Patients with special needs

Most anaesthetists recognize that there are specific groups of patients with whom communication is especially difficult due to issues relating to language. These groups are patients in whom a disease process interferes with communication—for example intellectual disability or hearing impairment, those with whom we do not share a common tongue, and those patients whose cultural background differs from ours. Patients with communication difficulties are disproportionately represented in the hospital population for a variety of reasons. The elderly form the bulk of hospital inpatients and are much more likely to have problems such as dementia, confusion, sedation and dysphasia. It is important to be cognisant of the issues that may arise with patients who have communication problems and, in addition to being aware of these problems, it helps to have a structured way of approaching the issue. Reading the patients’ notes prior to consultation gives advance warning of issues such as dementia or hearing impairment and allows communication to be tailored to the patients’ needs. Sometimes the patients’ understanding of language may be difficult to assess on first meeting—anaesthetists have all encountered patients who answer questions with a smiling ‘yes’ or ‘no’, only to subsequently discover their comprehension has been minimal. Enquiring of relatives, friends and staff helps to give a picture of a patient’s ability to communicate in the chosen language. Similarly, enquiring of the patient how communication can be facilitated, is helpful. … ‘It says in your notes that you have trouble finding words since your strok —is there anything I can do to make it easier for you to speak?’… Once the communication problem has been delineated it makes it easier to move on to the next step. Having orientated oneself to the patient’s particular problems with communication, it is also important to orientate the staff with whom one is working. …‘Rob, we are going to see Mr Smith now. He’s had problems with alcohol withdrawal over the last few days and he is still a bit confused. It is probably best if just one of us does the talking — are you happy to do that? ’ Not: ‘I wish you wouldn’t contradict me when I’m talking to patients…’ …