Engaging Challenging Patients and Clients – Wood Did It Best

“I’m here because of Mr. Wood. For the first time, I felt like someone listened to me, treated me with respect and like a human being.” Jose said this to Danie at the front desk, when he arrived for his first follow up visit with Wood.

In a previous article entitled, On Engaging Challenging Patients and Clients, Wood’s Example, I explained how the beginning of Jose’s first visit with Wood was very challenging, how Wood used the principles of engagement with Jose, and how Jose, at the end of the visit told Wood, “I’ll come here to see you. You know why? It’s because you treated me like a human being.”  In that article, I described two key principles that Wood used.  And in this current one, I will describe three additional principles.

1. Wood met him where he was at:

“You want to just finish your 6 months and get out of here. This is great. Let us do this together. I can see how important this is for you. Now, what needs to happen in order for you to reach this goal?” reflected Wood, in response to Jose’s statement, “All I want is just to finish my 6 months, get out here, and go to work and do my life.”

Meeting our patients and clients where they are involves listening with the third ear, paying attention to both verbal and non-verbal cues and attending to immediate needs or concerns.  Jose’s concern was to “just finish my 6 months, get out here…” Wood used the principle of meeting him where he was at, as part of his engagement efforts.

2. Wood focused on the moment:

Focusing on the moment starts with meeting our patients and clients where they are at, but then it goes beyond that.  It entails joining in, mirroring, and following their lead.  “Jose, you seem to be into your phone a lot. What’s going on?” asked Wood, with the goal to join in so that he could understand what was of that much interest to Jose.

“Oh, it is nothing. Even if I tell you, you won’t be interested. You’ll think I’m crazy,” responded Jose while smiling.  This was the first time he smiled, a sign that engagement was starting.  Wood, continuing to focus on the moment, followed Jose’s affect, directing his attention to his smile, building some form of positive reinforcement, as I explained in the first article of this series.

3. Wood showed instead of telling:

Show-don’t-tell is one key principle to master, if you are to be a great clinician.  Show-don’t-tell is a key strategy to harness when trying to de-escalate, and can be a powerful tool when trying to engage, establish trust, and lay the groundwork for a strong therapeutic relationship.

As illustrated in the first article, Wood, for the first time during his visit with Jose, stepped away from behind his desk, took his chair, put it next to Jose’s chair, positioned himself at his level and said nothing.

“I am with you,” “I understand you,” and “I see where you are coming from,” are words that may need to be said sometimes, but they are far more powerful when demonstrated not only verbalized.  Making eye contact instead of burying one’s face in one’s computer, placing the tissue box a bit closer and remaining silent, instead of trying to console, when eyes start to well up with tears, or like Wood did with Jose, stepping from behind the desk and placing his chair near Jose when previous efforts of engagement may have failed are all good examples of show-don’t-tell.

“I’m here because of Mr. Wood. For the first time, I felt like someone listened to me, treated me with respect and like a human being.”  Jose said this to Danie at the front desk, when he arrived for his first follow up visit with Wood.

These were neither easy words for Jose to articulate nor easy accolades for Wood to receive.  These were the result of perseverant, dedicated, committed, and sincere efforts of engagement and illustrate how there is always a way to engage even our most challenging patients and clients, even when everything else has failed.

References:

1. Street RL Jr, Gordon H, Haidet P. Physicians’ communication and perceptions of patients: Is it how they look, how they talk, or is it just the doctor? Soc Sci Med. 2007;65(3):586-98.
2. Frampton S, Patrick AC. Putting patients first: Best practices in patient-centered care, 2nd edition. San Francisco: Jossey-Bass Publishers; 2008.
3. Partnering with patient and families to enhance safety and quality: A mini toolkit. Bethesda, MD: Institute for Patient- and Family-Centered Care; 2013.
4. Carman KL, Dardess P, Maurer M, Sofaer S, Adams K, Bechtel C, et al. Patient and family engagement: A framework for understanding the elements and developing interventions and policies. Health Aff. 2013;32(2):223-31.