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4 Negotiating Tips From “Never Split the Difference”


We regularly negotiate with patients en route to shared decision making. Tips from Voss' book "Never Split the Difference" can improve your communications with patients.

Chris Voss’ book, “Never Split the Difference: Negotiating As If Your Life Depended On It,” is fantastic and now my favorite book on negotiation. Before reading this, I had a fondness for the 1981 classic “Getting to Yes: Negotiating Agreement Without Giving In,” but Voss’ book is more practical, explaining that we are always in negotiations.



Voss’ book can be incredibly useful for healthcare professionals. We regularly negotiate with patients en route to shared decision making. Examples include: (i) doses and durations of medications / therapies, (ii) whether to order testing and which one is most appropriate, (iii) whether and when to admit or discharge the patient from the hospital, and (iv) timing of follow-up—just to name a few that I encounter in a typical week. The book offers insights into how to support patients and suggests communication strategies that allows one to better understand the other’s perspective.



Here are four tips that resonated with me:


1. Be empathetic.

People are naturally defensive and opposed to change until they feel that they’re heard. Explicitly show your patients that you understand what they’re saying and how they’re feeling—it’s recommended that this be done with statements that begin, “it seems like you’re really concerned about . . .” or “it sounds like . . . is really important to you.”

This approach is great because if you’re wrong, your patient will offer clarification and keep things moving forward. These phrases may get them to share more of where they’re coming from and give clues for how to move them towards change.



2. Ask for empathy in return.

After building rapport by being empathetic, you can ask your patient to return the favor. Voss recommends beginning with, “how am I supposed to . . . ?”

Patients understand that healthcare professionals are most comfortable doing things a certain way and that there are guidelines or best practices that we try to follow.

For example, you could say something like, “I’m here to serve you and it’s ultimately your decision how we proceed, but how am I supposed to help you with the burning and tingling in your feet when you’re still drinking Coke™ and not taking the medication for diabetes every day?”



3. During negotiation, it’s okay to disagree but don’t be disagreeable.

It’s important to try to lessen negative feelings (such as fear, anger, or distrust). Voss suggests doing so by naming them. For example, “it seems like you’re scared.”

As a corollary, he notes the value of amplifying positive emotions. If people feel comfortable and trusting when negotiating, they’ll be more open-minded and make smarter decisions.



4. Use these three communication strategies during negotiations to get the other to open up and to share their priorities:

The first is “mirroring,” which involves repeating the last one to three words the other person said.

So, if the patient says, “I don’t think the test is a good idea.”

You say, “not a good idea?” and then you stay silent.


The second involves asking “calibrated” open-ended questions that begin with what or how.

An example might be, “what about this plan works for you?”

These questions never begin with “can,” “is,” or “do,” as these usually result in stunted yes or no answers.


The third approach is to ensure that at some point you get the other person to say “no.” Voss suggests that subconsciously it makes the other person feel like they are in control of the negotiation.

An example of such a question to a patient who is emphatic about have frequent screening tests and procedures might be, “do you want me to check your PSA every six months?”




This book is fabulous. Voss’ ideas are grounded in his experience in hostage negotiations for the FBI; if applied thoughtfully, the approaches can help healthcare professionals in their efforts to care for patients, as well as in their other relationships, both at and away from work.