Communication

S:
Whether completing a baseline Ax to a pt you are seeing for the first time or providing ongoing Rx to a regular pt, communication is very important. In this particular scenario I was seeing a pt for the first time. He was a 65 yr old gentleman who had a speech and hearing deficit and had arrived for Physiotherapy regarding his Parkinson Disease (PD).

T:
In regards to communication my desired outcome was to Ax and Rx this pt using an appropriate level of communication taking into account any disabilities or cognitive deficits. This included everything from voice projection to tone and how much I explained the tasks we were about to do.

A:
Through reading his notes I realised that he has an inner ear device that accounted for his decreased hearing, however I wasn’t sure about cognition and speech. I spoke to him at a normal voice projection and in a tone that more reflected the way I would speak to an elderly pt with cognitive deficits.

R:
At the end of the Rx my supervisor provided feedback about my communication. My communication throughout the Ax and Rx was inappropriate. This gentleman would delay his response for a few seconds before answering any qn’s. This was not because of any cognitive deficits, but due to delayed processing of words due to his hearing impairment and the PD. I misinterpreted this delay as him not understanding me and hence adjusted my communication for someone with a cognitive deficit. This made me appear to be condescending towards the pt, which he could have found very offensive considering he was cognitively sound.

E:
Although my communication wasn’t effective I believe there were some things I did right and other I could have done better. I would prefer to over explain to a pt and be interpreted as condescending to under explain and not get the task completed. However I initially did not give the pt enough time to respond, which if I had, I would have realised he understood perfectly it just took him time to respond. Although I felt rather disappointed I did take the feedback on board and the next week I improved ten fold and as a result gained much more rapport with the pt.

S:
Firstly ask someone appropriate rather than just read the notes. Say to someone “I have read that this person has hearing and speech difficulties, what is the most effective way to communicate with this pt?” From the first introduction, start to think about how this person presents wholistically, including cognitively so that you communicate effectively form the word go.