Want to unlock your powers of persuasion?

Recognize bad arguments and make good ones

Case managers often find themselves in the middle, dealing with the conflicting desires of patients, providers, and payers. Learning to think critically helps case managers sort through conflicting statements to find the best solutions. It also has the potential to help case managers present their own recommendations in a more convincing manner.

"When you talk with the parties involved in a difficult case, you must present statements in a logical way so that as they listen to your case, they are convinced in some way," says Jan Keffer, PhD, RN, CS, ANP, associate professor of nursing at the Indiana University School of Nursing in Indianapolis. "And the first step in being more persuasive is to become a more critical thinker."

Critical thinking does not mean merely being critical, however, Keffer points out. Instead, it involves these basic steps:

• questioning assumptions and beliefs;

• thinking and acting differently based on critical reasoning;

• developing a process of questioning, analysis, and reflection.

As case managers listen to arguments or prepare information to present to a provider, payer, or client, Keffer recommends they try to answer the following questions:

• What are the issues presented?

• What are the reasons and the conclusions?

• What words or reasons are unclear?

• What are the assumptions?

• What values are presented that may conflict with your personal values?

• Do any values conflict with each other?

• How good are the arguments?

• Is there any missing evidence?

• Do the statistics support the arguments?

• Are there any possible rival conclusions?

• What is possible in the situation?

• What might be done to maximize the positive outcomes?

"It’s always a shock to learn that we’ve made a wrong assumption," Keffer says. "In order to be a critical thinker, you must be careful not to jump to conclusions." (For a list of recommended readings on critical thinking, see box, at right.)

There are two types of reasoning used to construct arguments. Understanding the differences between them should help you weigh the value of arguments presented to you and those you construct to persuade others, Keffer says:

Deductive reasoning. Deductive reasoning often is used in ethical discussions. It moves from general arguments to specific ones, and its conclusion is presumed to be logically valid. Here’s a classic deductive argument: All men are mortal. John is a man. John is mortal.

Inductive reasoning. Inductive reasoning moves from specific arguments to general ones. Although its conclusion is based on facts, it may not hold true. A classic inductive argument states: This apple tastes sweet. The apple I ate yesterday tasted sweet. All apples must be sweet.

In addition, people often make errors in reasoning when they construct their arguments. Understanding some of these common errors should help you avoid making them and recognize them in the arguments of others, Keffer says:

Weak analogies. This is a fallacy of ambiguity, Keffer says. For example: Nurse 1 has attributes A, B, C, and Z. Nurse 2 has attributes A, B, and C. Therefore, Nurse B has attribute Z.

Composition. Another fallacy of ambiguity, composition argues that whatever applies to a part of something applies to the whole. For example: The United States is strong and efficient because each of its 50 states is strong and efficient.

Hasty generalizations. This is a fallacy of presumption, which uses insufficient evidence or an isolated example as a basis for a general conclusion. For example: I had a bad time with my first husband, therefore, all men are bad.

Appeal to populace. Based on consensus, this is a fallacy of relevance. For example: All hospitals in the area use antiseptic X in their operating rooms, so antiseptic X must be good.

Appeal to authority. Another fallacy of relevance, this occurs when an authority in one field attempts to qualify as an expert in another. For example: A psychiatric nurse tries to act as an expert in surgical nursing.

Argument against a person (ad hominem). A fallacy of relevance, this occurs when one party launches a personal attack rather than attacking the argument. For example, Nurse A wants to resuscitate a child dying of a brain tumor. When you question this decision, Nurse A argues, "You’re just afraid of your own death."

Understanding the elements of critical thinking, Keffer says, can be valuable to case managers. "Imagine being able to say to the surgeon who makes some grandiose statement, ‘I’m sorry, doctor, but that’s a hasty judgment, an error in reasoning, and it’s a deductive fallacy.’"

Arming yourself with this information means you no longer have to passively accept statements with which you disagree, she says. "You can listen to each argument with a critical ear and make decisions less often on emotion or feelings and more from skillful analysis and evaluation."