Amidst the hustle and bustle of the hospital, the reasons to make the extra effort to begin a conversation with your patient are abundant and vitally important.
Joel M. Brown II, MSM-MHA, RRT, FAARC, CEO and founder of Arrived Leadership, LLC, in Dagsboro, DE, and Andrew Klein, MS, RRT, RRT-ACCS, RRT-NPS, AE-C, manager of respiratory care at the University of Chicago Medicine in Chicago, IL, make the case that taking the time to really talk to your patients (and the family members at their bedside) can make a big difference in their treatment and recovery.
“Our conversations with our patients are not just to help time pass as we provide therapies — they provide additional information to ensure that we identify gaps in their care,” said Brown. “Our interaction with them can also calm the anxiety enhanced by hospitalization.”
He believes it’s especially important for therapists to take a few moments during routine care to learn more about issues the patient may face at home. Of course, you may not learn everything you need to know to help the patient in one visit. Still, during simple conversations, you can address topics like living conditions, family medical history, access to primary care, pharmacy services, and transportation.
“Many of us have taken care of patients that return to the ED frequently for a COPD exacerbation,” noted Brown as an example. “Simply discussing their access to a local pharmacy near their home could unlock what had led to difficulties with medication compliance and minimize the impact of the social determinants of health.”
Klein says some of the most impactful moments he has experienced as an RT have come from taking extra time to explain to patients and families what is going on with their care and why they are receiving the treatments they are receiving.
“If families ask questions that I don’t have an answer for, I seek out those answers so they can stay informed,” he said. “It is amazing how much patients and families appreciate a small effort on their behalf, and I can promise you it makes a difference in their experience during a stressful time.”
He says he has witnessed too many clinicians during his time in the profession who simply focus on the task and keep any communication to essentials only. That’s a mistake, in his view, and the clinician misses out as much as the patient.
“I believe a little extra time focused on authentic communication can create a very different dynamic between patient and caregiver— and both sides have a much better experience,” emphasized Klein.
Breaking the ice
How can you get the conversation started? Both Brown and Klein say it’s really pretty easy.
“I try to engage them in a comfortable way, sometimes by commenting on what they are watching on TV or reading,” said Klein. “Other times, I just ask about their therapy and if anyone has explained their medications or disease process with them.”
Brown advises therapists to approach a conversation with their patients just like they would approach a conversation with anyone else.
“After a formal introduction and documenting your initial assessment, pause and sincerely ask an open-ended question,” he said. “One of my favorites is, ‘Other than being in the hospital, how are you?’”
A question like that opens the door, and all you have to do is pick up on whatever the patient says next and run with it.
“Think of conversations as a moment of improv,” he said. “Don’t force your agenda but take what the patient offers and add to the discussion.” Then, the next time you see the patient, you can pick up where you left off, and the conversation will naturally evolve.
Of course, at times your attempts to start a conversation may be rebuffed. Brown emphasizes the importance of knowing when to call it quits.
“Be respectful and courteous at all times, and don’t take it personally if they are not up for conversation at the moment,” he said. “You can try again the next time you are in the room.”
Klein has found that once the ice is broken, patients are usually willing to keep up their end of the conversation, but if they aren’t, he doesn’t sweat it.
“Some patients and families are not in the mood for conversation, and that is perfectly fine,” he said. “My goal is to provide a comfortable environment for them either way. So if they want to chat about a baseball game on TV or a good book, we can. If not, that’s okay too.”
Say no to toxic topics, yes to cultural awareness
A good book, the baseball game, favorite foods, hobbies, and children (especially grandchildren) are all good conversation starters.
What shouldn’t you talk about? Brown advises therapists to steer clear of polarizing subjects like politics, gossip, and anything negative about the hospital or other clinicians involved in the patient’s care — even if the patient initiates the discussion.
“These topics can be toxic and be perceived as unprofessional,” he emphasized. “The key is to remain personable and professional throughout the interaction.”
In other words, stay positive and supportive.
Klein agrees some topics are best left untouched.
“When patients try to engage me in these conversations, I try to keep my comments very generic and let them talk, and when I see an opportunity to subtlety steer the conversation in a different direction, I take it,” he said.
It’s also important when chatting with patients to remain aware of any cultural differences that may exist between you and the patient. Klein says, to him, it comes down to understanding and respecting the beliefs and practices of others that may differ from his own.
“It is important to build an environment that respects the individual and minimizes the stress that can come from being removed from their comfort zone,” he said.
Cultural awareness can also help the RT face their own implicit biases and consider how overcoming them can reduce the cultural barriers that might otherwise spring up between themselves and their patients.
“When it comes to engaging with our patients, cultural awareness is the ability to remain curious and non-judgmental of cultural differences while being willing to learn,” said Brown. “Statements like, ‘I want to be respectful to your needs. Is there anything I need to know to improve your stay?’ can start the conversation off in the right direction.”
The key to closing cultural gaps, he continues, is to be humble and refrain from making assumptions as you respectfully ask questions to get the conversation going.
“Let the patient tell you their cultural needs and preferences instead of you telling them,” he said.
Mind, body, and soul
Conversations with patients are a great way to become more than just another person who comes into the room to do something to the patient stuck in the bed. They allow you to learn more about that patient and become a true advocate for their needs — not just during the hospital stay but when they go home and continue their recovery.
“The difference between good and exceptional care is knowing your patient’s preferences and potential barriers,” said Joel Brown. “Health is not one-dimensional. The mind, body, and soul are equally important. A culturally sensitive bedside manner and conversation can positively impact all three.”
Andrew Klein believes conversations underlie any good advocate’s ability to make an impact.
“Taking the time to get to know a little about them creates trust,” he said. “If they trust they can share their thoughts and concerns with us, perhaps we can use that information to create a care plan that works best for them.”
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