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Frames of Reference–What’s Yours?

by | Mar 4, 2015 | No Comments

Hi Everyone,

“Frame of Reference: A complex set of assumptions and attitudes we use to filter perceptions to create meaning.”

Every profession has a frame of reference. It’s the way we say and do things and the basic assumptions that make communication at work easier.

I didn’t know this at seventeen. 

At seventeen, I got my first waitressing job at the local New Jersey all-night diner. When my shift rotated to the dawn hours, the manager put me behind the take-out counter. Truck drivers, early morning commuters and those who’d been up all night flooded my station. 

“Give me a coffee. Extra sugar. Heavy on the cream.” Some said, grabbing, paying and leaving. 

The first hour was going well. Lots of quarters left on the counter. But then one of my customers peeled back the plastic lid and took a sip.

His head jerked and he shouted back over to me, “Hey! What’s the matter with you? I asked for a regular. This coffee’s black!” 

Of course it’s black. Regular old coffee. Black.

That morning, I got a lesson on coffee, Jersey style. 

Assumptions, Preferences and Frames of Reference

We all have our preferences. Me. I drink my coffee black. Like my dad. I thought that was regular. Regular coffee in a NewJersey diner? 1 cream, 2 sugars. And because I didn’t have another frame of reference, I made an assumption.

In health care we can take our frame of reference for granted. Beliefs, values and behaviors come naturally from our training and experience. And this frame of reference is validated repeatedly by our peers and processes. 

From the health professional frame of reference, assumptions about care are based on tens of thousands of patients, the ones that help us know what’s normal and what’s not. And that helps us move through our days with some level of ease. We don’t have to question every thing we do, every time we do it. 

But, health professionals and patients often have different frames of reference.

A person in our care operates from her personal frame of reference, one that comes from her beliefs about her body, health and from her experiences with healing.  

In other words, this person doesn’t operate from the knowledge of the ten thousand that you do. Her’s is a frame of reference of one. She’s only knows her body.

When a medical frame of reference bumps up against a patient’s frame of reference, we are at odds with one another.

Being at odds is uncomfortable. The shades of discord between you and the person you are working with may start out subtly, or come crashing in on you with someone’s anger.  Being at odds can be the first break in communication causing the patient to lose trust and you to feel frustrated.

What You Can Do 

Be curious. At the first hint of discord, confusion or frustration on either your part or the other person’s you are caring for, be curious. 

I find curiosity takes some of the charge out of my emotions; it means I don’t have to know everything, yet I can still be a scientist, an explorer learning about myself and another person. It’s a great way to get below the surface of my own assumptions and step into the other person’s frame of reference. 
It might take you an extra moment or two upfront, to ask a question or two but it will save you time later so you both don’t have to unravel upset, frustration, or anger.

I know that coffee is one thing, (although if you’ve ever been disappointed with a cuppa joe, you know it’s not nothing), but the important relationships we have with the people we are in service to, is everything.

Next time you’re feeling at odds, take a moment and wonder what’s the frame of reference, yours and theirs.

After that, your sincere curiosity can guide you to ask the questions needed for deeper understanding of the person in front of you, supported by your knowledge of the 10,000 others that came before.

Until next time and be well!


Jackie Levin


(206) 304-7703

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