Practice Management Alert

Hint: Think of language as its own entity, separate from communication.

Communication is a basic tenet of life practiced in some way, shape, or form by most organisms. Yet seemingly innocuous conversations go awry for people all the time. Communicating effectively is a crucial soft skill for business and life.

“When we think about communication, we have to have the mindset of that communication event, if you will. We want to distinguish if we are going to be confident, or maybe a more negative thought, like defensive, or something to that effect. We want to come back to this point of respect and empathy,” said Jacob Swartzwelder, CPC, CRC, CIC, CPMA, CEMC, during his presentation “Mastering Difficult Conversations at Work” with Rhonda Buckholtz, CPC, CDEO, CPMA, CRC, CGSC, COPC, at AAPC’s HEALTHCON 2025.

Use the PREP Framework

The acronym PREP stands for Prepare, Respect, Express, Pivot. This approach to a conversation is a focused strategy for solid communication that can achieve the best outcome.

“Preparation is the key component that’s often missed,” he said. Preparing for a conversation can include figuring out the desired outcome and how to structure the conversation accordingly.

Part of your preparation is approaching discussions with respect for the topic, any sensitivities, and the other person. Putting yourself in their shoes and understanding their perspective is crucial.

“This is going to make sure that our message has the intent we intended and that there is a level of emotional intelligence involved in our communication, and that we’re meeting our recipient where they are with their emotional intelligence, so that we can accomplish that communication objective,” Swartzwelder said.

Sometimes, when communication goes awry with certain individuals, it can feel like the minesweeper computer game: “clicking” around randomly and eventually losing.

“We’ve all had conversations that have been a landmine that we did not anticipate,” he said. Everyone has personal sensitivities for which the other person may be unaware, and in such a situation, it can be hard to maintain respect, he noted.

And finally, in conversations where you hope to achieve a particular outcome (rather than catching up), rely on facts and use “I” statements. (Many believe that using “I” statements in conversation allow people to communicate their feelings without blaming their conversation partner.) Try to focus on problem solving instead of blame assignation, and avoid absolute language like “always” or “never,” which can sound accusatory and heighten tension.

Being able to pivot, remaining nimble during a conversation (and able to redirect when something goes awry) is an important skill that rounds out the PREP acronym. When conversations start to deviate, it’s helpful to know how to get back on track before defensiveness or some other emotion-heightening situation unfolds.

“We want to make sure we’re kind of ‘unsimmering’ the pot, if you will, before we try to pivot back toward a positive place. We can do this by focusing on collaborations, a positive mindset — that solution-oriented focus — and coming back to the core problem,” he said. “A lot of times, these critical conversations start to snowball into things that are not the topic of discussion, and it can be very helpful to try to bring things into that simpler initial topic.”

Rely on Active Listening Skills

Active listening is a foundational skill for good communication, regardless of conversation topic or partner. Reframing and rephrasing what your conversation partner says may feel inefficient, but it can help emphasize that you are listening.

“There is a lot of efficiency in somebody feeling heard, and they can feel heard by you literally repeating what they said in a different form,” Swartzwelder said.

Showing empathy by acknowledging and validating a conversation partner’s experiences also helps people feel seen and heard. This tactic also helps show and develop respect.

Being able to sit in silence can sound — and be — awkward but allows a mutual finding of conversation pace. Silence can also help everyone feel more comfortable by providing time and space for thoughtfulness instead of reaction, which can lessen emotion and “unsimmer” the pot.

Asking open-ended questions is a well-known strategy for encouraging ongoing communication. Such an approach allows for actual conversation because people aren’t pigeonholed into communicating only short thoughts absent of helpful or necessary context.

Remember This Advice

Swartzwelder said that there are ways to balance directness with empathy.

You can be clear without being harsh, because direct communication does not mean being rude. Tone and phrasing are crucial to communicating clearly without slipping into rudeness.

Be mindful of the timing and setting in which you converse. For example, privacy may be crucial for comfort if you’re having a difficult conversation. And being sensitive to the timing of a conversation can affect the outcome. A difficult conversation right before a meal, when involved parties are hungry, can lead to disaster. Or, conversely, a conversation right after lunch when everyone is sluggish from digestion can feel more like an exercise in navigating stupor.

Of course, not all conversations can happen face to face. Swartzwelder recommended following a hierarchy of setting: in-person conversation is best, followed by virtual (with video), and then audio-only, and then written.

Don’t forget that communication can be nonverbal, too. When in conversation, be aware of your body language, facial expressions, tone, and eye contact. When managed successfully, these aspects of nonverbal communication can demonstrate sincerity and calm, deescalating tension and conveying empathy and respect.

Rachel Dorrell, MA, MS, CPC-A, CPPM, Development Editor, AAPC