Improving communication with patients - cognitive assessment

In this example, a medical student talks us through a key learning moment they experienced when trying to communicate with a patient with cognitive impairment.

'I was asked to perform a cognitive assessment on a patient who wasn’t thought to have capacity to consent. I explained how I hadn’t done this on a patient before, only on other students in our year for a teaching session, but that I’d give it a go. I was very apprehensive.

I introduced myself to the patient, and drew the curtains for both privacy and so they could concentrate better on the assessment. I explained that they had to fill in a sheet of questions to help the doctors, which the patient agreed to. I brought the table round and explained the first question. When asked if they could complete the first question, the patient remained laying under the covers and didn’t appear to understand what they were supposed to do. I tried explaining a couple more times, but the patient didn’t move, so I explained slowly and loudly and I started feeling embarrassed as the rest of the ward could hear me. I also started to feel frustrated; I didn’t want to return to the doctors without completing the sheet. I felt guilty for feeling frustrated, especially as the patient was so lovely. I decided to break the steps down a little more; I asked which hand they write with and then asked them to remove it from beneath the duvet. I was very surprised, and a little relieved, that this appeared to work. I handed the patient the pen and asked if they were comfortable.

This experience has improved my confidence when speaking to confused patients. I’ve learnt that these patients require everything to be broken down even into the simplest of steps; in this instance removing the patient’s hand from beneath the duvet. I’ve also learnt to stay persistent and try other ways of tackling a situation as ultimately the problem needs to be solved. In the future, when I’m a doctor, I will have to overcome problems on my own. I think that this experience will also ensure I’m less embarrassed in the future as I have more experience in dealing with uncomfortable situations.'