James has an intellectual disability and presents to you after suffering from constipation. James does not explicitly tell you that he has booked an appointment because of his stomach pain.
He usually sees a different doctor and you are not aware of his health history.
You begin your consultation by asking him a series of questions about his health history and prescription medications. James doesn’t really respond to your questions and is confused.
James tells you that he takes the bus to his health appointments. He tells you he got lost on his way to the appointment and his stomach hurts.
You suggest that James does a blood test. James asks if this is because of his ‘pressure’. You explain that it is to check his thyroid.
How could you have better communicated with James?
Good communication is circular and starts when you meet the person. It involves a constant cycle of active listening and speaking with care and attention. The four steps include:
to listen and receive information
check you understand
speak and express information
and check they understand.
Sometimes the most valuable information isn’t stated upfront for a variety of reasons. The person may think the information is insignificant or unrelated to their current health matter. It can also be helpful to see if the person would like a supporter present to assist them with communication and understanding.
In James’ case, he may have thought that he already communicated the issue to you. Let James tell his story by using open-ended questions to explore information. If James does not respond to an open question after a long pause for thinking, it may be best to use a closed question with a ‘yes’ or ‘no’ response.
When using closed questions, limit yourself to one concept at a time to avoid confusing James by asking him about too many things at once. This will reduce the chances of confusion and ambiguous responses.
Make sure to give James enough time to think before speaking and allow him to finish his own sentences. Sitting with a pause in communication can show James that you respect the time he needs in the conversation.
For more information, strategies and to learn about best practice in inclusive care for people with intellectual disability enrol in the online learning module Just Include Me - Inclusive Health Practice brought to you by the Council for Intellectual Disability.