Beyond the Data Building a relationship with a patient is just as important as tracking data and outcomes. From My Perspective
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From My Perspective  |   November 01, 2016
Beyond the Data
Author Notes
  • Ellen I. Hamby, PhD, CCC-SLP, is associate professor in the Department of Audiology and Speech Pathology in the University of Tennessee Health Science Center’s College of Health Professions. She specializes in the evaluation and treatment of adult neurogenic communication disorders. ehamby@uthsc.edu
    Ellen I. Hamby, PhD, CCC-SLP, is associate professor in the Department of Audiology and Speech Pathology in the University of Tennessee Health Science Center’s College of Health Professions. She specializes in the evaluation and treatment of adult neurogenic communication disorders. ehamby@uthsc.edu×
Article Information
Development / Speech, Voice & Prosodic Disorders / Dysarthria / Special Populations / Professional Issues & Training / Normal Language Processing / Attention, Memory & Executive Functions / Traumatic Brain Injury / From My Perspective
From My Perspective   |   November 01, 2016
Beyond the Data
The ASHA Leader, November 2016, Vol. 21, 4-5. doi:10.1044/leader.FMP.21112016.4
The ASHA Leader, November 2016, Vol. 21, 4-5. doi:10.1044/leader.FMP.21112016.4
He should not have survived. The fact that he did is nothing short of a miracle. He was left for dead in an alleyway, having sustained a severe gunshot wound to his head at point-blank range. He was only 22 at the time, proud of his service in the military, proud of his new infant son, and excited about all the experiences yet to come.
But in an instant, a bullet changed all that forever.
Meet Chris, a young man I’ve come to know, respect, admire and, yes, love over the past several years. He has had a profound effect on my view of the importance of relationships in the clinical setting as we direct and accompany our patients on their journeys through recovery.
I’ve been a speech-language pathologist for more than 40 years. During my career, I’ve observed various trends come and go as the treatment pendulum swings from one extreme to the other on a particular subject. One patient-care trend has been particularly concerning to me—the shift in emphasis from relating personally to our patients to collecting data about them.
With the current focus on goal setting, documentation, functional outcomes and productivity (not that those aren’t important!), it’s often easy to forget the importance of building a relationship, of getting to know our patients as unique individuals and allowing them to teach us how to best serve them. Chris renewed and restored my passion for the relational aspect of our profession as I was beginning to drown in the data. While I have been his clinician, he has been my teacher.
With Chris, I gave myself permission to go beyond collecting data to getting to know the person inside.

With the current focus on goal setting, documentation, functional outcomes and, it’s often easy to forget the importance of building a relationship, of getting to know our patients as unique individuals and allowing them to teach us how to best serve them.

Chris’ story
Chris’ severe and extensive gunshot wound involved most of his left hemisphere, parts of his right hemisphere, and subcortical and brain stem structures as well. As you might expect, he presented with significant physical, communication and cognitive impairments as a result of this injury.
Physically, Chris exhibited right hemiplegia, left hemiparesis and left facial paralysis. His communication was characterized by moderately severe word-retrieval and memory problems, as well as by a severe flaccid dysarthria. Cognitively, Chris had delayed responses to most stimuli due to slowed processing time and to his numerous absence seizures. However, he appeared to have functionally adequate comprehension, and his responses were typically relevant to the topic at hand.
From this profile, we established functional, relevant treatment goals. However, to optimally serve Chris and others like him, we need to go beyond the data and engage our patients relationally. We need to remember that our profession is an art as well as a science—that it’s about communication and not just data points, because data points neither tell the whole story nor always reflect the most important aspects of a patient’s progress.
Trust-building tips
If Chris hadn’t trusted and respected me, and vice versa, meaningful interaction between us would have been impossible. Some very simple, practical strategies helped foster this trust and respect.
Treat a patient as you would any other person their age. Chris did not need to be reminded that he was different; he lives with that every moment. He needed to be reminded of ways in which he’s just a normal guy, ways in which he’s similar to you and me. Interacting with Chris at eye level is a simple example. Because he couldn’t stand up to speak with me at my eye level, I needed to sit down to speak with him at his eye level. This common courtesy conveyed my respect for Chris and enabled him to feel valued and validated.

Chris did not need to be reminded that he was different. He needed to be reminded of ways in which he’s just a normal guy.

Talk normally. Similarly, Chris taught me the importance of using adult-level language, discussing adult-level topics, and allowing him to reveal his personality. I learned to focus on entering his world, instead of forcing him to enter mine. As a veteran, Chris had many experiences that were totally foreign to me. As he shared stories and pictures of his military service, drawing Chris out communicatively became far more valuable than my data collection. And, as he sensed my interest in him (and not just in his disabilities), his communication skills increased dramatically.
As another example, Chris intentionally caught me off guard one day by asking permission to tell a dirty joke. I did not want to squelch his spontaneity, but neither did I want to encourage him in anything that might be inappropriate. I told him to go ahead with his joke but indicated that I would stop him if it seemed to be in poor taste. “A big white horse stepped into a deep mud puddle,” he said. As I waited for the rest of the joke, not quite getting it, Chris burst into laughter. He knew that he had fooled me by telling a joke that was not dirty in the sense that we typically expect from patients with traumatic brain injury, but dirty in the literal sense. In a strictly data-driven session, I would have missed a huge belly laugh, and Chris would have missed an opportunity to interact at a normal adult conversational level.
Allow processing time. When I observed Chris carefully and got to know him better, I could easily tell when his processing was productive and when he needed some assistance. I also discovered that interrupting him during his active processing time communicated that I was either impatient with him or uncomfortable with the silence. Neither message fosters relationships. Together we developed a system in which he simply asked for help when he needed it.
Relinquish the lead. Chris can’t go where he wants to go, bathe or dress himself on his own, prepare his own meals, make his own bed, or do myriad other things that most of us take for granted. How must that feel to him? But there are so many things that he can do, particularly in the cognitive and communication realm. I let him lead in those areas: what he chooses to talk about, what he wants to work on (reading, writing, talking, etc.), when he’s ready to quit or to keep going. I learned not to force him to do or to talk about things that he chose not to merely for the sake of my data. I let my relationship with him take priority over the data.
Be honest. Chris is well aware of what he has lost and is only beginning to realize what he may never again have. I don’t need to minimize that loss. I don’t need to overlook his sadness because it is uncomfortable for me. And I don’t need to offer hope for what may never be possible for him.
Instead of platitudes and superficial encouragement, I learned how to offer genuine empathy. I learned to be willing to accompany him to those hard places to which he might sometimes take me. I learned to be upbeat—but authentic and genuine. And in interacting with Chris in this manner, in allowing myself to go beyond the data, both he and I achieved goals perhaps more significant than those reflected as percentages on my data sheet.
1 Comment
November 10, 2016
Sarah Szanton
Appreciation
Thanks, Ellen, for this lovely reminder that our humanity is ultimately more important that our number-crunching skills. When our clients reveal their vulnerabilities to us, we should feel grateful for the opportunity to be there for them. I appreciated your examples and your tips.
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November 2016
Volume 21, Issue 11