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Speech in the Schools

Learning from Clinical Mistakes

Published August 8, 2016 4:15 PM by Teresa Roberts
I hate making clinical mistakes. They make me feel bad about my skills and myself. Mistakes may often be based on lack of information, which affects the development of a relationship. Sometimes the desire to make a difference as quickly as possible negatively affects the collection of comprehensive background information and prolonged rapport-building activities. Often mistakes can come from not knowing our clients as well as we should.

Lack of information can be in any area:
•    Client history
•    Client temperament, personality, and interaction styles
•    Child preferences and interests
•    Client communication and learning strengths
•    Family understanding of communication disorders
•    Family grief stages and fears
•    Family expectations
•    Teacher concerns
•    Classroom curriculum and objectives
•    Peer interactions and behavioral concerns
•    Etc.

A lack of information combined with the false pride of “expertness” is a dangerous combination. We may know about communication disorders and be highly trained in providing intervention, but that doesn’t mean that we automatically know about the needs of every single client.

Gathering information takes time. Mistakes are often based on rushing to act before learning as much as you can about a client.

When I make mistakes, I move through stages:
•    Discomfort: Something about that session or interaction didn’t feel right.
•    Confusion: What made it feel off?
•    Shame: I can’t believe that I didn't do a good job.
•    Anger: Why is this so hard!
•    Self-righteousness: I’m a skilled professional. What I do is important.
•    Reflection: There are lots of different ways to accomplish a goal.
•    Awareness and understanding: I know how I could have made it better.
•    Remorse: I wish that I could go back in time and do it over.
•    Learning and planning: I will design systems and strategies to prevent this from happening again.
•    Apologies and amends: I will let the client and the client’s family know that I am sorry and provide suggestions about what might work better in the future.

Whether we are new clinicians or have many years of experience, we may still need basic systems and procedures to make sure that we aren’t skipping steps and starting with only limited information. We can create our own checklists, reminders, routines, forms, etc., that require us to slow the process and proceed methodically.

Rapport comes from knowing and understanding our clients and their needs. Although we may be able to intuit a great deal of information based on our clinical experience, we can also incorrectly assume that we know more than we do. Taking time to learn about our clients lets us create a therapy plan that matches who they are. I still make mistakes sometimes, though fortunately, mistakes help us learn. There’s always something new to learn because every client is a unique individual!

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About this Blog


    Speech in the Schools
    Occupation: School-based speech-language pathologists
    Setting: Traditional and specialized K-12 classrooms
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