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The Persuasive Pathologist

Persuasion is the ability to influence others. We, as pathologists, are physicians who are trained in the art and science of the disease process. As such, our role has been ascribed to be a 'doctor's' doctor. An effective pathologist is a persuasive professional-i.e., someone whose logic is understandable, thought-process is trustworthy, and opinion is actionable. Persuasive communication is the key to success as a pathologist and a laboratory medical director.

What and how we say (or write) has a significant impact in how we are valued within the medical staff

Unlike surgeons who can operate on tumors and internists who can manage a cluster of chronic conditions, the pathologist's core skill is the accurate use of words to describe a disease or a problem. Our scalpel is the correct taxonomy and our prescription is the pathology report. However, our words can have meaning only if the reader or listener can understand them and more importantly—trust them. For example, how do we communicate an unexpected cancer diagnosis to an unsuspecting surgeon or convince the administration to support an expensive capital purchase? More than the words, how we string them together in sentences and arguments makes a marked difference to whether our opinion is perceived as trustworthy or not.

Start with the right person

Before starting a conversation, verify if you are engaging the right person. So often, especially in administrative matters, much time is wasted in trying to persuade a person who has neither the responsibility nor the authority to act on your suggested course of action. Therefore, before you discuss any details, politely ask if the person is the right person or not. Do not try to guess your way up the medical or administrative ladder. If you need to engage a department that is unknown to you, send a short note to the group leader and ask to be introduced to the right individual. Refrain from sending a mass-email copying everyone you know in that department as everyone's responsibility often ends up being no one's responsibility.

It is important to distill your message

Begin by stating the findings that are irrefutable and verifiable. After you have displayed the facts, then move to your interpretation and end by stating any next steps or limitations. When trying to convince someone towards a favored course of action, start by identifying the most vital operational, safety, moral, and ethical imperatives. Then, clearly state why fulfilling that imperative is important to the recipient. Provide supporting data from reliable and verifiable sources. Aim to be known as someone who brings forth an issue after due diligence and through analysis and strive to make your words known for clarity, precision, and accuracy.

Know your audience

Remember that healthcare is a complex endeavor, and thousands of unique skill sets must come together to make a health system work. In this mix, your audience may have little understanding of your opinion and why it should matter to them. Therefore, put yourself in their shoes. If you are unsure, prepare a detailed brief with an executive summary that will help them navigate the issue with ease and spare them the embarrassment of asking around what you are requesting.

One strong point is better than many weak ones

Say your point from the most defendable position because it shows respect to the recipient's time and demonstrates the imperative clearly. Don't clutter your briefing with unnecessary data. A creative brief also covers the reasons that oppose your suggestions. It is best to be one's own critic over giving that chance to your audience or someone else who does not have the same situational awareness as you. For example, if something you are asking is too expensive, acknowledge that and explain the underlying utility.

Help others make the right decisions

The human mind strives for simplicity and most decisions are taken on a limited set of reasons- Has it been done before? What do others say about this? How are others handling this? For most decision makers, positive precedent is a powerful factor in decision-making. For example, when asking for additional staffing, mention that the emergency room patient throughput improved when a new analyzer was installed. However, you can also use negative precedent as an ally. In this case, mention the complaints from emergency room clinicians when testing could not be performed locally.

Project the benefit of many

It is easy to decline the request of one person but very difficult to decline it for a group. An opinion is more believable when more than one individual supports it. If possible, have others add their input in your briefing. For example, if you advocate for a new laboratory point of care information system, have your local information technology leader put in a word or two about the feasibility of software integration and have the local clinical leaders comment about the value of discontinuing manual charting point of care results. If your suggestion helps get your organization at par or ahead of its competitors, it would be seen as a plausible investment. No one wants their organization to be seen in the last quantile.

Deliver more, promise less

Brevity and a balanced opinion are often the most valuable virtues for the pathologist. When trying to convince a group, refrain from overstating the value of your suggestions. Always start with our argument and invite others to join in to add more benefits or risks. Clearly state that you are open to other experts weighing in. In large groups- beware of scope creep and refrain from promising more than you can deliver. It is better to be known as a person who under-promises and over-performs- than the opposite.

Ask but don't expect

You must understand that the right to advise is different from the right to decide. At the end of the day, your imperative may not align with the current condition or priority of the corporation. For example, your request for additional hiring may be inconsistent with their existing budgeting. When refused, do your best to control your disappointment and try not to burn bridges. Remember, most of us do not come to work to be unhelpful to others. Be known as someone who can be engaged and negotiated with- not as someone who points fingers when refused. In the depths of despair, do not pontificate and refrain from moral signaling. When refused, simply offer an alternative plan or timeline.

The path of persuasion is a path of a day-long marathon- it requires patience, practice, and planning. A wise marathon runner invests time and effort to chart out the route, find supporters on the way, and run at a sustainable pace. When pathologists think and act like marathoners- they prepare and practice their arguments. Thus, their opinions matter more and they are valued by their colleagues. In persuasion, an ounce of preparation deflects a pound of rejection.

Gaurav Sharma, MD, FCAP, is a clinical and molecular pathologist practicing at Henry Ford Hospital in Detroit, Michigan. He chaired the CAP15189 Committee and has previously served on the board of the Michigan Society of Pathologists, the CAP's Standards and DIHIT Committees, the CheckPath Clinical Pathology Committee of the American Society for Clinical Pathology, and the Informatics Committee of the U.S. and Canadian Academy of Pathology. Additionally, he is the chair of the Henry Ford Medical Group Charter and Governance Committee.

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