Taking myself out of the equation
am I over-complicating things?
I’m going to talk about sailing and boats for a minute. Stay with me.
Sometimes my patients just want to go for a nice little sailing trip around the bay for an afternoon. But instead, I gift them with a two-week cruise on Ultra Supreme Radiance of the Seas - a behemoth cruise ship with 24-hour entertainment, dinning, and activities. Why wouldn’t they want this amazing gift I’m offering?!? Isn’t it incredible?!? It’s so much better than an afternoon on a rinky-dink little sailboat in the harbor.
If all the patient wanted was an afternoon on a 20-foot catamaran - why am I trying to convince them they need this two-week cruise?
Don’t make it harder than it has to be, Leigh Ann
I want to talk about values and perspective for a hot minute and then segue into communication and maybe even touch on AAC. It’s going to be a wild ride…. so…. hold on to something.
I might place more value on the two-week cruise because I’d get to travel and stop at ports and have unlimited buffets and all that stuff the cruise ships do. From my perspective, that looks like the better experience because I’m getting SO MUCH MORE. But my patient places more value in the experience of sailing and can’t get that with the two-week cruise extravaganza. From my patient’s perspective, the 20-foot catamaran would be the better experience based on their values. In all honesty, me too. #teamcatamaran
Now, I’m sure you’re thinking… what does a catamaran and a cruise ship have to do with patient-centered care, communication, and eventually… AAC?
By listening to our patients - by learning their values and perspective - we can tailor therapy to fit them. If they want to sail around the bay - don’t force them to go on a cruise. Even if we have the tools, experience, and skills to make that the most magical two-week cruise of their life. They don’t want it. Let’s find out what the patient wants from therapy and work to give them that. And just that.
Let’s take a look at Communication/AAC & patient value mismatches
Working with adults and AAC after a stroke can be really rewarding or really hard or really…. meh. I’ve had experiences all over the place. In one instance, I really felt like using high-tech AAC would unlock all kinds of doors for a certain patient - but they were having none of it. I thought I was doing a really poor job of “selling it” to the patient to convince them that using AAC wouldn’t replace their speech, but assist it. Turns out, the problem wasn’t my “sales pitch,” but rather my inability to recognize and execute the patient’s wishes. I did a bad job of recognizing the patient’s values and perspective. I was only focused on mine. I thought I was right and they were missing out.
In another example, I can think of a patient that was set up with a very lovely high-tech AAC device. A lot of labor went into personalizing it, and the patient was capable of navigating it to supplement their language expression. But they rarely used it. I wasn’t there for the AAC evaluation or implementation. I’m sure the therapist evaluated multiple styles of AAC and felt that this one was the best fit. And I want to be clear that this is not a judgement on that therapist in any way. I am simply using this example as a thought piece. I wonder if the reason this patient didn’t use the AAC device is that it didn’t fully match with their values and perspective on expressive communication.
stop being so “helpful” Leigh Ann
I have fallen into this trap MULTIPLE times (and I probably will again in the future). When I learn a new tool, or I see the potential of a resource (like an AAC device), I want every patient I have to benefit from it. My trials examine if the patient can utilize it or not. Is it a functional fit or not? I don’t really examine whether or not the patient wants it. Or values it. Or would even like it. Let’s apply the sailing/cruise analogy to communication and AAC. So, I’ve given them an unwanted two-week cruise across the Mediterranean, and it turns out they don’t even have an interest in cruises.
Who could resist this? Turn out… loads of people.
The concept that I’ve had to wrestle with is learning to deliver what my patient needs AND wants. I could potentially set them up with a sweet AAC device that would rock their socks. But instead, they want to devote therapy to verbal expression - even if it means only being successful with “the basics” - greetings and physiological needs (hungry/thirsty, hot/cold, pain, happy/sad, etc.).
The patient could have the potential of communicating abstract ideas - wishes, dreams, desires, future plans, and more with an AAC device. And that’s what I want for them… I want them to have everything!!! Yet, the patient has different values… different perspective… and they are coming to me to meet their communication need.
It’s a slow process… but I’m learning to take me out of the equation. To listen to the patient and learn their values. Then work to meet those with the tools I have.
In closing, I’d like to state for the record…. I have a lot more to learn about effectively implementing low-tech and high-tech AAC. And even if a patient expresses ambivalence about AAC, I will still gently trial different avenues, because they might be operating under a misconception about AAC.
Providing patient-centered care is a tight-rope walk. I’m still figuring that out too. I’m trying to balance my clinical knowledge and experience with the patient’s values. To ensure I’m balancing the patient’s values with my clinical knowledge and experience, it is crucial to apply the principles of health literacy. I feel very strongly that our responsibility is providing opportunities for patients to make educated decisions on their plan of care. To do that, they need facts.
And this is where I spiral out into a discussion on health literacy and SLPs! That’s a whole ‘nother post for ‘nother day.
you may like listening to…
Podcast episodes focused on integrating patient-centered care and EBP into clinical practice in:
Voice therapy
Cognitive therapy
Aphasia therapy
Parkinson’s therapy
Goal writing
Using PROMs - patient reported outcome measures
you may like reading…
Resources illustrating modifications of EBP to fit pt’s ability levels, wants, and needs.
One resource I used to learn how to implement EBP into my practice was Medbridge. After learning about the WHAT and WHY in the presentation, I was able to watch the presenter demonstrate the HOW with real patients. I wasn’t just learning about a new technique, I was learning how to implement it. For me, that was key.
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As a Medbridge Affiliate, I am pleased to offer a promo code for a great discount on a year’s subscription. I find Medbridge has high quality instruction, paired with engaging visuals (another thing I like about Medbridge). As an affiliate, I will earn a commission that goes to support the Speech Uncensored Podcast and bring you free resources on this site.
CHECK OUT THE SPEECH UNCENSORED PODCAST
Covering all topics on the medical SLP scope of practice. Available for ASHA CEUs. Playing across all major podcast platforms (Apple Podcasts, Google Podcasts, Stitcher, Spotify, etc.). New episodes weekly.
