Some clinical skills are difficult to teach at the university, and one of those is how to establish client-parent-clinician rapport, otherwise known as your “bedside manner.”

 This episode explores six ways therapists can show they really care. They are:

•  Read the room
• Mindful conversation
• Do your work
• Perspective taking
• Own your mistakes
• Stay mindful until the end

 As SLPs, communication is supposed to be our strong point, but these skills take time and experience to develop. Because these insights came from being on the patient side of things, they address real and valid blind spots we may fail to see in ourselves.

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Music: Simple Gifts performed by Ted Yoder, used with permission

Transcript

Welcome to The Speech Umbrella, the show that explores simple but powerful therapy techniques for optimal outcomes. I’m Denise Stratton, a pediatric speech language pathologist of 30 plus years. I’m closer to the end of my career than the beginning, and along the way, I’ve worked long and hard to become a better therapist. Join me as we explore the many topics that fall under our umbrellas as SLPs. I want to make your journey smoother. I found the best therapy comes from employing simple techniques with a generous helping of mindfulness.

Hi, welcome to episode 77 of The Speech Umbrella podcast. Here we are in 2023, and no doubt a lot of us are thinking about ways to improve in the coming year.

2022 was my year to visit lots of doctors, so I had a lot of opportunity to observe various ways that medical professionals interact with patients. I noticed a particularly stark contrast between two doctors I visited. I would call one visit the experience I want all my clients and parents to experience, and I would call the other visit one I hope nobody experiences at my clinic. Regardless of whether we consider ourselves medical professionals or educational professionals, whether we work in a school or a clinic setting, what I have to offer today can apply to all SLPs. I’m calling this episode My Doctors’ Lessons about Client Care. The question I’m answering today is, how can I make my client’s and parents experience the best and communicate that I care?

First, I’m going to tell you about my experiences, then I will cover six suggestions for improving client care. Those suggestions are: reading the room, conversation, do your work, perspective taking, owning your mistakes, and staying mindful to the end. Now, I’ll go into detail about those after I tell you about my experiences.

Here’s a little background. About eight years ago, I had a torn retina in my right eye that was surgically repaired. Now the tear was mended, but I was left with some distortion in my visual field, and I don’t notice it when I’m using both eyes, but when I close my left eye, my good eye, things look really wonky. Faces look like something Picasso painted, everything’s a little crooked, and I hate, hate, hate closing my left eye. I get a swoopy feeling in my stomach whenever I do it. So you can imagine eye exams are not my favorite thing to do. They make me really aware of how dependent I am on my left eye continuing to function normally, and I’m already very, very near-sighted.

Early in 2022, I was at my regular eye checkup and my ophthalmologist discovered high pressure in my eyes. This is called ocular hypertension, and it can be a sign of glaucoma or it can put one at risk for glaucoma, so he referred me to a specialist. Now, the specialist didn’t think I had glaucoma, but the pressure in my eyes still needed to come down because that can damage the optic nerve over time.

So this entailed several visits to their office over the next several months. This is how it always went at this doctor’s office. When I first went in, I would see someone first, an intern, I think, who would do what I would call intake with me and run me through some eye tests before I saw the specialist.

Now I told you how much I hate eye exams, so I was already on edge whenever I arrived at the doctor’s office, and these interns would start in with this small talk that would make me super uncomfortable. I call it my Severus Snape moment. Just as Snape knew he should be nice to Harry, I knew I should be nice to these interns. After all, I was once a naive intern myself, but just as Snape was irritable and on edge with Harry, I was irritable. I was on edge, and my answers to their small talk attempts would leak outta my mouth with my lips hardly moving just like Severus Snape. In my mind I was thinking, can’t you see? I don’t want to chit-chat. Let’s just get on with it. Let’s just get this over with. And the small talk always ended oddly enough with asking me why I was there. Okay. This also drove me crazy. I was there four times in seven months, and I’m thinking, uh, didn’t you read my chart? Don’t you know why I’m here? Then they would ask me the name of the medication I was taking, the eyedrops which they had prescribed, which was so many syllables long, it took me several months to commit it to memory, to which I had to respond, I don’t remember the name of the medication I’m taking, okay? I always received professional competent care there, but something was lacking. I don’t doubt their desire to be sincere. Actually, it was rather painfully obvious how hard the interns tried to establish patient rapport with me, but it just didn’t take with me. Some essential ingredient was lacking in their attempts to be sincere.

It was hard to put my finger on it for a long time, but now I believe it was a lack of picking up on my subtle nonverbal cues, what we call reading the room. So you see people without autism can also experience social blindness. After seven months of monitoring my eye pressure, the medication wasn’t doing what they wanted, so the doctor referred me to a glaucoma specialist just as a precaution. Then he left the exam room after telling me this, and I was just feeling rather stunned. When he came back, he poked his head back in the room and cheerfully offered to do my cataract surgery when I needed it, because with a retinal repair such as I had a cataract in the future is a given, and then he left again.

At that point, a storm of emotions broke over me. I thought my case is being escalated. I thought they feel relieved to pass me along, and those are their parting words? Now, while I was appreciative of the fact that the doctor knew he needed to refer me on, my feeling was ‘I am not coming back to this place.’

I’m normally a very calm person and I take most things in stride, but I was a little rattled after this. I went to Hobby Lobby in a daze, walked around, spent a lot of money on a ridiculous amount of pumpkins until I felt I could manage my emotions. And then I had to ask myself, am I like that? Do I ever give off the pretended sincerity vibe, unintentionally?

Now I’m not done with my story yet. Let’s fast forward to the new glaucoma specialist. There was an entirely different atmosphere in the office, I had a much better experience. Now, that office also had a person doing intake with me. Again, probably an intern, but when he asked me the usual, getting to know you questions, I had no trouble answering them. And again, it was hard to figure out what the difference was exactly, cause I was still really on edge when I arrived. The best I can get at is the sincerity was so real, you could almost touch it. It just felt so different. I met with two specialists who just made me feel so relaxed and comfortable. Both doctors that I met took the time to get to know me.

They took the time to establish a personal connection with me to find connections that we both shared. And with every test they did, they explained everything thoroughly. They explained why they thought I had ocular hypertension, which no one had ever been able to explain to me before, and they also explained why they thought my condition was not something to be really concerned about, but just to monitor, and I just felt so relieved after that visit. It was such a different experience. I know my condition is far less severe than what they usually deal with, but all the same. I never felt silly for being so anxious, they were so able to put me atease. At the conclusion of the visit, which was extremely reassuring as far as my long-term prognosis is, by the way, the doctor asked if I had any questions at all.

I had a very small question pass through my mind, but I thought, oh, this is so insignificant, and I decided not to ask. But this physician is so good that he stopped and said, I know you have a question. I saw it in your face. Wow. Just wow. Talk about picking up on subtle nonverbal cues. This man is now my hero and my role model.

This is how I want to be with my clients and the parents of my clients. To that end, I’ve been pondering how to improve in 2023, and this is what I’ve come up with. So number one, read the room. And I know we commonly use that term for picking up on subtle nonverbal cues for a whole room full of people, but I love this term and I’m using it for even if you’re just reading the subtle non-verbal cues for one person or two people that you’re dealing with, so take a moment to be mindful of the emotions present when you first meet them, and number two, when we engage in conversation, let your room read be your guide. Let that guide your conversation so that you can talk mindfully. We all engage in small talk, so we don’t just jump into the big issues, but I think if we let what we have picked up on their emotions guide our conversation, then we’re talking mindfully instead of mindlessly.

And I always try to remember that ‘how are you’ is a loaded question cuz that person may be feeling kind of a mess when they first come in. They may be very anxious about their child. Saying I’m so glad to meet you, or I’ll be asking you some questions to help me figure out this situation might be received better.

Number three, do your work. If you have parents fill out a case history beforehand, read it and remember the key things from it. Now, sometimes parents hand it to me when they first arrive, and in those cases I’ll say, I’m gonna take a moment to look at this and I know what sections to scan quickly for vital information, for themes I need to be aware of, to understand where they’re coming from and how they’re feeling.

Also, review your intake notes from prior conversations you’ve had. That way you can avoid asking them to repeat things that they’ve already communicated. You can always ask them to elaborate of course. In a school situation, doing your work is really mandated by law, but unfortunately still gets ignored sometimes.

We’re supposed to discuss the student’s present performance with parents before the IEP meeting, so we can include that in their input on the IEP and we’re supposed to consider their perspective as we set new goals. And I know from what parents tell me, this doesn’t always happen. Even though they are part of the IEP team. To me, this is the equivalent of when people ask me why I was at the doctor’s office and I thought that they should know, why are you asking me that? It was if they didn’t know or didn’t bother to look it up. I think if parents aren’t consulted before the IEP meeting, it’s like you didn’t bother to contact them about their child.

Number four, perspective taking. Remember that we see a huge range of communication impairments, and disorders that seem mild or moderate to us don’t necessarily feel that way to parents. And you may have a different, and perhaps an even more accurate perspective on their child’s outcome, but remember that their emotions are still valid. If you need to refer to another SLP, don’t do it with a feeling of relief like, oh, I didn’t know how to fix that, I’m glad I am sending them onto someone else, because that’s going to come across as feeling glad to be done with them. Instead, I think it’s better to try and convey your gratitude that you know someone who can serve them better and your gratitude that they chose you in the first place.

Number five, fess up to your mistakes. So, for example, if you’ve been listening to this podcast for a while, you’ll heard several stories about my client that I call David, and I first met him when he was a preschooler and I was working in a school setting and one evening his mother came to parent teacher conferences. I was rushing around trying to collect signatures from certain parents, and so when she saw me in the hall, I wasn’t expecting to see her, and she started talking about David without mentioning his name, and I drew a total blank.

I absolutely could not remember whose parent she was. It was so embarrassing, but I had to fess up and ask before we got in too deep. And just last fall after some major surgery, I returned to work. I walked into my waiting room and got the shock of my life as I realized I could not remember the name of the client who was waiting for me.

He was new. I’d only seen him once before, just before my surgery. I had forgotten to add his name to my schedule and there was nothing for it, but to fess up and apologize. I think his mother had some reservations about me for a while, but after his lisp was corrected, she brought in another child for therapy, so no permanent harm was done.

And number six, stay mindful till the end. Keep reading the room as you talk. Watch for questions and emotions that flash across their faces. And another way to say this is be willing to stay in the moment until the parent or client leaves you, which is exactly what my physician did with me when he saw that question flash across my face.

I know this takes mental discipline. It seems simple, but it’s deceptively simple. But when you master being in the moment till the very end, some of those complexities of client, parent, clinician interactions are going to take care of themselves.

Well, there you have it, six suggestions for improved client care. Just to go over them one more time. Remember, read the room, let reading the room guide your conversation so it’s mindful and not mindless. Do your work. See the situation from their perspective. Own your mistakes and stay mindful till the end. I’ve decided in 2023 I’m going to focus on reading the room or being in the moment better with the parents of my clients. I’ve worked on this for a long time with clients, but I haven’t been so mindful of doing it with the parents of my clients. And so that’s my goal for 2023. What’s your goal for 2023? I’d love to hear it. Who knows? That could be the topic for another podcast. You can comment on this podcast or you can send me an email at denise the speech umbrella.com. Thanks for listening, and I’ll talk to you next time.

Thanks for listening to The Speech Umbrella. We invite you to sign up for the free resource library at thespeechumbrella.com. You’ll get access to some of Denise’s best tracking tools, mindfulness activities, and other great resources to take your therapy to the next level. All this is for free at thespeechumbrella.com. If you’ve enjoyed this podcast, subscribe and please leave us a review on Apple Podcasts and other podcast directories.