Ask the Expert: The Approach

The Approach
Fortunately there is a basic communication technique that can greatly enhance your ability to communicate effectively. In addition to describing this technique, we will provide you a list of dos and don’ts (see sidebar) that may help you.

Basic communication skills development is the best place to start any communication strategy. In this instance, we mean employing yes/no questions. This may be counterintuitive to many practitioners who are taught that yes/no questions do not involve the patient and thus precludes effective dialogue. With non-verbal patients, establishing a yes/no dialogue early-on is key to effectively communicating and enhancing the patient’s experience and your comfort.

We establish a yes/no system by asking the patient a few questions at the initial meeting. Here are some simple ideas:

Dr. Robey
When I meet with a non-verbal patient for the first time, I simply say, “I understand you’re not verbal – can you show me how you say yes?” I will also ask, “How do you say no?” a couple of times. Caregivers are also helpful – but keeping the patient as the focus, instead of talking to the caregiver only, is most important.

Dr. Eddey
Whenever I meet a non-verbal patient I begin my conversation by asking them, “Do you raise your eyes to say yes?” It is a reference to a book entitled I Raise My Eyes to Say Yes. This book was authored by Ruth Sienkiewicz-Mercer, a woman who has cerebral palsy, spastic quadriplegia with pseudobulbar palsy, that left her non-verbal. Unfortunately, she was also diagnosed with mental retardation as a child, a diagnosis that was incorrect. The book is the story of her life and the title reflects how she communicates. The technique of raising one’s eyes to say yes is used by many non-verbal individuals to communicate. Her memoirs are the story of her life and her struggle to communicate with others.

Other Methods
Of course there are other ways to establish yes/no, including, where possible, head movement and hand gestures. When practical, other modalities employed to communicate effectively with non-verbal patients include the use of computer keyboards and common-phrase boards. Additionally, allocating more time with the patient, such as scheduling longer patient appointments, will allow for a more relaxed atmosphere that fosters appropriate communication.

Implementing an education/training program for this issue, or incorporating these techniques into an existing program for all health professionals, is very important to ensure that all contact is appropriate and effective. While training can take various forms, we have had good experience with a unique twist on a common educational technique currently being employed at medical schools.

Typically, medical schools hire actors to simulate diseases, and medical students are charged with the task of conducting a clinical interview and examination to determine what illness is being portrayed. Our unique twist is a program that involves actors who are non-verbal due to cerebral palsy. The standardized patients that we use here at Matheny have disabilities. The students/trainees learn to establish a yes/no communication system, demonstrating the importance of establishing this system. They pinpoint the problem by asking a wide range of questions.

Benefits