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Guidance for healthcare staff

In any medical or nursing setting you may come across a patient whose speech is difficult for you to understand. There might be times when you wonder whether the patient is able to fully understand what you are saying. This section relates to those people who have speech, language or communication difficulties due to a condition such as MND, MS, brain injury, stroke, cerebral palsy, learning disability, etc. Here we give you some tips and guidelines to make communication easier - for the patient and for you.

Note. These suggestions do not contain specific guidelines for communicating with patients who have English as an additional language, or who are deaf, though some of the general tips may also be useful for these patients. Contact your local interpreting services for specific guidance and help.

  • Conversations will take longer - if possible allocate a double appointment to patients with communication difficulties; the patient will be more relaxed, you won't feel rushed and you are more likely to gain a fuller case history, etc.
  • Ask questions one at a time, and wait for the patient to reply to the first question before asking the next one or for clarification. This is harder than it seems.
  • Look at the patient - this might seem obvious, but you can gain a lot of additional information which might help you understand what s/he is saying better.
  • Speak to the patient even if they are accompanied by a relative/friend.
  • Don't pretend to understand if you haven't - people can spot this immediately and find it insulting. Ask the person to repeat what they have said, ask them to say it in a different way, or ask if they can write it down. If all else fails ask a relative/carer to interpret.
  • Speak in short, clear sentences using non-technical terms where possible. If the patient is able to read, write down key words on a piece of paper as you are speaking. Demonstrate what you are saying using gestures, pictures and props, if appropriate. If you are talking about specific procedures, some people may find photographs of the procedures easier to understand. Whilst this may be time consuming to create the photographs, they could be useful for others. Similarly a simple diagram may explain a procedure much clearer than speech. You could also add specific gestures to what you are saying, e.g.pointing with your thumb to the upper arm to indicate 'injection'.

Patients with little or no speech

If the patient has no speech, or speech that you find virtually impossible to understand, you might find these techniques helpful:

Ask questions requiring a 'yes' or 'no' answer. If the patient is unable to indicate yes/no in the usual manner, you might need to ask how the person indicates 'yes' and 'no'. Say to the patient: "Show me how you say YES. Show me how you say NO." Some techniques might be blinking once for 'yes' and twice for 'no', looking up for 'yes' and down for 'no', head nod/shake, thumbs up/down, pointing to 'yes'/'no' symbols, etc.

Ask if the patient could use any alternative method to back-up their speech:

  • Can the patient write? If so, they may be able to use a pen and paper to support their speech.
  • If the patient can spell but is physically unable to write then you could use an 'alphabet chart'. If the patient is unable to write, write the letters of the alphabet on a piece of paper and ask the patient to spell out what they are saying by pointing to the letters. If the patient cannot point to the letters on the alphabet board, you can point to letters in sequence, asking him/her to indicate when you reach the desired letter. It helps to have a pen and paper handy to write down the letters as they are dictated.
  • Does the patient have a communication aid? If so, encourage them to use it.

Communication Breakdown

Finally, if your patient appears to be trying to communicate something to you and you simply don't understand, then try the following three questions:

  • Who are we talking about? List the main people involved in the patient's care
  • Where are we talking about? List the key events and places that the patient has gone through
  • When are we talking about? Is it something that happened today, yesterday, or is going to happen?

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