MGordon_MD
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Aug 29, 2007, 1:58 PM
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Talk to me - the challenge of communication
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By Dr. Michael Gordon
The following occurs frequently in my geriatric medicine assessment clinic, and likely in medical offices around the world: we see an older person who is accompanied by a younger family member. The doctor proceeds to talk primarily, if not exclusively, to the family member, almost ignoring the patient. This is especially so if it is known that the patient suffers from cognitive impairment or has sensory problems such as hearing loss.
In modern medical offices, this tendency may be exacerbated by the use of the popular shift to the electronic health record. Many physicians are typing and reading as they speak, a situation that increases the likelihood that they will be distracted from direct verbal patient interaction.
Because of this tendency, I have, over the years, arranged my office in such a way that the patient and the primary family member or members are sitting in a position that enables me to make eye contact with all of them. I try to focus my attention first on the patient, greet him or her and have some verbal interaction about how they are or have been since our previous visit.
I then ask them if I should speak primarily to their accompanying family member. The response is almost always positive, and I can then direct further questions to the family member, all the time trying to keep looking from one to the other.
Another technique I have tried to maintain is that from time to time after speaking to the family member, I ask the patient for his or her comments on what has been said.
Depending on the nature of the medical condition, the degree of interaction and dialogue with the patient as compared to that with the family member may vary. There are many times when I am trying to assess the ability of the patient to provide reliable information and I have to remind the family members, sometimes more than once, to avoid interjecting their comments, even when their loved one turns to them for input, which is very common with individuals suffering from cognitive impairment or dementia.
When I observe the dynamic, content, and responsiveness to such questioning, it is usually possible to assess the cognitive capabilities of the person to some extent and understand the degree of dependency the patient may have on the direction and cognitive input of the family member.
Such an interactive arrangement appears to take more time than simply speaking to the cognitively intact family member, but it is less rich in terms of understanding what is actually going on. Thus, it is important for physicians to remind themselves of the importance of such efforts to engage with their patients, irrespective of the degree of cognitive impairment.
A well-known neuro-psychologist, Steven Sabat, has written extensively on the language difficulties and patterns of speech and communication in individuals with Alzheimer’s. In his outstanding book, The Experience of Alzheimer’s Disease – Life through a Tangled Veil (Blackwell 2001), he promotes the concept of careful listening and finding the meaning behind what might otherwise seems to be garbled and disconnected language.
A parallel situation often occurs when members of the service industry, such as shop clerks and salespeople, tend to speak to younger family members who are accompanying an older relative, without first attempting to address the older person – even if the elder of the two is clearly the primary customer. It sometimes seems as if the person is invisible.
When this happens, as gently as possible, we should redirect the sales staff back to the customer, to acknowledge the older person’s visibility, vibrancy and individuality and ensure that he or she is directly addressed and listened to.
This article originally appeared in The Canadian Jewish News
Dr. Michael Gordon, is vice-president of medical services at Baycrest in Toronto, Canada, and co-author with Bart Mindszenthy of Parenting Your Parents.
Parenting Your Parents is available in bookstores and online at: Indigo-Chapters, Amazon and Barnes & Noble.
For bulk orders email info@dundurn.com. Call: 416-214-5544 or Fax: 416-214-5556
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(This post was edited by MGordon_MD on Sep 24, 2007, 1:37 PM)
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