lessons learned

Learning the Tea Party Lesson

Everyone needs help understanding—and remembering—important info.

Jack Runninger, O.D.

The grandfather was babysitting his 3-year-old grand-daughter. She had recently received a toy tea set, so the two of them played tea party. She brought him a cup of “tea,” which was of course water.

“That sure is delicious,” he enthused as he drank it. After numerous cups of “yummy” tea, Grandma returned home.

“You've got to see how cute this is,” said Grandpa, as he asked for more tea, and the little girl brought him yet another cup.

“You do realize, do you not,” said Grandma, “that the only place she can reach water is in the toilet?”

Me, too

As I've gotten older, I find that my cognitive powers are not as sharp as they used to be. When I was in practice, I'm afraid I didn't fully realize how seniors' loss of cognition ability, along with hearing and memory worsening, was adversely affecting my communicating with them. Perhaps my experiences can help you better appreciate these problems, so that you can better communicate with your senior patients. For example—hearing.

What did you say?

You're carefully explaining instructions to Mr. Brown, while he keeps nodding in agreement. You assume he understands and will follow through. But I now realize that he's often just pretending to hear you, so that he doesn't have to go through listening to the whole cotton pickin' explanation all over again. I've been there and done that.

Perhaps my favorite example of hearing loss affecting doctor-patient communication appeared in Medical Economics many years ago:

“Big breaths,” said the physician to an elderly lady patient, as he placed the stethoscope on her chest. “Yes,” sighed the lady. “But you should have seen them 50 years ago.”

Like the old grey mare

Many of your older patients' memories, like the old grey mare, ain't what they used to be. Which is the reason you need to write down their instructions. Through personal experience, as I've gotten older, I've found I'll often forget things if I don't write them down. I've had to resort to writing reminder notes to myself. Even so (a): I often forget to later look at those reminder notes, or (b): If I do remember, by the time I look at said notes, I can't read my handwriting, or (c): By the time I've taken the note pad and pen from my pocket, I've forgotten what erudite gem it was that I was going to jot down.

He did it right

Because of these hearing, cognitive, and memory problems, it is wise to also explain diagnosis and treatment to a senior's family member, who hopefully has a better memory. Years ago, an optometrist (I can't remember names either) told me about an experience in which he did all the right things. He was trying to explain how to perform lid scrubs to an elderly patient with blepharitis. Not sure that his instructions were registering, he wrote down his instructions, and also went out to the reception area to bring the man's wife back to his exam room, in order to explain to her what she should do to help.

“Do you have any questions?” he asked her after spending 10 minutes demonstrating the procedure on her husband

“Yes,” she replied. “Where does he live, and how often do I need to do this?”

Turned out he had the wrong wife. OM