From Conflict to Collaboration: How to win friends and influence patients

A 78-year-old gentleman, Alex, with a history of COPD, heart failure, and a recent stroke, was admitted to the hospital following a fall at home. His case presented a complex web of medical, physical, and emotional challenges.

On initial evaluation, Alex exhibited several issues:

• Swallowing difficulties: A clinical swallow evaluation revealed significant dysphagia with signs of aspiration risk.

• Respiratory compromise: His COPD exacerbated his breathing, making him reliant on supplemental oxygen via nasal cannula.

• Mobility limitations: The stroke had left him with right-sided weakness, impacting his ability to move and perform daily activities.

• Emotional distress: Mr. Evans was anxious, frustrated, and withdrawn. He expressed feelings of hopelessness and a reluctance to participate in therapy.

Thank goodness he had an interdisciplinary team dedicated to his care, including an attending physician, nursing team, respiratory therapists, physical therapist, occupational therapist, social worker, certified nurse's aide (CNA), and an SLP. That's a lot of hands cooking in the same kitchen. At one point, the physician neglected to follow the SLP's diet recommendation for pureed food and thickened liquids and instead continued a regular diet. Further, the CNA fed Robert the regular tray and was rushing because she didn't receive any help that morning after another CNA called out, and Alex had a choking event and required the Heimlich to dislodge a large piece of meat successfully. This was too close a call, and so the team came together to try and pave a path forward to ensure this never happens again.

Dale Carnegie’s Timeless Lessons

In healthcare, where compassion meets complexity, success isn't solely measured in clinical skills. There's more to a swallow evaluation than knowing the cranial nerves and observing for signs and symptoms of aspiration. Medical SLPs navigate a web of interactions daily with patients, families, and a myriad of medical disciplines. How do we ensure these interactions are effective and positive and contribute to the best possible patient outcomes? We use the timeless insights from a timeless author, Dale Carnegie. 

I've read Carnegie's book "How to Win Friends and Influence People" three times now, and its simple yet profound messages never cease to resonate with me. The best part is that they can be directly applied to our work as medical speech pathologists, and I'll illustrate how…

The Power of Connection

Three out of every four mistakes are due to poor communication and teamwork. That’s a tough statistic to swallow. But it also comes with some good news. It suggests that we can significantly reduce the vast majority of mistakes in healthcare by simply enhancing the way our teams communicate and collaborate. 

With so many disciplines working alongside us, succeeding in this profession by ourselves is impossible. Even if we wanted to ignore everyone else and try to be the lone hero, we'd only be able to understand and manage a tiny sliver of the whole pie. Not utilizing our interdisciplinary team is like trying to surf on the sand and ignoring the ocean's waves. The tidal wave of teamwork is there, just waiting to be tapped into. But the sea can be scary, and you're bound to drown if you don't learn to surf the waves.

The interdisciplinary team only takes us halfway. We still need two other hugely important elements: Patient cooperation and family support. You can bring a horse to water, but you can't make him drink. Similarly, you can run all the fancy tests, utilize the most innovative medical technologies, and write the most pristine documentation recording your recommendations, but if the patient doesn't follow it and the family doesn't understand it, it's just very expensive words on a page. And this happens more than you might think.

Half of patients don't follow recommended medical interventions. Yes, you read that correctly. Half. All that testing, treatment, and follow-through, and you can essentially flush half of it down the toilet. Why? Because we aren't connecting with the patient and their family in a way that resonates with them. 

Carnegie emphasizes that success comes from "the ability to express ideas, to assume leadership, and to arouse enthusiasm among people." And he's right. Clinical expertise will fall flat if we can't communicate effectively, build rapport, and inspire patient confidence. Below are some ways that we can do just that.

Creating Positive Interactions

• "Leave everyone you meet feeling slightly better than they were before." This is a powerful guiding principle. In healthcare, patients and families often face anxiety, fear, and uncertainty. A kind word, a reassuring smile, or a moment of genuine connection can make a significant difference. What might this mean in a practical sense? This connection may inspire them to listen to you when describing your discharge recommendations to improve their safety and function long after they leave your facility.

• "Become genuinely interested in other people." Tap into people's natural desires. What motivates our patients? What are their goals and aspirations? Understanding their "eager want," we can tailor our interventions and communication more effectively. A patient with a craving for a steak won't give a hoot about your goal for ground meats. What's their goal? If you could stick a note to their dry-erase board that excites your patient to wake up in the morning and think about it throughout the day, what would that be? That's what you should be working toward.

• "Remember that a person's name is to that person the sweetest and most important sound in any language.": In a busy healthcare environment, it's easy to see patients as just another case or colleagues as just another person you need to work with for a few minutes here and there. However, remembering a patient's name, background, family, and interests demonstrates respect and builds trust. "Names are the sweetest sound for the person carrying them."

• "Treat people not for who they are but for the person they can become." This speaks to the heart of rehabilitation. We see patients at their most vulnerable but also envision their potential. By believing in them and encouraging their progress, we can help them achieve their wildest goals.

Building Collaboration and Avoiding Conflict

• "Get the other person saying ‘yes, yes’ immediately." In interdisciplinary team meetings, finding common ground and building consensus from the beginning is crucial. If you don't know where you're destination is, it won't matter how fast you can go– You'll just be getting lost at a more rapid pace. By focusing on shared goals (such as getting a patient home safely) and seeking early agreement on exactly what we're striving towards, we can direct our team and resources in the right direction, rather than bumping up against each other because we haven't discussed that goal. 

• "Cater to people's good nature." Most people want to do the right thing (even if they sometimes strive for the opposite). We can encourage cooperation and positive change by appealing to their sense of fairness, responsibility, and compassion. For example, suppose your physician diminishes the importance of your recommendation for an instrumental swallowing evaluation to figure out what's best for your patient. In that case, you can say, "You always do right by your patients and I know this time is no different. I'm curious, do you think this test will somehow lead them astray? I want to understand where you're coming from." 

• "If you are wrong, admit it quickly and emphatically." See being wrong as an opportunity to shine. In healthcare, we are constantly learning. Unfortunately, denying mistakes and wrongdoing has become standard practice to avoid malpractice lawsuits. This denial can create a vicious cycle. By sweeping errors under the rug, we can never give them the light they need to examine, learn from, and incorporate their lessons for the next patient. We need to view our errors as an opportunity to bring the team together and improve the quality of our care.

• "Don't criticize, condemn or complain." “Any fool can criticize, and most fools do.” Criticizing will never accomplish your goal. It will only make people defensive and dig in their heels. In healthcare, this translates to focusing on solutions rather than blame. Carnegie tells a story about a pilot flying a plane that crashed because his copilot forgot to put gas in the tank. Instead of reaming him out as most would have, he allowed him to rise to the occasion and put him in charge of ensuring the plane was refueled every morning. The copilot never let him down after that. 

Back to Alex

Instead of sweeping the mistake under the rug, the interdisciplinary team held a meeting to acknowledge it immediately and discuss the issue. The team even included Alex and his daughter in the meeting. "Our goal is to make things better," the attending physician said. "Not worse." There was no finger-pointing, but instead, there was a genuine curiosity about how this happened and a concerned interest in improving it, so it never happens to Alex or anyone else. The SLP explained her diet recommendation but ensured all team members were on the same page. Turns out, the patient wasn't. The team took a genuine interest in what Alex's goals were. Alex wanted a regular diet and was sick and tired of the pureed food. The team did an excellent job of seeing Alex not in terms of his limitations, but in terms of his potential. This paradigm shift led to an in-depth discussion about risks and benefits, and eventually, a comprehensive, individualized plan to get Alex as close to a regular diet as possible, using compensatory strategies, exercises, and safety precautions. At the end of the meeting, everyone agreed with the plan and ensured we were all moving in the same direction toward achieving Alex's primary goal: a regular diet.

Conclusion

Dale Carnegie's principles offer a powerful framework for enhancing our interactions in the medical world. By focusing on genuine interest, appreciation, and understanding, we can cultivate stronger relationships, foster collaboration, and ultimately provide more effective and compassionate care. 

Liked this? Subscribe below for articles just like this one.