Using improv techniques in a health care setting, Bonus: "Signposting"
In this series “extra,” trainer Shana Merlin describes how to use “signposting” techniques in your face-to-face conversations helps patients and colleagues more clearly understand your meaning and overall messaging.
This episode is a companion piece to episode 3, Improving patient communications.
Also available on Apple and Spotify. A transcript of this podcast is found below.
Additional episodes in this series:
Episode 1: Fundamentals of medical improv
Episode 2: Dealing with difficult patients
Episode 3: Improving patient communications
Episode 4: Interprofessional medical communications
Transcript:
Tony Passalacqua:
Shana, you were just talking a lot about the curse of knowledge and how sometimes we can use like these different acronyms or words that maybe individuals do not understand. Are there any tips and tricks that you have that we can actually make these conversations easier to understand for those patients?
Shana Merlin:
Yeah, so doctor's visits, um, nurse visits are getting shorter and there's more and more information to communicate and more misinformation to, uh, deal with. So, it's, it's a really big challenge to communicate effectively in the time that we have. So, one of the things we can do for ourselves, and our patients is to really, um, organize the conversation and communicate the structure of the conversation.
So that's using a technique called signposting. So, we did that first with our building a shared agenda. That gives a sense of where, where this conversation is going to flow, the overall, uh, flow of the conversation. And then signposting as you move through each place in the conversation so that someone can follow you.
Uh, sometimes we use signposting by having slide decks when we're presenting. Signposts are something when you're walking on a trail, right? That gives you a sign of what's happening next and what's to come.
So, that signposting might be something if we're talking about the beginning of a conversation. I might say, you know, “Hi, I'm Dr. Shana and I'm going to be your internal medicine doctor today.” So, giving a signpost of who I am, what I am, “I'm going to be taking care of you today,” or “I'm going to... what my role is here and what your role is here.” So that can be a nice introduction today. We're going to, we're going to talk about this. I'm going to help you.
Your job is to answer my questions and, um, and help us we’re going to make decisions together. So that can be a nice, some introductory signposting options. Um, because a lot of people assume, you know, who this person is and what, what this appointment's about and what's going to happen, but sometimes, you don't.
And you, you have to think about it from the patient's point of view. They're talking to somebody at the front desk. Somebody's bringing them back and doing some things. Some other person comes in and does some other measurements. The doc, some other person comes in and then they talk to another person.
They don't know who a lot of any of these people are necessarily. So, making that clear what your role is, whether it's, “I'm the medical assistant and I'm going to be taking your blood pressure and your pulse and getting some measurements so that I can share that with the doctor, and they can give their assessment.”
That's a great thing to do, to not just know your name, but what, what your role is. You can also give that sequencing. So, after you introduce yourself, give me a sense of first, we're going to get your vitals and those kinds of things. Second, we're going to talk about what issues you are brought here. Third, we're going to come up with a plan of how to help you get feeling better. Okay. And fourth, you're going to get this all in your health care portal at the end, right?
So, it gives a map of where this conversation is so I can lead you a step at a time. And that way, we can kind of have this like first, next, finally, give a sense of where you are in the conversation.
That also can really help you stick to the time you have allotted. When people know we're in the beginning, we're in the middle, we're in the end, it gives them a sense of, okay, this is time to open up. This is time to wrap up. A lot of times when you're talking quickly and you've given a lot of information, you want to use signposting to emphasize a point.
So, one of the best ways, and we're going to talk about this in a second, um, to emphasize a point is to…
Stephanie Downing:
Repeat it?
Shana Merlin:
Pause. (Laughs.) Repeating it is important too. Yeah. Pausing though is like underlining. It gives that sense of like, okay, pay attention. Here it comes. Um, but you also might use the signposting. Say, “The important thing to remember is…blank.” “The thing you're going to want to listen for is blank, right?” So, pay attention because this is, this is the important part. And giving those clues about what's important is really, is really important. (Laughs) You're giving a lot of information, and we want to kind of highlight, underline, the things we want that person to remember.
And then, as we wrap things up, we want to use those signposting words to help give a sense of closure. “Before we end, I want to talk about,” or “Today we talked about, let me recap that.” Signposting is like being a GPS. It's guiding them a step at a time along the journey so they know where they are in the conversation and can follow along the whole time. Uh, “Before I end, what questions do you have?” Right? Be a good combo.