The issues: Communication with patients
Why you must talk to the patient
An introduction to the issues involved in communicating with patients who have a learning disability.
From the GMC's guidance
'You must listen to patients…You must give patients* the information they want or need to know in a way they can understand.' (Good medical practice, paragraph 31-32)
* 'patients' here includes those people with the legal authority to make healthcare decisions on a patient’s behalf.
Everybody has a way of communicating, even if you don’t understand it at first.
Good communication with your patients, taking care to listen and observe as well as providing information in a way they can understand, is an essential part of every doctor-patient partnership.
Respect and rapport
From the GMC's guidance
'You must treat patients as individuals and respect their dignity and privacy' (Good medical practice, paragraph 47)
Mutual respect is a key part of every successful doctor-patient relationship. In order to demonstrate respect towards your patients with learning disabilities, patients and carers agree that it’s important you address the patient directly during the consultation.
Speak to the patient, even if it seems that they may not be able to communicate verbally, and even if it’s the carer that is addressing you. This shows your patient that you respect them and value them as an individual.
A major advantage of establishing rapport with a patient is that it not only improves your current consultation, but future consultations are likely to go much more smoothly when a patient trusts and understands you, and believes that you respect and understand them.
Respect and rapport: the therapeutic relationship
Dr Roger Banks describes the importance of the therapeutic relationship.
Everyone has a right to two-way communication for its own sake (ie not just functional, demand-driven communication) and on their own terms.
This is one of the principles of intensive interaction, a form of communication that you can use with people with profound and multiple learning disabilities (PMLD).
To find out more about intensive interaction, and lots of other communication tools and tips, visit Into practice: communication with patients.
Challenging behaviour and communication
Speech and Language Therapist Stevie Newman & self-advocate Patricia Charlesworth examine why ‘challenging’ behaviour can occur.
'Many people with profound and multiple learning disabilities do not communicate using formal communication like speech, symbols or signs. But this does not mean that they can’t communicate.'
Sometimes people with learning disabilities who have problems with their communication may display 'challenging' behaviour, such as aggression directed at others or at themselves or disruptive actions. Experts agree that when someone with communication difficulties behaves in this way it invariably means that there has been a breakdown in communication. Either the person does not understand, or is not being understood. For example someone may be in pain but unable to express that verbally.
It's important to take the time to find the best way to communicate with your patient, and to allow them to communicate with you. Someone who does not have verbal language skills may well be able to communicate in other ways, such as the rhythmic movements or sounds used in intensive interaction. When a person feels able to express themselves, and feels they are being listened to, they feel valued and are far less likely to behave in a challenging way. Have a look at the Into practice: communication with patients for tips on how to improve your communication.
By paying attention, showing a willingness to communicate, this demonstrates respect for the patient and their means of communication. This in turn can help to build trust and establish a rapport with your patient.
In the above video, Patricia describes how she once behaved in a challenging way when she had a blood test (‘it took three nurses to hold me down’). As she goes on to say, this situation could have been avoided by letting her know in advance that she was going to have a blood test and allowing her to prepare for it. See Scope's challenging behaviour section for some practical tips about how to deal with challenging behaviour.
Challenging behaviour and communication #2
Dr Pepera speaks from personal experience to demonstrate how challenging behaviour can result from communication problems.