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9. Welcome to Module 1 of What Elders Want. Return to main menu

10. In this module you will watch 3 videos. Each video will depict a different doctor-geriatric patient interaction. Return to main menu

11. While you watch each video, make note of how each doctor interacts with his or her patient. Return to main menu

12. A short quiz will follow each video. This quiz will ask you to identify actions and dialogue from the scene that could have negatively or positively influenced the doctor’s communication with the patient. Return to main menu

13. Good luck! Return to main menu

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15. Did you catch everything? Let’s see it from the patient’s perspective to be sure! Return to main menu

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17. 1. In this scene, the doctor calls the patient by the wrong name. What is the most significant way this error could impact the doctor-patient relationship?a) The doctor might be reading the wrong patient chartb) The doctor might become embarrassed and could make further mistakes during the consultation as a resultc) The patient might become angry and aggressived) The patient might lose trust in and respect for the doctor Return to main menu

18. You are correct!

19. If the doctor is reading the wrong patient file, the doctor will likely realize this error when the patient’s story contradicts the information in the patient file.

20. If the doctor becomes embarrassed, they will likely strive to be more meticulous as they continue the consultation.

21. If the patient becomes angry, the doctor can address and correct the error before the situation becomes worse. Mistakes don’t usually significantly hinder communication if they are acknowledged and addressed appropriately.

22. Names are important. By forgetting the patient’s name, the doctor indicates to the patient that the patient is not important. The patient will then be more likely to mistrust the doctor’s diagnosis. To mitigate this error, carefully check the patient file before entering the consultation room. If you are not familiar with the patient, you can also introduce yourself and ask for the patient’s name.

23. 2. What is the doctor’s focus during this entire scenario?a) The patient’s medical concernsb) The patient’s psychosocial concernsc) The patient’s previous historyd) The patient’s son Return to main menu

24. You are correct!

25. Though the patient attempts to discuss her psychosocial concerns (i.e. her personal life and illness experiences), the doctor ignores these topics in favour of another aspect of the consultation.

26. The doctor does question the patient fleetingly regarding the patient’s previous visit; however, this is not the primary focus of the consultation.

27. Though the patient mentions her son during the medical interview, the doctor does not address these comments.

28. Though the primary purpose of any medical consultation is to address medical concerns, it is also important in geriatric care to understand the patient separate from their medical ailments. This includes learning about the patient’s Activities of Daily Living (ADLs) (i.e. self-care tasks such as bathing, dressing, and eating) and their Instrumental ADLs (i.e. tasks not fundamental for functioning but necessary for independent living; e.g. managing money). [Continued on next slide]

29. Since geriatric patients often suffer from chronic diseases that don’t have obvious medical solutions, learning more about how they live and who they are as people can help you provide better medical care. Research also demonstrates that focusing solely on the medical aspects of a patient’s health can cause the patient to feel like a bundle of symptoms as opposed to a person, which can lead the patient to doubt the doctor’s medical decisions.

30. 3. What non-verbal communication behaviour could significantly help the doctor with assessing the patient?a) Looking at the patient when she responds to questionsb) Smiling at the patient to build rapportc) Probing the patient further on the presenting problemd) Touching the patient to examine the patient’s mobility Return to main menu

31. You are correct!

32. While smiling at the patient can often help build rapport, thereby increasing the chances that the patient will actively participate in the encounter, rapport takes more than just one visit to build.

33. Probing the patient is a verbal as opposed to non-verbal means of gathering information.

34. Since the patient’s presenting problem is her breathing, assessing the patient’s mobility is not necessary for gaining more information about the presenting problem.

35. By watching the patient when they respond to questions, the doctor will be able to see non-verbal cues that could lead the doctor to a more accurate diagnosis. Non-verbal cues will also help the doctor identify when the patient is confused, which will allow the doctor to address these difficulties before they become a problem. Finally, looking at someone while they speak conveys active listening, which can help patients feel that their concerns are being heard, and can improve patient trust in the diagnosis and in the doctor.

36. 4. What impairments does the doctor fail to recognize in the patient?a) Physical (mobility) and hearingb) Hearing and cognitivec) Cognitive and visuald) Visual and hearing Return to main menu

37. You are correct!

38. At the beginning of the scenario, the doctor asks about the patient’s physical impairment (her difficulties with mobility due to her foot). Thus, the doctor does NOT fail to recognize this impairment.

39. When watching the scenario from the patient’s point of view, there is no evidence that would suggest the patient suffers from a visual impairment.

40. The doctor first fails to recognize the patient’s hearing loss, which leads to miscommunication. Though subtle, the doctor also fails to notice the patient’s slight cognitive impairment. When watching the scene from the patient’s point of view, you can see that initially, the patient doesn’t recognize the doctor (she mentions that the doctor looks young and might not know what she is doing). Then, when the doctor asks the patient about her previous visit, the patient indicates that this doctor provided her with medication. The cognitive impairment is so subtle that it would be very difficult to discern without directly asking the patient. Thus, it is always good to inquire about any potential impairments.

41. 5. What does the doctor physically do that might have helped improve communication with the patient?a) She knocks before entering the consultation roomb) She asks the patient how she’s doingc) She touches the patientd) She sits at eye level with the patient Return to main menu

42. You are correct!

43. If the doctor knocked before entering the room, we, as viewers, did not hear this knock. It is therefore safe to assume that the doctor did not knock before entering. However, it is good to note that knocking before entering a consultation room is important, and demonstrates respect for the patient.

44. Asking a question denotes verbal communication as opposed to something the doctor does physically; however, it is important to note that asking the patient how she’s doing could have helped improve communication provided the doctor had actually listened to, and acknowledged, the patient’s response.

45. The only point at which the doctor touches the patient is when she proceeds to auscultate. This touch is perfunctory and does not convey much, if any, communication-related cues to the patient.

46. In this scenario, the doctor enters the room and sits directly across from the patient. She sits fairly close to the patient as well. In doing so, the doctor demonstrates she is ready to spend time discussing the patient’s concerns. The doctor also makes the consultation more comfortable for the patient, both physically and psychologically. Physically, the patient can lip read, and can comfortably watch the doctor for non-verbal clues to the conversation. Psychologically, the patient may feel more equal with the doctor, and may feel that the doctor is comfortable in her presence.

47. 6. What does the patient consistently discuss that the doctor fails to acknowledge?a) Her foot painb) Her emotionsc) Her breathlessnessd) Her son Return to main menu

48. You are correct!

49. The patient does mention her foot pain but she only does so once in the scenario.

50. The patient’s breathlessness is the patient’s presenting problem and as such, the doctor does not fail to address this concern.