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

Online retailers make it pretty easy to return items you purchase if you are not satisfied. But what happens to those items? Are they just put back in the system and sold to someone else? This episode begins with the surprising answer. https://www.cnn.com/2021/01/30/business/online-shopping-returns-liquidators/index.html Just because you can get a medical test for something you are concerned about doesn’t mean you should. That’s according to my guest Dr. Suzanne O’Sullivan. She is a consultant neurologist and clinical neurophysiologist and author of the book The Age of Diagnosis: How Our Obsession with Medical Labels Is Making Us Sicker (https://amzn.to/41Re7Or) . Listen as she explains how medical tests can cause undue anxiety and lead you down a rabbit hole of worry that may be unwarranted. Just because you have a symptom doesn't always mean it needs a diagnosis and treatment. You talk to people all day long. Are you good at it? Do you consider yourself a strong verbal communicator? For those of us who are not 100% confident in how we speak, I have Michael Chad Hoeppner in this episode with some great suggestions to improve your verbal skills. He is a communications expert who has coached presidential candidates, CEOs, and Ivy League deans. He is author of the book Don’t Say Um: How to Communicate Effectively to Live a Better Life (https://amzn.to/441pK6I). On the front of every man’s suit or sport jacket, there are buttons. So which ones do you button and which ones do you leave open – and when? Listen and you will hear what Esquire magazine has to say on the topic. https://www.esquire.com/style/mens-fashion/advice/a33367/how-to-button-suit-jacket/ PLEASE SUPPORT OUR SPONSORS!!! FACTOR: Eat smart with Factor! Get 50% off at https://FactorMeals.com/something50off TIMELINE: Get 10% off your order of Mitopure! Go to https://Timeline.com/SOMETHING INDEED: Get a $75 sponsored job credit to get your jobs more visibility at https://Indeed.com/SOMETHING right now! SHOPIFY: Nobody does selling better than Shopify! Sign up for a $1 per-month trial period at https://Shopify.com/sysk and upgrade your selling today! Learn more about your ad choices. Visit megaphone.fm/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Mike Carruthers?

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• 1:28Mike Carruthers?

  Today on Something You Should Know, what happens to all the things you buy online but then return? Probably not what you think. Then, you can get a lot of medical tests when you're sick, but it's not always a good idea.

• 1:41Speaker 01

  Very often, time is a better answer to medical problems than bunches of scans and loads of blood tests. You can be over-diagnosed very, very easily if a doctor sends you for a scan every time you go and see them.

• 1:55Mike Carruthers?

  Also, which buttons on a blazer are you supposed to button or leave unbuttoned? And a top communications coach helps you improve your verbal skills and looks at just how good or bad a verbal communicator you are.

• 2:09Speaker 02

  Most of the folks who think they're terrible communicators, they're not actually as bad as they think. And on the flip side, the people are like, "Ah, I communicate all day long. I'm great at this." Very often, they're not nearly as good as they think.

• 2:22Mike Carruthers?

  All this today on Something You Should Know.

• 2:27Mike Carruthers?

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• 3:10Mike Carruthers?

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• 3:52Mike Carruthers?

  Get free shipping on your order and 365-day returns. Now available in Canada and the UK, too. And when Quince asks where you heard about them, please let them know it was Something You Should Know. It's the best way to support the show.

• 4:22Mike Carruthers?

  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. Hi and welcome to this episode of Something You Should Know. 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. And you might think those items are just repackaged and resold to someone else. And that does happen sometimes. To be sure, Amazon, Target, and Walmart resell a portion of returned products themselves.

• 5:04Mike Carruthers?

  Amazon has Amazon Warehouse, a marketplace for used and refurbished products. Similarly, Walmart lists refurbished electronics on its website and sometimes resells returned products in its stores clearance section. 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 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. For example, the product might be discontinued, the store doesn't even sell that product

• 5:48Mike Carruthers?

  anymore, or it isn't cost-effective to repackage and resell it to anyone. 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. And that is something you should know.

• 6:13Mike Carruthers?

  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. 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. Suzanne O'Sullivan. She is a consultant neurologist and clinical neurophysiologist and author of three previous books. She has a new one out called "The Age of Diagnosis: How Our Obsession with Medical Labels Is Making Us Sicker." Hi, Doctor, welcome to Something You Should Know.

• 6:57Speaker 01

  Thanks for having me.

• 6:59Mike Carruthers?

  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.

• 7:08Speaker 01

  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. If you catch a diagnosis early, you'll promote long-term health. You know, that the more health conditions you recognize, the more treatment you give, the more you promote long-term health of the population. And those assumptions, you know, they make a huge amount of sense. One can understand why we think that way. However, when we look at the statistics of diagnosis, we see something that suggests those assumptions may actually be quite problematic. 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.

• 7:52Speaker 01

  We have screening programs for learning problems that are detecting milder forms of problems like autism and ADHD. 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. 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. 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, and we have just as many people with late-stage problems.

• 8:36Mike Carruthers?

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

• 8:58Speaker 01

  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, we have gradually increasing amount of cancer diagnosis with late-stage cancer also. 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. Only certain cancer cells grow to become malignant, life-threatening cancers. If you catch lots and lots of

• 9:40Speaker 01

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

• 10:03Mike Carruthers?

  Well, you know, I have heard that, or something like that before, that, you know, if you looked at any of us with 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?

• 10:22Speaker 01

  Yeah, so what I always say to people is, you know, 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. 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. So what we have is... A sort of, we've got all these new types of technology that allow us look inside

• 11:03Speaker 01

  the healthy body in a way that we never have before, and we're detecting things that were always there, that we didn't know were there. 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. There was a study in Detroit of men, and they found that forty five percent of men in their fifties had prostate cancer at the time of death. Their deaths were for things other than prostate cancer, and that those, those numbers were substantially higher as men got older. So huge numbers of men have early cancer cells that never caused them, in their prostate, that never caused them health problems. We didn't know about them because we didn't have the means to look for them. So now that we're finding

• 11:47Speaker 01

  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. 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.

• 12:10Mike Carruthers?

  So that, I get that. That's really interesting. 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.

• 12:27Speaker 01

  Precisely. And, you know, a lot of countries don't do prostate screening because of the problems of overdiagnosis of prostate cancer. 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 ten to twenty men for prostate cancer who didn't need treatment, because these abnormal cells in the prostate are so common. 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? 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, when this sort of thing

• 13:09Speaker 01

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

• 13:16Mike Carruthers?

  So I get what you're saying about cancer, but what about something like heart disease where it's reversible in many cases, so it would seem the earlier you catch it, the less reversing you have to do, so why not catch it early?

• 13:29Speaker 01

  So a lot of focus at the moment with regard to something like heart disease is on identifying the risk factors that might put you at higher risk of heart disease going down the line. So for example, something like diabetes or something like hypertension. So over the years, you know, there's no point at which a blood sugar suddenly turns into diabetes. There's no right point. At some point, too much glucose in 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? Is it 130 over 80? Nobody knows. So what has been happening over the years, in order to reduce the risk of something

• 14:12Speaker 01

  like heart disease or strokes down the line, committees of specialists have been gradually changing the parameters required to be diagnosed with something like prediabetes or hypertension, with the idea that if you address these issues, you'll prevent heart disease at a later date. Now, this runs into the same difficulties as the early cancer diagnosis. If you adjust the parameters of blood pressure to identify more people as hypertensive, as happened not that very long ago, you can identify huge numbers of people as being potentially hypertensive and potentially at risk of heart disease or stroke. But actually, of those huge number

• 14:57Speaker 01

  of people, you will certainly be helping a percentage of them. Maybe 20% of them will genuinely be at risk of stroke. But you are inevitably going to be over treating maybe 80% of them who were never at risk because they didn't have other high risk factors. And similarly, if you identify lots of people with prediabetes, only a percentage of those people would actually develop diabetes if you didn't identify them. So you've always got this health economics going on where you're saying, I identify 100 people. Ten of them might benefit, but ninety 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.

• 15:41Speaker 01

  You've saved ten people and the other ninety 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.

• 15:51Mike Carruthers?

  We are discussing a very important change in healthcare, and my guest is 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." This episode is sponsored by Vinted. You know, I remember interviewing an organizing expert who offered this really clever trick for figuring out which clothes you should get rid of. You go to your closet and you look at the clothes hanging there. And chances are, the ones toward the middle are the clothes you wear most often. But the clothes pushed way over to the left or the right, some of those you probably haven't worn in years, and yet there they hang, taking up space.

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• 17:20Mike Carruthers?

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• 17:32Mike Carruthers?

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• 18:17Mike Carruthers?

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• 19:02Mike Carruthers?

  So go to shopbeam.com/sysk now. That's shopbeam.com/sysk. 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." And the underlying assumption there is, so you know what it is, what the diagnosis is, and therefore you can treat it. But then you also hear doctors say things like, "Well, we'll keep our eye on it." And I don't like that. That sounds very non-committal, very vague.

• 19:45Mike Carruthers?

  "I don't want to keep my eye on it, I want to fix it."

• 19:48Speaker 01

  Well, I mean, with regard to sort of if somebody notices a symptom and goes to the doctor, we do, you know, I'm certainly not advocating that they don't do that. The distinction I'm making is between us 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. If we work really hard to try and find loads of asymptomatic people at risk of problems, we overdiagnose. But obviously symptomatic disease is a completely different thing that does need to be taken more seriously. However, when it comes to things that come to a doctor and how one should approach that,

• 20:31Speaker 01

  very often the 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. 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. Because again, the problem is that scans and blood tests, they pick up irregularities all the time. You can be overdiagnosed very, very easily if a doctor sends you for a scan every time you go and see them.

• 21:09Mike Carruthers?

  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? But that seems to be impossible or close to impossible.

• 21:25Speaker 01

  Yeah, I mean, obviously, you know, finding progressive cancer early is the aim. But the difficulty is that 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. 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 It's often already spread and that can be a difficulty. So other cancers spread very slowly or grow or don't grow at all.

• 22:06Speaker 01

  And that's where overdiagnoses 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. 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.

• 22:29Mike Carruthers?

  Well, you just used the term progressive cancer. The only way you can tell if something is progressing is to look at it at least two points in time. You can't look at something once and say it's progressing. You don't know.

• 22:43Speaker 01

  Well, that's precisely the point 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 presents with symptoms is completely different. But let's say a cancer found on screening. You can actually consider a watchful waiting program for those cancers. 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 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?

• 23:25Speaker 01

  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 cancers are not all equal. A screened 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. 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.

• 24:03Mike Carruthers?

  But you just used the word frightening, but. 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, 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... It's an emotional knee-jerk reaction, but it's certainly understandable.

• 24:28Speaker 01

  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. 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. And I think probably, one of the issues there is we're calling all of these things cancers, but they're not necessar... That's not necessarily representative of what is being found. 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. Because the minute we kind of hear, "Oh, it's a cancer," well, you just want it out, and you'll be subjecting

• 25:13Speaker 01

  yourself to treatment which could be harmful in itself. 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, and perhaps to solve the problem of fear, we should give these screened abnormal cells a name that is less frightening than cancer.

• 25:30Mike Carruthers?

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

• 25:48Speaker 01

  No, obviously, you can't withhold those kind of findings, although, you know, I don't want to frighten your listeners in any way, 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 know, it's quite unusual. 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, and scans constantly

• 26:29Speaker 01

  show little white spots, and cysts, and things, you know, they are just incredibly common.

• 26:36Speaker 01

  And it's a doctor's job all the time to decide what is important and what is unimportant. 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, 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 of or not. 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. And there is an argument for some tests, not cancer per se, but some tests that, you

• 27:18Speaker 01

  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.

• 27:29Mike Carruthers?

  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, 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.

• 27:53Speaker 01

  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, etc. You know, a lot of medicine isn't an emergency situation and a lot of time a better diagnosis is made and the patient is better treated if you take a little bit of time to think. Most problems are not rapidly progressive and usually, you know, a patient working in concert with the doctor, with 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.

• 28:37Speaker 01

  Feeling a need to label things immediately to satisfy the patient isn't necessarily the best type of medicine and very often. 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. We don't know why people go through various transient symptoms. 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.

• 29:07Mike Carruthers?

  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. 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. And there's a link to her book at Amazon in the show notes. Dr. O'Sullivan, thank you for explaining all this, making it much clearer. Hiring the wrong person is expensive, but it's also exhausting because now you haven't solved your problem, you've created a new one. You've spent time interviewing and training

• 29:51Mike Carruthers?

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• 31:20Speaker 03

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• 31:50Mike Carruthers?

  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. 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? All these things are important because others are certainly making judgments about you based on how you speak. Here with some great advice on how to speak for maximum effectiveness is Michael Chad Hoeppner. He's coached presidential candidates, prominent CEOs, and Ivy League deans on their communication skills.

• 32:34Mike Carruthers?

  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.

• 32:43Speaker 02

  Thank you. It's great to be here.

• 32:45Mike Carruthers?

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

• 33:02Speaker 02

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

• 33:38Mike Carruthers?

  And so what is the biggest problem? Either the real problem or the perceived problem in the way people communicate?

• 33:47Speaker 02

  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. 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, they breathe in a more limited way, they use less vocal variety, they use less dynamic enunciation, all of those things. The problem with this is that what ends up happening

• 34:32Speaker 02

  is they don't look like more professional, or more dignified, or as though they're conveying more gravitas. No, they just look like a more limited version of themselves. Bored by their topic, perhaps. 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. More monotone voice, faster rate of speech, more stumbles, more ums and ahs and filler. But you can all, you can trace a lot of that back to that first initial adjustment of contracting.

• 35:10Mike Carruthers?

  And is that nerves? What causes that?

• 35:14Speaker 02

  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. 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. To speak is to move. We breathe in, our diaphragm moves down, our rib cage expands and moves out. And then we allow the air to flow over our vocal cords.

• 35:52Speaker 02

  Our mouth moves in this tremendously dynamic way to enunciate words. Speaking is moving. 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. 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.

• 36:21Mike Carruthers?

  Knowing this, what is it that people should be looking to do? What, like, when people present, have their big presentation that's coming up, are they preparing right and then just failing in the moment? Or would better preparation or different preparation have prevented the falling apart in the presentation?

• 36:43Speaker 02

  Yeah, you ask a really important question. 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. 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. 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. And it is exactly like it sounds. As opposed to grabbing the laptop or a pad of paper to begin, no, stand up, walk around the room,

• 37:28Speaker 02

  and ask yourself some big, open-ended prompt to get your ideas flowing, 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 gonna be bad. Fine, 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. Not only that, but it will sound more like how people actually use language in speaking. You will have come up with it, with a muscle memory experience of relaxation and release, as opposed to effort and tenseness.

• 38:13Speaker 02

  And you will already have started to loosely memorize what you wanna say. And it's almost instant. 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 gonna have to do anyway, which is speaking. 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?

• 38:44Mike Carruthers?

  Yeah.

• 38:45Speaker 02

  So, people try to correct problems, not just ineffective ways, but counterproductive ways. And I'll give you an example. 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. The first is, it's negative. The second is, it's general. And the third is, it's mental. So, the first, it's negative. What does that sound like? Don't talk too fast. 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."

• 39:29Speaker 02

  So it's negative. It doesn't work. It's the "don't think about a pink elephant" trick. Number two, then it's gonna get general. So what do they typically hear next? "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," there's a pretty good chance you can throw it out. "Just slow down." In each word? Between the words? Between the sections? 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,"

• 40:12Speaker 02

  or "remember to pause." 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. Speaking essentially is a sport. So we have to dramatically rethink how we try to help people improve at the sport of speaking.

• 40:36Mike Carruthers?

  And so how do you do that?

• 40:37Speaker 02

  By using kinesthetic tools to change bad habits and build good ones. So let's take the "speaking too quickly" example. As opposed to all that garbage of, you know, negative, general, and mental. Instead, and I'll demonstrate this now. You can probably even hear it in my voice if I go far enough with it. 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, 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.

• 41:23Speaker 02

  Until I have figured out which word I want to share. And I will often tell clients that 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, placing each and every single finger step on the desk or table, essentially walking their ideas across the table. 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.

• 42:07Speaker 02

  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. Because as opposed to "don't say um," 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. 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.

• 42:44Mike Carruthers?

  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 um and ah. You say what you 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?

• 43:10Speaker 02

  I would say both. You just said, "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. By the way, we have, I mean, as a species, we have done this many, many times. We've had whole cultures that are dedicated to rhetoric and elocution and things like that. 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, I'm a bad presenter, I'm a bad networker.

• 43:53Speaker 02

  No, it's stuff you can train at, just like an athlete. But to your second point, yeah, experience is crucial. 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. This is not like, I want to get better at coding, so I have to carve out time in my day to work on my coding. You could get better at speaking ordering a cup of coffee, talking to an operator on a customer service phone call. There are endless opportunities to practice this stuff throughout our days.

• 44:33Mike Carruthers?

  Well, but there's, 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. One of the reasons is I know I could do it over again if we had to, and edit it or whatever. But this is very easy for me. But if there were 20 people in this room watching me, that's a different story. 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

• 45:14Mike Carruthers?

  of people will hear this, that plays, doesn't play into my concern at all.

• 45:21Speaker 02

  Which is all the more reason that people should treat speaking like a sport. 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. Let's say that you know when you get nervous, you tend to speak in a more monotone voice. 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. By the way, monotone, we think of that solely as pertaining to pitch, meaning high and low. But monotone just means more uniform. So if you know about yourself when you get nervous that you speak more quickly,

• 46:06Speaker 02

  you never take any pauses, and your rate of speech is uniform with very little variation, that is monotone. So if you know this about yourself, then it's important to train the ability to use what I call the five Ps of vocal variety, and those five Ps are pace, pitch, pause, power, and placement. Pace is speed. Pitch is high and low. I just said that one before. Pause is silence. 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,

• 46:50Speaker 02

  more of a chest voice. Where is the sound placed in the body? We use these five Ps fluidly, fluently, to get our ideas across to each other. 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 Ps to communicate how you want to. 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. You practice speaking, but you don't get to use the benefit of sound.

• 47:33Speaker 02

  So imagine you're lip syncing, okay? Or you're on a television and someone has muted you. You're gonna speak just like you would. You're gonna mouth the words, move your hands, because they have a story to tell too. Allow your face to be as expressive as possible to try to communicate what you're saying, even though your listener has no sound. 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. 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 Ps of vocal variety.

• 48:18Speaker 02

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

• 48:26Mike Carruthers?

  Since it's the title of your book, let's talk about um, um and ah and those things, 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, more frequently than I think the people who said them know, think that they said them.

• 48:52Speaker 02

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

• 48:56Mike Carruthers?

  And why do we do that?

• 48:58Speaker 02

  There's a lot of fascinating research about this, and we should be very nuanced, because it's not as though I am the um police, or ums are sins. In fact, humans use ums for some interesting reasons, some that are pretty valid. As an example, if you really wanna get your voice into a conversation, but you have not yet figured out what it is precisely you wanna say, but darn it, you wanna claim that conversational moment. People sometimes use ums just to get their voice started and into a conversation. They sometimes similarly use them to demonstrate to somebody, "I'm not done talking yet, so don't interrupt me, because I'm still gonna keep making sound." By the way, these strategies don't always work, okay?

• 49:43Speaker 02

  But I'm simply saying that there are some reasons that people use ums. So I don't consider myself the um police because I'm not on a mission to eradicate ums. 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 how much more they do it when they're not at their best.

• 50:11Mike Carruthers?

  But for people who know they say um and ah a lot and would like to not do that, it's hard to know how do you stop it? How do you stop saying um and ah?

• 50:23Speaker 02

  I'll give you a fun example. 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, you would very likely not say any ums. Why? 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. Well, when you do that, you've unlocked your brain to do what it's really good at,

• 51:08Speaker 02

  which is make real time decisions between one word and another. But you've deeply, deeply enhanced your brain's concentration on that crucial activity of choosing words. 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.

• 51:32Mike Carruthers?

  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 and you've given some really good advice. Michael Chad Hoeppner has been my guest. He is author of the book, Don't Say Um: How to Communicate Effectively to Live a Better Life. There's a link to his book in the show notes. Michael, I appreciate you coming on.

• 51:59Speaker 02

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

• 52:04Mike Carruthers?

  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. 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. The two-button jacket should never have both buttons fastened. On a three-button jacket, the rule is simple: sometimes, always, and never. 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.

• 52:47Mike Carruthers?

  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. And with a double-breasted blazer, you can keep it buttoned when you sit down. And that is something you should know. 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 Micah Rutherford, thanks for listening today to Something You Should Know.