I once had a supervisor, in an attempt to help me polish my beside manner, provide me with the example of a high school counselor. She asked me to imagine my own high school counselor. Then, she asked me if I would feel compelled to open up to that counselor if I did not like her (no!).
Unfortunately for me, my supervisor was not just interested in soliciting my opinion on high-school staff members. In her example, I happened to be the unapproachable counselor that high-school students avoided at all costs (say what?!).
She explained: “If you don’t like someone, you’re probably not going to want to share stuff with them, right?”
Being the lousy high-school counselor was not a role I had any desire to play. In fact, my entire life, I had prided myself on being highly personable.
I was, and am, the obnoxious type of person that makes best friends with the grocery store clerk in a twelve second time span over our love for grapefruit. I stop and talk to the neighbors. I exchange life experiences with my Uber drivers. I genuinely like people!
So, how could this be? If I felt I was innately personable, then why was I receiving constructive criticism on my bedside manner?
My supervisor had to be misunderstanding the situation, right?
My supervisors comparison was not without reason. I had skipped over a critical aspect of the initial evaluation. I neglected to establish rapport.
As a student, I feared my execution of an assessment would be riddled with “rookie” mistakes. That I’d expose myself for the novice I was. Because of this, I hyper-focused on accurately administering the assessment and obtaining relevant data.
I worried I’d forget to complete an important step during the evaluation process, or that I’d accidentally veer off from a diagnostic script. I was concerned I wouldn’t remember to ask an important question necessary to yield clinically significant information.
My fears guiding me, I entered the patients room, ready to implement what I’d been taught with precision. I then proceeded to evaluate the patient with precision and thoroughness, but also with robotic-like fidelity of implementation.
In my robotic execution, I had removed myself from the fact that my patient was a human being, and therefore, desired to be treated as such.
My evaluation process allowed me only to know the deficits my patient presented with. I didn’t really know my patient, as a person, at all. Not knowing the patient as a person meant that I couldn’t know how his deficits would impede his daily life. I didn’t know what he wanted to gain from therapy.
How could I write a plan of care without knowing what we would be working to achieve?
Moreover, my lack of bedside manner undermined my ability to recruit buy-in from the patient. This was highly problematic because I needed my patient to want to work with me and see value in therapy in order to maximize treatment benefit.
My supervisor taught me many things over the period of time I was fortunate to have her guidance, but the importance of establishing rapport is one of the greatest lessons she bestowed upon me.
Establishing rapport begins the minute you step into a patients room. It is your presence; this includes the professionalism, compassion, and positivity you communicate both verbally and non-verbally. It is asking the right questions, in the right way, in order to better understand the patient and their individual needs, desires, and preferences.
The process of establishing rapport is fluid. You are challenged to modify your behavior, objectives, and presentation style as you continue to gather information and gain insight into what is important to the patient. What worked for one patient will often not work for another. Good treatment is evidence-based, but great treatment is evidence-based and individualized. Only after understanding the patients unique story are you able to progress with developing the treatment plan.