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social, health, political imagery through the lens of George J Huba PhD © 2012-2019

Posts tagged care giver

There are many kinds of dementia, but in many types, one huge change is that you lose partially or fully the ability control your facial expression, body posture, and other physical movements that indicate to another person how you feel, how attentive you are, sudden joy, fear, and especially empathy.

Since my diagnosis of FTD (and several years before that), I have heard statements like these from strangers, friends, and family members. Many people think I am angry, disinterested, or not listening to them.

“You never smile.”

“We’re waiting for you not to frown so we can take the selfie.”

“You don’t care what I think, all you do is look at me with a smirk on your face.”

Well, most of the time I am happy and/or neutral although I am sometimes depressed to varying degrees. I am usually interested in what most people are saying. Sometimes I have to break into conversations multiple times to say that I am confused. That confusion is, for me, more likely to indicate that I cannot decode your words because I am losing language skills, not because I was not paying attention to you. I slouch a lot, I often walk looking directly down because I easily trip over over cracks in the pavement and that sometimes leads to falls (I am currently typing using my left thumb on the spacebar because I broke my right thumb in a fall a month ago).

You cannot judge how I am feeling physically or mentally by looking at me unless you are part of my core family and see me very often and sometimes not even then.

That sucks.

Much of how we feel about people is based on their nonverbal gestures and facial expressions. Somebody like me who can barely smile gives people the impression they don’t like what is being said or are annoyed or distracted.

Most people infer negative things from my posture and face and staring that are simply not true.

This is probably a huge factor in how miscommunications often occur among persons with dementia and those they interact with. Even people who interact with me regularly and know my medical problems often misinterpret me.

The following mind model shows some issues in communicating with persons with dementia and possibly misinterpreting what they are thinking and feeling because they look at you with unintended disinterest, never smile, and look distracted. People have often misinterpreted my attempt to smile as smirking.

And if you are a person with dementia, look at yourself in the mirror or in recent photographs and see if you can make some improvements in facial expressions and posture. And if not, when you talking to people, especially friends and family, remind them that you not in complete control of your facial expressions and that sometimes when you think you are smiling or even grinning, the other person just sees a blank face. You can also make a joke out of the situation.

Click on the mind model image below to expand it.

Missed patients appointments represent a major wasted cost within the healthcare system.

Huge amounts of resources are wasted when patients miss appointments. Expensive healthcare providers in expensive medical office space with expensive equipment and expensive staff are not utilized to their fullest resulting in a loss to the overall system.

To deal with missed patient appointments, clinics often schedule a few more patients than they have time slots in order to compensate for the number of patients who may not arrive or may arrive later than scheduled.

If everybody actually shows up at appointments in the compensatory, over-booked environment, several things happen; doctors and staff get stressed because they have to squeeze patients into the schedule and patients get pissed off their doctor cannot be in their examination room on time or earlier.

So the system needs to get patients into healthcare clinics on the correct day at the correct time. A number of strategies are typically used.

Do you think that the average elderly or cognitively challenged individual (and caregiver) understands and remembers those reminder messages left on their voice mail or those short telephone communications from an obviously harried staff member?

Do you think that the small type, too many words, black-and-white business letter does the trick? Do you think the letters get opened? Do you think that aging folks can all read small fonts or understand a packed letter without white space?

Do you want to increase the rate of patients showing up for appointments? Look at this general framework and the example I provide below.

Use a mind map, improve patient care and help make the service system more efficient.

Click on images to expand.

Reminder  [optional use of name]

Reminder Jill Brown

chapel hill ambulatory

A clerical staff member should review the completed form with a patient or caregiver.

Personally I would send the mind map home (or in the mail) with a few brightly colored refrigerator magnets (with my phone number on them) suggesting that the patient or caregiver put the appointment mind map on the door. I would also send a second copy to be put wherever these things usually go, or to share with the caregiver. Refrigerator magnets are very inexpensive and if printed with your name and phone number will increase the number of times patients will call to reschedule rather than just skip the appointment because they cannot find your phone number (and guess what percentage of elderly or cognitively challenged or disabled or practicing physician adults might not be able to find the business card and did not enter your office phone number into their smartphones?).

Oh, and even if the form slips off the refrigerator and is whisked off to recycling by a rushed and harried house cleaner, the refrigerator magnets will still be there so the patient can call to get the scheduling information.

Try something like this. If it works you save a lot of wasted time and loss of income and frustration. Your patients get better healthcare because they remember to see you when it is medically desirable to do so. The caregivers will like it because it makes their jobs easier.

And if it doesn’t work better than the same-old, same-old, you have only lost a few hours of clerical time spent implementing a system of mind map appointment reminders.