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I’m Theresa Richard. I’ve been a medical speech pathologist for 15+ years, I’m a Board Certified Specialist in Swallowing and Swallowing Disorders, and I’m incredibly passionate about evidence-based practice and equally considering patient preferences with clinical experience and research.

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The Bedside Eval or Bedside Manners — Which is More Important?

by | Jul 11, 2018 | Blog

This will all sound totally cliche but #whatevs but when I dove head first into this pool of blogging and podcasting I really had no idea that there were all of these really, really cool people out there. But not just really cool people, like people that have the same visions for their careers and outcomes for their patients that I desire. I say the more the merrier!

The more SLPs we have advocating for evidence-based practice, the better outcomes we will get for our patients, which in turn helps to move the needle of our profession forward. And as much as I totally dig all of the evidence we have in swallowing land, my eyes have opened up so much more to those 2 other legs of the stool – clinical expertise and patient outcomes.

Now, just like my friend Ed Bice likes to say — just because I say clinical expertise – that doesn’t give you a license to do crappy, outdated therapy for 40 years and call it a day.. no sir! You are ethically bound to keep up with the latest research, but some things just can not be taught in the classroom — and I think we do a major disservice to our profession just by not knowing how to communicate effectively, appropriately, and professionally with our patients.

Now, thank you instagram for introducing me to this gem of a clinician, Stephen Groner. Not only does he have the COOLEST Instagram page (@heardtohealed) — ok I think his wife is a graphic designer but that’s besides the point, anyone can put lipstick on a pig and make social media magic happen, but it’s not this kid’s graphics that are most beautiful, it’s his words. I LOVE WORDS!

What makes his words so beautiful? The fact that he is 100% dedicated to patient-centered therapy. He treats every single patient as if they were… a person! I’m totally okay with saying that we have to look at every patient as an n of 1, as an individual research project, but I say that WITH a grain of salt, because I’m begging all of us not to forget the human aspect of our therapy, that we are actually working with a person! A real live human being with feelings and (gasp) rights! (If you haven’t listened to this episode of the Swallow Your Pride podcast with Nannette Crawford, I recommend that you do.)

Not sure where to even start or how to even break the ice with your patient? Read this post!

You see, the Patient Self-Determination Act went in to effect in 1990 (28 FLIPPING YEARS AGO) and some clinicians still have never heard of it. We are writing “orders,” and “putting” people on diets, and “restricting” liquids, and “modifying” diets, all without our very own patient’s input — doesn’t that sound horrible when I put it that way?

We’re petrified to call a family member or have a professional dialogue with a physician, but that is such an important part of what we do. Knowing the patient’s wishes, or presenting options to allow the *patient* to make an informed decision, makes *ALL* the difference in the world in our plan of care. We all have advanced degrees in communication disorders yet we’re so scared to have an open dialogue and “let” the patient do what they want, because it might conflict with everything we’ve been told would kill them.

Now I KNOW there is a time and a place for all of those strategies, believe me I make those recommendations myself, but I really want to dedicate 2018 to putting the “patient” back in to PATIENT-centered care, and really, really, truly try to imagine if this were your husband or wife or mom or dad or brother or sister going through this experience.

In the famous words of the amazing Dr. Paula Leslie – We have to worship the dog not the larynx!

But for real, I want to challenge all #MedSLPNewbies (come join our Facebook group!) and #MedSLPOldiesbutGoodies to step out of their comfort zone and get comfortable having these discussions with your patients, their families, and your colleagues.

Not sure where to even start or how to even break the ice with your patient?

That’s where my new instagram friend Stephen comes in – he totally gets it. In fact, he “gets it” so freaking much that he wrote a book about it. And not only did he write a book about it, his book includes references about bedside manner and patient outcomes. Like real life research about bedside manner! How gnarly is that?

And since he’s one of the coolest kids since sliced bread, he is sharing a sneak peak of his new book here with all of you. If you totally love what he has to say below, he is giving away the first chapter for free, and then if you totally love Stephen’s work even more, you can check out purchasing the rest of his book here. (And no – all of you nosey Nancy’s – I have ZERO financial stake in his book, I just totally dig Stephen’s work because I think this is a huge missing, critical piece in our profession.)

So let’s dive in to chapter 1 of Stephen’s book, “Bedside Manners for the Healthcare Pro,”

1. Get on the same eye level.

Many things elevate us over our patients: the scrubs, the white coats, the flashy badges. And perhaps for good reason: we’re extremely knowledgeable, capable, and, in the end, responsible for their well-being. But it never feels good to be the one who feels small.

That’s why one of the simplest ways to level the playing field is to get on the same eye level as your patient. If they’re in bed or sitting down, grab a seat next to them so you can talk to them face to face.

Just yesterday, I was talking with an elderly patient of mine who’d been a nurse for thirty-something years and had lived alone with her two black labs until last week. Now she was crying in the hallway in her wheelchair as she realized her nephew had dropped her off here, gotten rid of her dogs, and that this was her new normal. I knelt down and put my arm around her. She looked at me and then to the left, where photos of the entire rehabilitation team hung. She pointed at them and said, “I guess you all can be my family now. ”Cue the waterworks. “We so will be,” I said.

Research backs this tip up. Kelli Swayden, RN and Dr. Paul Arnold found in 2011 in their randomized controlled trial that 95% of patients really liked their doctor if he or she sat down with them as they talked, compared to only 61% of patients whose doctor stood and talked over them instead4. That’s a 56% increase in satisfaction just for sitting down.

Those researchers also found that patients thought their doctors had spent 37% more time with them when they sat down, although doctors spent the same amount of time with patients in both conditions, meaning there’s no time cost to this little trick.

2. Ask them what they’d like to be called.

I don’t know about you, but I really open up to my close friends. I tell them what I’m really thinking and how I’m really feeling. I can also tell you none of them call me Mr. Groner. Would you like to be called Mr. or Mrs. Your-Last-Name by everyone that came to see you in the hospital? I sure wouldn’t. While I get it’s respectful to use a formal title, I think it’s even more respectful to ask, at the start, “What would you like me to call you?” or “What do you like to go by?” And then just always use that.

Dr. Parsons, Dr. Hughes, and Dr. Friedman found in 2016 that only 1% of patients actually want healthcare providers to call them by their last names5. Only one out of a hundred!

I once had a patient who came to us for short term rehab after a fall at home, but she eventually transferred to long term care because her dementia had gotten too bad for her family to take care of her anymore. Everyone called her Mrs. Knabb*, from the nurses, to the doctors, to the therapists. And boy, she was a handful. She’d constantly ask you what was going on even if you told her 10 times and she always rolled her wheelchair backwards down the hall and crashed into things, from wet floor signs, to linen carts, to other patients. A lot of us seemed to get overwhelmed by her.

One day, the daughter of another patient came to visit and stopped me while I was talking in the hallway with Mrs. Knabb. “I know her through my older sister! They used to be friends. Everyone calls her Lillian.” Lillian. It was her middle name.

At the sound of it, Mrs. Knabb looked straight up into her eyes and said, “Well hello! How are you? I’m stuck here for some care and I’m looking for my son,” the most clearly and lucidly I’d ever heard her speak. It was like night and day.

Ever since then, I’ve called her by her name, Lillian, and our conversations have been so much easier. Who knew it could be such a good way to get through to people?

*name changed for privacy

3. Forecast what’s coming up and narrate what you’re doing so patients don’t have to guess.

As I made my way through the confusing maze of parking garages, elevators, and check-in desks to try to make my 7:15 am GI appointment before a full day of classes, my stomach was tying itself harder and harder into knots. I had zero food in me and the signs were about as easy to read as hieroglyphics. My throat was throbbing. When I found the clinic, I sat for a few minutes in the waiting room full of magazines I never read. Once called back by the nurse, I caught her up on my story and tried not to miss anything. Then vitals and some more questions. The whole time, I was scouring the exam room for the drawer or cabinet that invariably held the shot they were going to give me (a hold-over from childhood, I think). All I knew was I was in a new place, had gotten lost finding it, and I was about to have a ten-minute conversation with a doctor that would decide if I lived the next few months in pain or not.

That’s why forecasting and narrating can be so life-giving. It drains the strain from our patients minds. Orienting patients to the progression of the session you’re envisioning at the start, and then, as you go on, narrating what you’re doing while you do it, takes away all the mental guesswork.

For example, after I ask them if I can come in and what they like to be called, I might say, “First, I’d like to hear about what got you here, then I want to do an assessment to see what’s what, and then we can make a plan together about where to go from there.”

Then, a little into the session, if I find myself growing silent and staring intently at my computer screen, leaving my patient out of my thought process, I might narrate, “I’m looking at the scan they had done of your head to see if the radiologist found anything I should know about.”

In fact, Dr. Wendy Levinson at the University of Toronto and her colleagues found in 1997 that doctors who had never been sued made 30% more of these kinds of orienting comments than doctors who had been sued, for a medium effect size of .537. Let patients in on what you’re thinking and they’ll let you in too.

Thanks *SOOOO* much Stephen for sharing this invaluable info with us! If you guys are all diggin’ his work, click below to download the rest of chapter 1 for *FREE* or to purchase the entire book

If this entire post is completely greek to you, or if you would just like some additional support while trying to stay afloat on dysphagia island, please consider joining us for the Medical SLP Collective. We provide brand new weekly resources in the form of handouts and videos, a panel of experts to answer ALL of your Medical SLP questions (anonymously, and not limited to dysphagia) and monthly webinars for ASHA CEUs.

Click Below to get Chapter 1 from “Bedside Manners”:

If you thoroughly enjoyed this sneak peek of Stephen’s new book, you can purchase the rest of it here: