Ask the Expert: The Approach: Sidebar

A Strategy for Interviewing Persons who are Non-Verbal

DOs

• DO approach the patient first. Even if the patient does have cognitive impairment, the individual is likely to be a key source of information and is the person with the greatest stake in the outcome of the encounter. Before turning to whoever might have accompanied the individual to the setting, engage the patient and determine the patient’s ability to provide the information you need.
  
• DO establish “yes” and “no” responses. Determine how the individual says “yes” and how the individual says “no.” Different individuals use different ways of indicating yes and no, ranging from head nods to eye movements.
  
• DO ask if the individual has some other means they wish to use to communicate. The individual might have an electronic communication device or some type of manual communication device that he or she might want to use in communicating with you, allowing you to expand your questioning beyond a simple “yes/no” approach. However, individuals who use these devices don’t often have them in the clinical setting, particularly in emergency situations.
  
• DO ask if the patient is in discomfort and if he or she can show you the location of the discomfort. Some patients may be able to point to the area of discomfort or concern; others may have some other body movement to attract your attention to that part of the body. If you’re unsure whether the patient is using an intentional movement to tell you something or if the movement is unintentional, simply ask the patient.
  
• DO use a body region approach if the patient can’t show or tell you the location of the discomfort. Starting with “Is the discomfort above your waist?” ask about progressively smaller body areas until you have narrowed down the region of the complaint. Avoid asking if the discomfort is “in your head.” That question can have multiple meanings but is typically interpreted as “Do you have a headache?” A “no” response to this question might be misleading if the patient has ear pain, mouth pain, or some other discomfort that is, indeed, in the head area. It is typically better to ask “Is the problem in your neck or above?” or “Is the problem in your head area?”
  
• DO seek numerical or time information in a systematic fashion. Establish that the response falls within a certain range, then systematically bisect or otherwise narrow the range until you arrive at the answer.

DON’Ts

• DON’T assume that communication impairment is accompanied by cognitive deficit. Keep in mind that verbal communication and cognitive ability are two different (but at times related) issues. Impairment in verbal communication does not mean that the person has cognitive deficits, and the quantity of information you can obtain from the individual is not necessarily limited by his or her lack of verbal communication.
  
• DON’T ask “double-barreled” questions. Questions in the form “Do you feel A or B?” do not have a single “yes” or “no” answer. Make sure that your questions can be answered with a simple “yes” or “no.”