Before I write anything else, I want to share that I had a fabulous vacation and I returned invigorated and ready for the next few months - I am delighted to be back blogging again!

My meetings with clients stimulate many of my thoughts for writing and the first meeting of today set off a chain of ideas around a question my client asked, which was "What is the conversation that is NEEDED here to clear the air, or move us forward?"

As entrepreneurs, we are faced with the need to have many critical conversations (Susan Scott calls them Fierce Conversations in her book of the same name). Scott defines a "fierce conversation" as "one in which we come out from behind ourselves into the conversation and make it real".

In order to succeed in business, you set and then accomplish goals. Since "no man is an island", this entails interacting with others. And interacting with others invariably involves conversations, many of which are"critical".

Critical conversations convey your vision for business or practice, communicate your values and standards, clarify ideas and concepts, and correct misunderstandings. These conversations  have the greatest impact when you are genuine - you come out from behind yourself and show up in all your authenticity.

Here are some of the critical conversations a skilled entrepreneurial physician should consider having:

With yourself. This is often the most difficult kind of conversation to have as it is drowned out by the mental chatter of what Buddhists call our "monkey minds". I'm sure you're familiar with this kind - the incessant "ping-ponging" debate or argument we have with ourselves involving the call of duty, guilt, desire, ambition, need, anxiety, wish and fear.

The critical question to be answered here is "What do I really, truly want out of my professional and personal life?"

With your spouse, significant other, and family. Unless you're unencumbered by any family responsibility, it is likely that you'll need to have critical conversations with others in your life who might be impacted by your business decisions. How do you balance your personal and professional needs with those of the important people in your life? 

An early question might be "What kind of support can I expect if I follow my dream of becoming an entrepreneur?" And a corresponding question to expect from the other person or people is " How will your decision impact OUR lives and what changes must we anticipate?"  

It will pay to be truthful (once you have had that critical conversation with yourself!) - and if you encounter resistance, you can turn to negotiation as your strategy to reach a successful outcome.

With your associates or partners. Whether you intend to become more entrepreneurial within your existing practice or part ways to start your own venture, you're likely to have to engage in critical conversations. One client of mine is in such a position -- an enormous challenge as she is accustomed to being thought of as the "junior partner" who keeps her mouth shut and sucks it up. The resulting stress and resentment are sufficient to cause her to want to leave and go into practice on her own. She is ready to engage in critical conversations with her partners.

With your friends and colleagues. These can be tricky conversations as you are likely seeking constructive feedback for your ideas. Instead, you may get dire warnings, hostility, envy, or apathy. In this situation, you will need to hold your ground (remind yourself of those critical conversations you had with yourself), thank the listener politely and seek more thoughtful support.

With potential customers or patients. Much of the frustration I hear expressed by physicians when talking about their patients or by entrepreneurs when discussing their customers stems from a lack of clarity about what they want from each other. I saw the movie "Knocked Up" yesterday, and cracked up at the scene involving the last-minute obstetrician and the laboring patient. Those of you who've seen the movie will undoubtedly know what I am referring to. Several critical conversations took place during those tense and funny moments and I cannot imagine a physician who has not wanted, at least once, to tell a patient just what was on his or her mind!

With employees. What are you tolerating from employees that is annoying, or showing you or your business or practice in a poor light? And if you do not yet have employees, what are the critical conversations you will need to have during your hiring process to make sure you get the best and most committed talent for the job?

Learn how to provide the most effective feedback you can to your employees, and even the people you are considering hiring. You will become known for the quality of your critical converations and you will be handsomely rewarded for your effort, in loyalty, thoroughness and satisfied patients or customers.

These are just some of the many critical conversations that you will need to handle as an entrepreneur. Do you have any other to share that have been important to your success?