The Rule of Association

 
by John V. Guiliana, DPM, MS
Hackettstown, New Jersey

In the last two editions of New Docs on the Block, you laid down the first two building blocks of the bridge to patient trust and credibility. Hopefully you are already diligently practicing your listening skills, and you are speaking more decisively when addressing patients. It’s now time for the next building block…The Rule of Association.

The Rule of Association

People have a much easier time accepting what is familiar to them. Recall that in the previous edition of New Docs on the Block, I suggested that you write out scripts for your discussions of the most common foot conditions.  In the design of these scripts, be sure to craft your language to be one that is recognizable to the patient. Accurately associate some rather unfamiliar podiatric treatments to ones that are more familiar throughout society.

In the following dialog with a patient needing an orthotic, the “doctor” misses the association whereas the “caregiver” hits the mark. The words in parenthesis are NOT spoken. They are intended to serve as an example of the subliminally associated thought (and possible inaccuracy) that may exist in the mind of the patient during the discussion.   

Doctor: “I think that you need an orthotic for your heel spur. They will help support your feet properly (arch support?). They are made by casting (broken bone?) your feet.” 

Caregiver:  In order to help resolve your pain, it’s essential that I get you into an orthotic. Orthotics are removable inserts made by an impression (like dentures-laboratory made- and of intrinsic value) of your feet. They help control the mechanical weakness in your feet, much like eye glasses control weakness of the eyes (like eye glasses, OTC devices are not appropriate in all cases).

Noticeably absent in this later dialog are the words “arch” and “support”. If the patient merely needs an arch support, dispense one. If they need an orthotic, use language that does not confuse them.  

The caregiver relates mechanical weakness of the foot to that of the eyes-and orthotics to eye glasses. The caregiver takes “impressions” not “casts”. Both serve as excellent examples of the Rule of Association. People understand these terms and the terms transfer value.

Aside from the association, medical jargon should be kept to a minimum. Patients with a bunion are rarely ever interested in hearing about subtalar joint pronation leading to an unlocking of the midtarsal joint and failure of the peroneus longus to maintain the alignment of the first ray! Keep things simple, understandable, and relatable.
Certain words evoke a negative emotional response. These words should be avoided and substituted with more palatable words. Some examples are:     

Try to avoid:                                   Instead consider:

Cut                                                             Incise
Break                                                         Surgically fracture
Support (for orthotic presentation)            Control
Pain                                                            Discomfort
Needle                                                        Injection
Tourniquet                                                 Pneumatic cuff
Spend                                                         Invest
Cheap                                                         Inexpensive/ cost effective
Deformity                                                  Condition/ misalignment, etc

Additionally, there are certain "trigger" words that cause people to become more difficult and noncompliant, especially in emotionally charged situations. They should be avoided.

These include:

Instead of the words "have to" which are very controlling type words, why not try "are you willing to…" or just a straight - "Will you…."

“Can't”, can be replaced with - "I'm unable to because…."

"I'll try," which is indecisive, can be replaced with something more honest and decisive - "This is what I can do" or "This is what I'm unable to do"

"But" is a word that contradicts what was said before it. Replace it with "and" or "however" (which is a softer way of saying 'but')

"Sorry" is often a word to avoid because it is so overused in society that it has literally lost its value. Think of the number of times you've complained or commented about something and you hear - "Sorry 'bout that."

If you're going to use the "sorry" word then you need to use it as part of a whole sentence - "I'm sorry you are still having pain, Mary”.  Sometimes it's appropriate and professional to use the word 'apologize' instead of 'sorry.' "I apologize for not getting you that information sooner."

If you wish to avoid blame, you might want to consider replacing the word “sorry” with the word “regret”.

You now have three building blocks in place for the construction of your bridge to patient trust and credibility. Start practicing. Next up…The Rule of Contrast.

 

Dr. Guiliana is a nationally recognized speaker and author on topics pertaining to medical practice management. He holds a Master’s in Health Care Management and is a Fellow and Trustee of the American Academy of Podiatric Practice Management. He practices in Hackettstown, New Jersey and can be reached at John@soshms.com