June 2014 | ISSUE 12
Take I – Long-Term Patient Project

By Stewart Retnam

My partner and I sat on the couch, facing the elderly gentleman sitting across from us. We were on our first Long-Term Patient Project visit with Phillip (not his real name), and it wasn’t going swimmingly.

Phillip was slightly hard of hearing and used a hearing aid connected to a little amplifier that we had to speak into. Even so, communicating with Phillip was by no means a breeze. We often had to repeat ourselves multiple times and soon started asking shorter and shorter questions because we were getting out of breath. I was tired, and to be honest, rather frustrated too.

Prior to the visit, I’d envisioned scenes of us enjoying tea and biscuits with the patient amidst a lively conversation about the impact of his condition on his life, what he thought about our healthcare system and so on… well, so much for that. It didn’t help that Phillip favoured truncated or one-word responses to our questions, making me feel that our efforts weren’t being adequately rewarded.

The experience taught me how speech and hearing difficulties and different mannerisms of speaking can hamper communication with patients. It was easy to imagine how frustration could build in a doctor handling such a patient, leading him to make misjudgements, miss a vital clue or attempt to bring the consultation to a close as quickly as possible, all out of exasperation.

But I realised that it is the doctor’s responsibility to be patient, regulate his own emotional frame of mind and to adapt his own clinical approach to the patient’s mannerism and style of talking. And it was my responsibility to temper my patience with Phillip and either persevere with our current style of conversation or find alternate ways to allow him to share his thoughts.

We also spoke to his daughter and primary caregiver. Through our conversation, I grew to appreciate the importance of a primary caregiver in the life of a patient. Not only did she support her father in his day-to-day life, she was an invaluable source of medical information as she was always around her father and was observant of any symptoms and changes in his condition. She was especially helpful as she was far more forthcoming when sharing Phillip’s medical history than he was.

More than anything, communicating with her was quicker, easier and allowed less room for misunderstandings. I learnt that caregivers can be especially helpful in the context of patients who suffer from communication (speech/hearing) impediments, or even neurological issues, such as dementia.

When probed on whether his health issues were impacting his life in any way, Phillip brought up the frequency of hospital visits. Phillip wasn’t unhappy about having to go back to the hospital every day; he was unhappy because it was encumbering the lives of his loved ones. This highlighted the need to keep in mind the spillover effects when designing a treatment plan with a patient; they are, for all intents and purposes, invisible to the doctor in his consultation room, but can become very much alive and a burden in the daily life of the patient and his relatives. Even more so, for elderly patients who may need assistance ambulating from place to place.

Perhaps the best treatment plan isn’t what covers all aspects of what needs to be treated on paper – it’s what is practical, feasible and most importantly doable for the patient. Maybe with a lower frequency of follow-ups and intensity of treatment than the doctor would like, but designed to be manageable in accordance with the means, lifestyle and wishes of the patient and his family. That could work better.