Talking in Elder Medical Care
What is really being said?
When my elderly mother-in-law was in her final days, I was with my husband Joseph through much of his vigil. Her doctor had communicated clearly the gravity of her situation although, as Joe was an emotional train wreck, he didn’t “hear” a lot of what was said. I translated for him, gingerly converting into real words what the medical care terms indicated.As Joe’s mother’s neurological system collapsed, she experienced seizures. To the nurse practitioner Joe desperately pleaded, “Seizures are treatable, right?”
“Yes” she answered with a much-too-bubbly voice for the dire circumstances. “Most seizures can be managed.” She didn’t expand on the exception to this case, a dying woman in full organ failure.
That’s all Joe heard: His mother was having seizures; seizures can be managed, so manage them!
I was annoyed. If the NP had really “listened” to my husband’s anguished plea about medical care, she would have realized that he was grasping to save his dying mother. Her seizures couldn’t be “managed,” and the nurse should have elaborated and calmed him.
My mother-in-law passed away two days later. It was almost a year before my husband and I revisited the medical explanation for her seizures. Joe was more than miffed, feeling very mislead, as I elaborated on what the nurse practitioner glossed over.
Listening in Elder Medical Care
What is really being asked?
I certainly understand how fear, grief, shock etc. can twist words and create an illusion of mistruths.
At a minimum, any eldercare or medical care professional interacting with families should remember these points:
- Be accurate with the information you provide but more importantly, listen to don’t just hear what the family is really saying.
- Be careful not to layer on your personal biases.
- Know your audience! Don’t dazzle them with medical jargon they can’t absorb. Use simple terminology and examples.
Dialoging with families of loved ones with dementia requires a unique skill set, in part because their orientation/behavior fluctuates between lucid/appropriate and confused/goofy.
Answer a family’s question with a question so you can better answer their questions.
Don’t laugh; it’s a legitimate approach. The point of which is - in order to really understand what the family wants to know, what their concerns are, what’s important to them - you have to ask carefully-worded but probing questions.
“When can my mother go home?”
On the surface it appears to be a straightforward question about necessary medical care. And it is, if it’s asked in behalf of an otherwise stable person who is perhaps post appendectomy.
However, if the parent has experienced a compromising stroke, major surgery, or has Alzheimer’s, “going home” is a far-from-simple question. Then, it’s on you to gently probe.
- Is the family in complete denial?
- Are they confused as to the severity of their parent’s (or other elderly relative's) needs?
- Are they expecting a recovery that’s unlikely or unreasonable?
- Do they think they can manage their loved ones exhaustive needs on their own?
With tasteful inquiries, you uncover the layers of their concerns; fear and misunderstanding are likely underlying factors in the family’s questions. Your medical care expertise balanced with professional courtesy will provide the basis for meaningful dialogue with families in crisis.