectively to Live a Better Life. Hi, Michael.
Welcome to Something You Should Know.

Speaker 3 Thank you. It's great to be here.

Speaker 1 So I'm curious, since you talk to people about this all the time, do you think most people think of themselves as pretty good communicators, that they speak well?

Speaker 1 Or do most people or do a lot of people think, I'm not very good at this. This is a real problem.

Speaker 3 My funny answer to your question is that I think for both groups, their perception is not equal to reality.

Speaker 3 And what I mean by that is most of the folks who think they're terrible communicators, they're not actually as bad as they think.

Speaker 3 They have some sort of tape playing in their head about how bad they are in this situation. They can't tell stories.
They can't tell jokes. And usually they're being too hard on themselves.

Speaker 3 And on the flip side, the people are like, ah, I communicate all day long. I'm great at this.
You know, I've been talking to groups my whole life. Very often, they're not nearly as good as they think.

Speaker 1 And so what is the biggest problem, either the real problem or the perceived problem in the way people communicate?

Speaker 3 The thing I see the most commonly, And I'll give it one big title, but then I'll show you how it manifests in a bunch of behaviors, is that people contract when they're in these higher stakes kind of communication situations?

Speaker 3 And I mean that technically. They close their mouth more.
They use their face in an expressive way less. They restrain their hand gestures.
They collapse their posture.

Speaker 3 They breathe in a more limited way. They use less vocal variety.
They use less dynamic enunciation.

Speaker 3 All of those things.

Speaker 3 The problem with this is that what ends up happening is they don't look like more professional or more dignified or as though they're conveying more gravitas.

Speaker 3 No, they just look like a more limited version of themselves.

Speaker 3 Bored by their topic, perhaps.

Speaker 3 And the assumption they make that I should be more serious or I should be more professional shoots them in the foot pretty badly. That then manifests into a whole bunch of things.

Speaker 3 More monotone voice, faster rate of speech, speech more stumbles more ums and uhs and filler but you can all you can trace a lot of that back to that first initial adjustment of contracting

Speaker 3 and is that nerves is it what causes that well for some people yeah for sure i mean i'll give you you can think of the three evolutionary threat responses of fight flight or freeze When you're giving a big presentation or you're at a networking event or whatever the thing might be, you can't fight anybody.

Speaker 3 There's no one to fight. You can't flight.
You can't leave the room. So, what do you do? Well, you freeze a little bit.
But speaking is moving.

Speaker 3 To speak is to move. We breathe in, our diaphragm moves down, our rib cage expands and moves out.

Speaker 3 And then we allow the air to flow over our vocal cords. Our mouth moves in this tremendously dynamic way to enunciate words.
Speaking is moving.

Speaker 3 So if those nerves and those anxieties manifest in freezing, what you're doing is, yes, contracting yourself quite dramatically. Other people contract for different reasons.

Speaker 3 They might, as I suggested earlier, think it's more professional or dignified or something like this. And most of the time, in my experience anyway, it's just wrong.

Speaker 1 Knowing this, what is it that people should be looking to do?

Speaker 1 Like when people present, have their big presentation that's coming up, are they preparing right and then just failing in the moment?

Speaker 1 Or would better preparation or different preparation have prevented the falling apart of

Speaker 1 the presentation? Yes,

Speaker 3 you ask a really important question.

Speaker 3 Oftentimes they do prepare badly and it shoots them in the foot. And I'll give you the primary culprit.
Most people think of preparation as writing.

Speaker 3 So they type a bunch of stuff or they write out all their comments, but they're doing an activity that is completely different from what they're actually going to do in the moment, which is speaking.

Speaker 3 So one of the first missteps people make is this writing first approach. And what I often coach people to do is something I call out loud drafting.

Speaker 3 And it is exactly like it sounds, as opposed to grabbing the laptop or a pad of paper to begin.

Speaker 3 No, stand up, walk around the room, and ask yourself some big open-ended prompt to get your ideas flowing.

Speaker 3 Something simple like, if my audience were to walk away with one thing from this today, what would I want that to be? And then answer the question. Well, the first answer is going to be bad.
Fine.

Speaker 3 Do it again. Second answer, a bit better.
Third time you answer the same question, I promise you, you will already have come up with something that you can begin to work with.

Speaker 3 Not only that, but it will sound more like how people actually use language in speaking.

Speaker 3 You will have come up with it with a muscle memory experience of relaxation and release as opposed to effort and tenseness.

Speaker 3 And you will already have started to loosely memorize what you want to say. And it's almost instant.

Speaker 3 So once you've done that a few times, then sure, grab a pad of paper or grab your laptop at that point and jot a few notes, but begin the process by doing the thing you're eventually going to have to do anyway, which is speaking.

Speaker 3 So that's on the preparation side of things. But then when it actually comes to delivering your communication message, whatever it is, there's some pitfalls there too.
You want me to get into it?

Speaker 3 Yeah.

Speaker 3 So people try to correct problems, not just ineffective ways, but counterproductive ways. And I'll give you an example.

Speaker 3 If people know about themselves that they speak way too quickly, either they know this or people always tell them this. Oftentimes the advice they get is wrong in three terrible ways.

Speaker 3 The first is it's negative. The second is it's general.
And the third is it's mental.

Speaker 3 So the first, it's negative. What does that sound like? Don't talk too fast.

Speaker 3 Okay, well Now all I'm trafficking in is thought suppression. I hear a don't.
All I can do is fixate on the don't. So it's negative.
It doesn't doesn't work.

Speaker 3 It's the don't think about a pink elephant trick. Number two, then it's going to get general.
So what do they typically hear next?

Speaker 3 Just slow down. But that's so general.
How does one actually do that? And in fact, if you get advice, I would challenge folks to this idea. If you get advice that begins with the word just,

Speaker 3 there's a pretty good chance you can throw it out. Just slow down.

Speaker 3 In each word, between the words, between between the sections?

Speaker 3 How would I even do that? And then the third thing they get is a mental adjustment for what is a physical activity. So the third thing they hear is remember to breathe or remember to pause.

Speaker 3 But you're being given a mental instruction for what is a physical activity, speaking. And we would never give an athlete a bunch of mental instructions for how to perform better.

Speaker 3 Speaking essentially is a sport. So we have to dramatically rethink how we try to help people improve at the sport of speaking.

Speaker 1 And so how do you do that?

Speaker 3 By using kinesthetic tools to change bad habits and build good ones. So let's take the speaking too quickly example.

Speaker 3 As opposed to all that garbage of, you know, negative, general, and mental, instead,

Speaker 3 And I'll demonstrate this now. You can probably even hear it in my voice if I go far enough with it.

Speaker 3 This is an exercise called finger walking. And the way it works is the following.
I walk my fingers across a desk or a table,

Speaker 3 and I choose every single word that comes out of my mouth. If I don't know what word to say next, I pause the walking forward of my fingers

Speaker 3 until I have figured out which word I want to share. And I will often tell clients that

Speaker 3 if they fail in this drill, it's not a mental failure. It's not even a failure in the mouth.
It's a failure in the fingers. They need to be more specific,

Speaker 3 placing each and every single finger step on the desk or table, essentially walking their ideas across the table.

Speaker 3 Now, what this does is it activates something fancy called embodied cognition, which is simply thinking or learning with your body. And it forces you to actually fixate on choosing words.

Speaker 3 So what does it do? Well, automatically it slows you down, but it also gets to a thing that you and I were talking about earlier, which is it makes your language a lot more precise.

Speaker 3 Because as opposed to don't say um,

Speaker 3 what you're thinking about is which words should I actually choose? So that's one example. I actually did that, but a bigger version with one of the co-anchors on Good Morning America.

Speaker 3 I made her walk on a balance beam, which is the more fully realized version of this exercise, in which you actually use a balance beam and walk your feet, just like I described walking your fingers.

Speaker 1 One of the things people seemingly struggle with when it comes to speaking, and one of the things that listening to you, that you demonstrate, is your voice is clear as a bell. You don't amanah.

Speaker 1 You say what you came came to say and you say it well right off the top of your head. Is that something that you learn or is that something that experience gives you?

Speaker 3 I would say both.

Speaker 3 You just said,

Speaker 3 do you learn it or does experience give you? I actually think those two things can work in a very virtuous cycle. So yes, one can train to get better in these things.

Speaker 3 By the way, we have. I mean, as a species, we have done this many, many many times.
We've been whole cultures that are dedicated to rhetoric and elocution and things like that.

Speaker 3 So, yes, you can train for these things. And in fact, if I could give listeners one big aha moment, it is that this stuff can be learned.
This is not a fixed mindset thing. I'm a bad joke teller.

Speaker 3 I'm a bad presenter. I'm a bad networker.
No, it's stuff you can train at just like an athlete. But to your second point, yeah, experience is crucial.

Speaker 3 And the more that you give yourself opportunities to speak in situations that matter, the better. But the gift about speaking that I think so many people miss is that we do it all day long.

Speaker 3 This is not like I want to get better at coding. So I have to carve out time of my day to work on my coding.
You could get better at speaking, ordering a cup of coffee.

Speaker 3 talking to a operator on a customer service phone call. There are endless opportunities to practice this stuff throughout our days.

Speaker 1 Well, but there are different kinds of speaking in my experience. Like, I can sit here and talk, and I'm not the least bit nervous.
I'm not the least bit self-conscious.

Speaker 1 One of the reasons is I know I could do it over again if we had to

Speaker 1 and edit it or whatever, but this is very easy for me. But if there were 20 people in this room watching me,

Speaker 1 that's a different story.

Speaker 1 Speaking in public is a different kind of speaking than sitting here talking into a microphone where there's nobody else listening, even though ultimately thousands and thousands of people will hear this.

Speaker 1 That

Speaker 1 doesn't play into my concern at all.

Speaker 3 Which is all the more reason that people should treat speaking like a sport.

Speaker 3 Because what you have to rely on in those moments of tremendous nerves is the muscle memory that you have built. So let me make this very specific.

Speaker 3 Let's say that you know when you get nervous, you tend to speak in a more monotone voice.

Speaker 3 I'm not saying that about you, okay, but let's, the mythical you out there, someone, you get nervous and you start speaking in a more monotone voice.

Speaker 3 By the way, monotone, we think of that solely as pertaining to pitch, meaning high and low.

Speaker 3 But monotone just means more uniform.

Speaker 3 So if you know about yourself when you get nervous, that you speak more quickly, you never take any pauses, and your rate of speech is uniform with very little variation, that is monotone.

Speaker 3 So if you know this about yourself, then it's important to train the ability to use what I call the five P's of vocal variety. And those five P's are pace, pitch, pause, power, and placement.

Speaker 3 Pace is speed. Pitch is high and low.
I just said that one before. Pause is silence.

Speaker 3 Power is volume. Loud and soft.
And then placement is where the sound is placed in the body. So more of a nasal sound, more of a front of mouth, mid-mouth, back of mouth, more of a chest voice.

Speaker 3 Where is the sound placed in the body? We use these five Ps

Speaker 3 fluidly, fluently, to get our ideas across to each other.

Speaker 3 Now, if you're this person and you get nervous and you know that I get much more monotone when I'm nervous, it's very important to build the muscle memory of even when you're nervous, being able to use those five P's to communicate how you want to.

Speaker 3 How do you do it? The best exercise for this that I have developed is called silent storytelling. And it works just like the name of the drill sounds.

Speaker 3 You practice speaking, but you don't get to use the benefit of sound. So imagine you're lip syncing, okay, or you're on a television and someone has muted you.

Speaker 3 You're going to speak just like you would. You're going to mouth the words.
Move your hands because they have a story to tell too.

Speaker 3 Allow your face to be as expressive as possible to try to communicate what you're saying, even though your listener has no sound.

Speaker 3 They have to be able to perceive what you're saying just by watching you. Well, what happens when you do this? Your communication instrument becomes much more expressive.

Speaker 3 And then once you've done this a little bit, put sound back into the equation. Allow sound back.
And all of a sudden, you will hear your voice is filled with those five P's of vocal variety.

Speaker 3 You practice that just a little bit and it builds muscle memory and you can rely on muscle memory even when you're nervous.

Speaker 1 Since it's the title of your book, let's talk about um, um and ah, and those things

Speaker 1 which do get in the way for a lot of people. And I don't even know if people really know how much they do it.
I hear it a lot when I, you know, listen back to interviews. I hear um, ah, and you know

Speaker 1 more frequently than I think the people who said them know,

Speaker 1 think that they said them.

Speaker 3 I'm sure of that. I'm sure your perception is right about that.

Speaker 1 And why do we do that?

Speaker 3 There's a lot of fascinating research about this, and we should be very nuanced because it's not as though

Speaker 3 I am the um police or ums are sins. In fact, humans use ums for some interesting reasons, some that are pretty valid.

Speaker 3 As an example, if you really want to get your voice into a conversation, but you have not yet figured out what it is precisely you want to say, but darn it, you want to claim that conversational moment.

Speaker 3 People sometimes use ums just to get their voice started and into a conversation.

Speaker 3 They sometimes similarly use them to demonstrate to somebody, I'm not done talking yet, so don't interrupt me because I'm still going to keep making sound.

Speaker 3 By the way, these strategies don't always work, okay? But I'm simply saying that there are some reasons that people use ums.

Speaker 3 So I don't consider myself the um police because I'm not on a mission to eradicate ums.

Speaker 3 What I am on a mission to do, however, is help people become aware of how useless a lot of the sounds that they allow to come out of their mouth are and

Speaker 3 how much more they do it when they're not at their best.

Speaker 1 But for people who know they say um and ah a lot and and

Speaker 1 would like to not do that, it's hard to know how do you stop it? How do you stop saying um and ah?

Speaker 3 I'll give you a fun example.

Speaker 3 If magically everyone listening, I could just click a button and put you all on mute and then say, you have to speak for the next 60 seconds, but you have to speak so expressively with your mouth, your face, and your hands that someone could actually understand what you're saying, even without sound.

Speaker 3 You would very likely not say any ums. Why?

Speaker 3 In order to mouth the words sufficiently that someone could read your lips, Think of the amount of concentration you have to dedicate to choosing your words because you're going to have to mouth them so expressively that someone could read your lips.

Speaker 3 Well, when you do that, you've unlocked your brain to do what it's really good at, which is make real-time decisions between one word and another.

Speaker 3 But you've deeply, deeply enhanced your brain's concentration on that crucial activity of choosing words.

Speaker 3 And so therefore the ums go away as a byproduct of you actively trying to choose your words, as opposed to just opening your mouth and letting a bunch of words tumble out.

Speaker 1 Well, what's great about this is I think it makes people think about a topic that most people, I don't believe, think about all that much. And yet it's so important how you speak to people every day.

Speaker 1 And you've given some really good advice. Michael Chad Heppner has been my guest.
He is author of the book, Don't Say Um, How to Communicate Effectively to Live a Better Life.

Speaker 1 There's a link to his book in the show notes. Michael, I appreciate you coming on.

Speaker 3 It's my pleasure, Mike. I enjoyed that a lot.

Speaker 1 Every man's suit, coat, blazer, or sport coat has buttons on it. But which ones do you button and when? Well, according to Esquire magazine, the one-button jacket, well, that's pretty easy.

Speaker 1 It should be buttoned while you're standing and unbuttoned when you sit down. The two-button jacket, well, the top button is all you need.

Speaker 1 The two-button jacket should never have both buttons buttons fastened. On a three button jacket the rule is simple.
Sometimes always and never.

Speaker 1 It means you should sometimes fasten the top button if you feel like it. Always fasten the middle button but never fasten the bottom button.

Speaker 1 On the double-breasted jacket fasten every button except the bottom button even though there is some leeway there. English royalty have been known to fasten every button when they feel like it.

Speaker 1 And with a double-breasted blazer, you can keep it buttoned when you sit down. And that is something you should know.

Speaker 1 If you enjoyed what you heard in today's episode, my guess is you know someone else who would probably enjoy it as well. So please share this episode with someone you know.
I'm Mike Carruthers.

Speaker 1 Thanks for listening today to Something You Should Know. Next up is a little song from CarMax about selling a car your way.
You wanna sell those wheels? You wanna get a CarMax instant offer? So fast.

Speaker 1 Wanna take a sec to think about it. Or like a mom.
Wanna keep tabs on that instant offer. With OfferWatch.
Wanna have CarMax pick it up from the driveway.

Speaker 1 You wanna do it? So, wanna drive? CarMax. Pick up not available everywhere.
Restrictions and female play. The Infinite Monkey Cage returns.
Imminently.

Speaker 1 I am Robin Ins, and I'm sat next to Brian Cox, who has so much to tell you about what's on the new series. Primarily Primarily eels.
And what else?

Speaker 1 It was fascinating, the eels. But we're not just doing eels, are we? We're doing a bit.

Speaker 1 Brain-computer interfaces, timekeeping, fusion, monkey business, cloud, science of the North Pole, and eels. Did I mention the eels?

Speaker 1 Is this ever since you bought that timeshare underneath the Sagasso C? Listen on bbc.com or wherever you get your podcasts.