Care partner communication tips for medical appointments
Mirror Images and Memory Loss: Communication Tips for Medical Appointments
by Ann Cartier
RN and founder of Elderpilot.com
I was raised to be a people pleaser, and I am unapologetic about it, unless I offended you by writing this, to which I would say, “I’m sorry”…
And so begins my early saga of treading lightly, and being careful to find ways to keep the peace, by preempting and reducing opportunities for conflict. Little did I know this skill set would serve me well, as a daughter to a mom living with dementia.
I think my attentiveness to body language became heightened as a result of these characteristics, and I found myself acutely aware of the nuances of changing posture. I could readily detect annoyance, generally before it evolved into frustration and anger. In doing so, I learned ways to diffuse situations that may have had the potential for escalation. In most cases, my approach was to solve the problem, undertake or assist with the task, offer a path of lesser resistance, or redirect, refocus, and lastly, if all else failed, introduce humour where acceptable. It is interesting how we can contribute directly or indirectly to a situation, through action or inaction.
I also learned to train my ear to the changing tone of voice and pitch, noticing small inflections that indicated there was conflict on the horizon. The eyes, it is said, are windows to the soul, and facial expressions speak loudly, more often than words.
I believe having lost my father at a young age, contributed to this heightened perception. My mother was bewildered after dad’s death for some time, and needed to rebuild a life outside of caring for her family. Dad was always the comedic relief, the gregarious one; while mom was less inclined to be the social butterfly. In our tiny home circle, my brother was living with mental illness and was subject to fleeting bouts of anger and remorse. My older sisters were married, so the three of us attempted to reconstruct our lives, and restructure the balance of power, as best we could.
I quickly discovered it was easier to navigate around small incidences at home, than to deal with larger ones. Hence reading emotions and moods became as much as a survival technique, as it was second nature.
With time I married, and had a family of my own. This caused another transition, leaving my mother and brother behind to reconfigure new ways to balance the loss of another member in our small coalition. Eventually, mom showed evidence of memory loss and was later diagnosed with dementia. With time, evidence emerged that her home situation was crumbling. She and my brother had become the unfortunate victims of fraud, in one of many ongoing misadventures.
In order to help resolve some of the issues at hand, mom was taken for further medical consultation and potential treatment. I remember a stressful episode, attempting to explain risk management concerns about her personal well-being, to a health care professional. With mom beside me, I was intent on providing the information at the appointment. Unfortunately, I left my intuitive tuning fork by the wayside, and spoke as if mom was invisible, not once deferring to her, or establishing eye contact.
I wonder how her body language changed as she listened to me prattle on. A clearing of her throat broke the silence, as she interjected into the conversation. She called me a liar, prefaced by my maiden name. That was so unlike her, the tone, and indignation! In her eyes I was an errant child who had spoken out of turn, and I was too emotional to have realized my insensitivity.
Mom was struggling with language, and was reading between the lines to understand the situation. Instinctively and intuitively she became angry, because she perceived a threat to her autonomy. Her response was a mirror to the situation, and really, who could blame her?
My poetic reflection speaks to that day…
Mirror Images: Unspoken Language
The words were jumbled more or less,
Context, though, was accented
Like errant tapping of hail on a tin roof.
No good is to become of this.
But the eyes spoke clearly, words aside,
Brows lowered with indignation,
Narrowed, emphatic, sharp, unyielding,
Displeasure has befallen us.
The lips were absent of the curve,
Watchful, hoping, a smile emergent,
Would rescue us from unknown foes.
React, and ready my defenses.
The body stiff, arms woven tight,
Threaded across a posture poised.
A skilled combatant drawing closer,
Imminent danger floods my thinking.
The approach is quick, direct, in view,
Feet echoing thunderous, drawing nearer.
Escape eludes me, exits vanish,
Self-protection, counter quickly.
Moments collide, and senses falter.
The situation clearly demanded,
Primal response, and quick reaction,
Mine alone to safely render.
When I forget, I conceptualize,
Tone, and posture, shape and form.
My point of reference, clear to me,
A mirrored response to your reflection.
Care Partner tips to improve communication when seeking medical careIn retrospect, I should have attempted to make an appointment without mom to discuss my concerns. I was the Power of Attorney (health) and my worries would have been voiced more constructively, in a different environment. Her perception of the situation caused a catastrophic reaction; that could have been avoided.
Here are some Care Partner tips that may improve communication when seeking medical care:
- Does your medical office have a nurse practitioner or office nurse that can act as a liaison to further communicate concerns to a physician?
- Is it possible to book a medical appointment just prior to the one scheduled for the individual living with dementia, to allow for a private, confidential discussion, if needed?
- Some communities have outreach teams that conduct home visit assessments. These appointments can be less stressful, and may offer insight into the impact of environment, on an individual’s behaviour. Ask your family doctor if this is appropriate.
- During stressful times, organizing important points in writing allows for a better medical appointment. Prepare your thoughts in advance of the visit
- When language and communication are impacted, never lose sight that your loved one living with dementia is watching your behaviour, listening to your tone, and observing body language
- The Alzheimer Society can help teach communication strategies, and act as a navigator of the health care continuum. Call your local office, and speak with someone about available services
Last but not least, as a care partner/caregiver, seek ways to reduce your stress throughout your shared walk through this disease. We all need to reserve some of our nurturing and love for self-care, because you are an equally important part of this journey. Keeping the lines of communication open starts with a rested mind and re-energized spirit.