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Welcome to Module 1 of What Elders Want.
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In this module you will watch 3 videos. Each video will
depict a different doctor-geriatric patient interaction.
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While you watch each video, make note of how each doctor
interacts with his or her patient.
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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.
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Good luck!
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Did you catch everything? Let’s see
it from the patient’s perspective to
be sure!
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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 chart
b) The doctor might become embarrassed and could make
further mistakes during the consultation as a result
c) The patient might become angry and aggressive
d) The patient might lose trust in and respect for the doctor
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You are correct!
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.
If the doctor becomes embarrassed, they will likely strive to
be more meticulous as they continue the consultation.
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.
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.
2. What is the doctor’s focus during this entire scenario?
a) The patient’s medical concerns
b) The patient’s psychosocial concerns
c) The patient’s previous history
d) The patient’s son
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You are correct!
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.
The doctor does question the patient fleetingly regarding the
patient’s previous visit; however, this is not the primary
focus of the consultation.
Though the patient mentions her son during the medical
interview, the doctor does not address these comments.
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).
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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.
3. What non-verbal communication behaviour could
significantly help the doctor with assessing the patient?
a) Looking at the patient when she responds to questions
b) Smiling at the patient to build rapport
c) Probing the patient further on the presenting problem
d) Touching the patient to examine the patient’s mobility
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You are correct!
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.
Probing the patient is a verbal as opposed to non-verbal
means of gathering information.
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.
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.
4. What impairments does the doctor fail to recognize in the
patient?
a) Physical (mobility) and hearing
b) Hearing and cognitive
c) Cognitive and visual
d) Visual and hearing
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You are correct!
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.
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.
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.
5. What does the doctor physically do that might have
helped improve communication with the patient?
a) She knocks before entering the consultation room
b) She asks the patient how she’s doing
c) She touches the patient
d) She sits at eye level with the patient
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You are correct!
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.
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.
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.
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.
6. What does the patient consistently discuss that the doctor
fails to acknowledge?
a) Her foot pain
b) Her emotions
c) Her breathlessness
d) Her son
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You are correct!
The patient does mention her foot pain but she only
does so once in the scenario.
The patient’s breathlessness is the patient’s presenting
problem and as such, the doctor does not fail to
address this concern.
While the patient does mention her son when she is
discussing her tumour experience, she does not
consistently talk about him.
The patient repeatedly attempts to share her emotional experiences
of her health with the doctor and instead of acknowledging these
comments, the doctor focuses on the medical aspects of the
encounter. For example, when the patient says, “I could have died,”
in reference to her tumour, the doctor ignores the comment and
asks, “Do you have a heart specialist?”. Addressing a patient’s
emotional and psychosocial concerns in addition to their medical
concerns is an important part of providing excellent
healthcare to your patients.
7. In the scenario, what prejudice was expressed that could
potentially hinder communication between the doctor and
the patient?
a) The doctor’s ageist attitude
b) The patient’s ageist attitude
c) The doctor’s partiality towards medical knowledge
d) The patient’s partiality towards emotional knowledge
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You are correct!
In this scenario, the doctor never expresses any ageist
attitude toward the patient.
While the doctor does favour medical knowledge over
emotional knowledge, this partiality would not impact the
doctor-patient communication as significantly
as an ageist attitude.
While the patient does favour emotional knowledge during
the scene, this partiality would not impact the doctor-patient
communication as significantly as an ageist attitude.
When watching the scene from the patient’s point of view, it is
revealed that the patient thinks the doctor looks too young to know
what she is doing. This unfair assumption could prevent the patient
from fully trusting the doctor. Ageism is something you might end
up facing once you start treating patients. Be aware of this
prejudice but do your best to not take offence…you probably just
remind your geriatric patients of their grandchildren! Perhaps being
aware of this attitude can help you remember to ask about the
grandchildren of your geriatric patients—something that could help
you build rapport with them instead!
8. What question does the doctor ask that most significantly
demonstrates the doctor’s genuine concern for the patient’s
well-being?
a) Asks whether the patient has a heart specialist
b) Asks how the patient is doing
c) Asks about the success of treatment following the
patient’s previous visit
d) Asks about the heart tumour the patient had
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You are correct!
The doctor in this scenario does ask whether the patient has
a heart specialist; however, the question is merely
perfunctory and would not likely give the patient the
impression that the doctor is genuinely
concerned for her well-being.
If the doctor had actually listened to, and commented on the
patient’s response to this question, then the doctor would
have demonstrated a genuine interest in the patient’s wellbeing. However, the doctor simply asks the question out of
social courtesy and doesn’t listen to the response.
The doctor doesn’t ask for any details regarding the heart
tumour and she fails to acknowledge the patient’s
description of her heart tumour experience. Asking about
the patient’s heart tumour in this manner is therefore
unlikely to demonstrate the doctor’s genuine interest in the
patient’s well-being.
By following up on the results of the patient’s previous visit,
the patient is more likely to believe the doctor is concerned
with the patient’s wellbeing. If the patient believes her
health is important to the doctor, the patient will be more
likely to trust the doctor’s diagnoses, and might feel more
comfortable discussing concerns that may be more sensitive
in nature (e.g. discussing incontinence).
9. What communication practice does the doctor engage in
during this interaction that provides clarity to the patient?
a) She explains her next steps (her process)
b) She writes down important notes during the assessment
c) She makes eye contact when the patient is speaking
d) She warms the stethoscope before auscultating
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You are correct!
While making notes will improve the doctor’s ability to
recall important information at a later date, this practice
does not provide clarity to the patient.
Making eye contact is an important part of effective
communication with any patient. However, in this scenario,
the doctor does not make eye contact with the patient often,
nor does this eye contact provide clarity to the patient.
Warming a cold stethoscope before pressing it against
someone’s warm skin is a nice gesture, but it does not really
clarify any information for the patient.
A good habit to develop that will help you communicate
more effectively with your patients is to remember to
explain what you are doing before or while you do it (It is
also good practice to explain your reasoning behind any
diagnosis you make and treatment plan you prescribe). By
explaining your process, you allow your patient to prepare
mentally and physically for the next steps of the medical
consultation.
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In addition, explaining process can help the patient feel
more comfortable with you (and the more comfortable they
feel, the more likely they are to actively participate in the
consultation). There’s nothing more disconcerting than being
touched by someone without warning, especially if you
suffer from a visual or hearing impairment that prevents
you from really being able to see or hear what is going on!
10. What poor communication is exhibited by the doctor
when the patient fails to answer the doctor’s question?
a) The doctor frowns at the patient
b) The doctor shouts at the patient
c) The doctor leans closer to the patient
d) The doctor gets angry with the patient
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You are correct!
The doctor might frown at the patient, but frowning would
not be considered the most damaging communication
exhibited by the doctor in this scene.
If the doctor were to lean closer to the patient when reasking her unanswered question, the doctor would
demonstrate good communication as opposed to poor
communication.
The doctor in this scenario does not display any indication
that she is angry with the patient when the patient fails to
answer the doctor’s question.
When the patient does not respond to one of the doctor’s
questions, the doctor raises her voice to re-ask the question;
this can come across as shouting, which can make the
patient feel belittled. If a patient has not heard a question,
it is always best to try to lower the pitch of your voice while
slightly raising the level at which you speak (higher pitches
are harder to hear as we age). Rephrasing the question can
also help the patient understand. Finally, facing the patient
when speaking can help the patient hear better while also
allowing them to lip read if necessary.
11. What’s the one thing the doctor could have done with
this patient that would likely prevent communication failure
in the future?
a) Make eye contact when speaking
b) Ask if the patient understands each question
c) Write out everything the doctor says
d) Inquire about any visual, hearing, or cognitive
impairments
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You are correct!
Making eye contact would allow the patient to lip-read,
which could help subvert miscommunication resulting from
the patient’s hearing impairment. However, the doctor could
do something else that would be even more useful for future
encounters.
Asking if the patient understands each question is a poor
choice because a) it would be redundant to ask about the
patient’s understanding if the patient is responding easily
to the doctor’s questions, and b) it could
come across as patronizing.
It would be very time-consuming for the doctor to write out
everything said to the patient. In addition, the patient could
have a visual or cognitive impairment that might prevent
her from being able to read what the doctor writes;
or the patient might not be able to read due to
low literacy levels.
The patient failed to hear one of the doctor’s questions
because the doctor was unaware of the patient’s hearing
impairment. Often geriatric patients will forget to wear
glasses, hearing aids, dentures etc. which can disrupt their
ability to communicate effectively. As well, geriatric patients
are less likely to be forthcoming about their impairments.
Doctors are encouraged to inquire about potential
impairments when seeing new geriatric patients. Once they
have been discussed and noted in the patient’s file, the
doctor needs to try and remember to check that patients
with impairments have their assistive devices.
12. What important communication behaviour does the
doctor consistently fail to do?
a) Smile
b) Nod
c) Make eye contact
d) Enunciate
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You are correct!
At the beginning of the consultation, the doctor does make a
point of smiling at the patient. While she could smile more,
there is something more significant to improving
communication that the doctor fails to do.
The doctor does nod when she acknowledges the patient’s
response to her questions. However, there is something
more significant to improving communication that the doctor
fails to do.
During this scenario, the doctor speaks fairly clearly and
does not appear to mumble. Instead, there is something
more significant to improving communication that
the doctor fails to do.
Throughout almost the entire consultation the doctor fails to
make eye contact with the patient. This lack of eye contact
can prevent the patient from elaborating or raising
additional concerns due to feeling as if she is a burden to
the doctor. Research indicates that making eye contact
during medical consultations helps to improve rapport
between doctor and patient because eye contact indicates
active listening and respect for the patient.
Ready to try the next scenario?
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1. What is the most obvious communication barrier in this
scenario?
a) The patient feels as if the doctor is God and therefore is
not to be questioned
b) The patient feels as if the doctor isn’t listening to him
c) The patient feels that the doctor is rushed
d) The patient feels that the doctor doesn’t care about him
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You are correct!
In this scenario, it is not clear whether or not
the patient sees the doctor as “God.”
While it is very clear that the doctor is in a rush,
this is not the most obvious communication
barrier in this scenario.
While the patient probably has the impression that the
doctor doesn’t care about his well-being, this feeling can be
attributed to something the doctor is doing (or failing to do).
Attentive listening is one of the most important aspects of
the medical consultation. When a patient feels as if their
doctor is listening, they are more likely to trust their
doctor’s diagnosis and follow their treatment plan. When
the patient feels the doctor is not listening, they are more
likely to stop participating in the consultation. By refusing
to participate, or by only contributing the minimum
amount of information, the accuracy of the doctor’s
diagnosis could be compromised.
2. What attitudinal barrier hinders the communication
between the doctor and patient during this scenario?
a) The patient’s ageist attitude
b) The patient’s racist attitude
c) The doctor’s ageist attitude
d) The doctor’s racist attitude
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You are correct!
Unlike in the previous scenario, we are not privy to any
ageist commentary on behalf of the patient. It is therefore
safe to assume that the patient does not harbour any ageist
attitude against the doctor.
While it is possible to encounter patients who hold racist
attitudes that will hinder communication with doctors who
look and/or sound different from themselves, the patient in
this scenario does not express any racist attitude towards
the doctor during the scene.
While it is possible to encounter doctors who hold racist
attitudes that will hinder communication with patients who
look and/or sound different from themselves, the doctor in
this scenario does not express any racist attitude towards
the patient during the scene.
The doctor clearly states that he believes the patient’s
problem could be a result of the patient’s age. Many good
doctors have and will hold the assumption that age is to
blame for geriatric patients’ medical ailments. While it’s
true that patients’ bodies and minds can slow with age,
often this slowing is a result of other factors. For example,
when seniors suffer from an unidentified impairment, such
as a hearing impairment, they can become depressed, which
can lead to mental and physical deterioration.
[Continued on next page]
In addition to the impact on diagnosis, ageist attitudes can
also cause the patient to feel unvalued, to feel a lack of
control over their illness, and to distrust the physician.
3. What physical barrier is also a communication barrier in
this scenario?
a) The patient’s hearing impairment
b) The patient’s cognitive impairment
c) The patient’s physical impairment
d) The patient’s visual impairment
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You are correct!
In this scenario, it is never indicated that the patient
suffers from a hearing impairment.
While it’s possible that the patient may suffer from a
cognitive impairment, in this scenario,
there is no indication of such.
The physical barrier that is also a communication
barrier is not the patient’s mobility.
Because the doctor fails to ask if the patient suffers from
any impairments, the patient’s visual impairment prevents
the patient from providing the doctor with accurate
information regarding his medications. The patient’s wife
may not know about all the patient’s prescriptions, so the
patient’s inability to verify the accuracy of the list might
lead the doctor to misdiagnose the patient. Thus, it is
always important to ask geriatric patients if they have any
impairments and if they do, to remind them to bring and
use any necessary assistive devices.
4. In this scenario, the doctor consistently practices what
good communication behaviour?
a) Probes the patient about the presenting problem
b) Smiles at the patient to build rapport
c) Makes eye contact with the patient
d) Tells the patient his next steps
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You are correct!
The doctor asks the patient a lot of questions regarding the
potential cause of the patient’s illness; however, this
probing is strictly medically-oriented. Also the doctor
fails to really listen to or consider the patient’s
responses to these questions.
The doctor in this scenario almost never smiles at the
patient during the consultation.
In some ways the doctor does reveal the next steps in the
diagnosis process; despite the fact that the doctor is
ordering more tests, the doctor already seems to have a
diagnosis in mind (i.e. old age).
The doctor consistently makes eye contact with the patient,
especially when the patient is talking to him. Though the
doctor fails to actually acknowledge the patient’s concerns,
making eye contact usually indicates attentive listening.
When patients feel their doctor is listening to them, they are
more likely to trust the doctor and to reveal information that
might help the doctor make an accurate diagnosis.
5. What physical action on the part of the doctor might
prevent the patient from communicating?
a) The doctor’s constant eye contact
b) The doctor’s constant shifting
c) The doctor’s constant use of crutch words like “umm”
d) The doctor’s constant note-taking
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You are correct!
While the doctor does make eye contact pretty consistently
throughout the scenario, usually eye contact indicates
active listening and acts as a communication
facilitator as opposed to a barrier.
While the constant use of crutch words can make the
information a doctor provides more difficult to follow, crutch
words more often indicate thinking, which is something
patients want their doctors to do. In any case, crutch words
do not fall under the category of physical actions.
As we saw in the previous scenario, note-taking can become
a barrier to patient communication. In this scenario,
however, the doctor takes no notes.
The doctor in this scenario certainly looks like he is in a
rush. He constantly shifts his weight from foot to foot, and
he acts impatient while he listens to the patient. While
patients understand that doctors are busy, patients will
actually withhold information from a doctor who is very
clearly itching to get out the door. When a doctor looks
pressed for time, patients feel unimportant and unvalued.
Be sure to look calm and collected when working with your
patients. And remember, glancing at your watch for
anything other than checking a pulse is a guaranteed
way to make your patient feel rushed!
6. In this scenario, you watch the end of a medical
consultation. What does the doctor fail to do before leaving
the consultation room?
a) He doesn’t provide the patient with treatment options
b) He doesn’t explain the patient’s next steps
c) He doesn’t listen to the patient’s concerns
d) He doesn’t verify the patient’s understanding
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You are correct!
Because there is no real diagnosis made, there are no
treatment options to provide to the patient.
The doctor in this scenario could certainly take a little more
time to elaborate on the patient’s next steps; however, there
is something else the doctor should have done
before leaving the room.
Unfortunately, the doctor fails to listen to the patient’s
concerns throughout this entire scenario, not just
at the end of the consultation.
It is always important to ensure your patient understands
their diagnosis and treatment plan. To verify your patient’s
understanding, have the patient repeat back the information
you provided to them. Don’t ask the patient if they
understood everything; this question will likely lead to a
nod, even if the patient didn’t understand. You can also ask
the patient what questions they have for you, which subtly
indicates that you expect the patient to ask a question. This
wording will help encourage patients to actively seek
clarification for anything they might not have understood.
7. In the scenario, what language-based communication
barrier hinders the communication between the doctor and
the patient?
a) The doctor’s accent
b) The patient’s cognitive impairment
c) The doctor’s use of jargon
d) The doctor’s reliance on a written note for information
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You are correct!
While the doctor in this scenario does have an accent,
the patient doesn’t seem to have any difficulty
understanding what the doctor is saying.
While it’s possible that the patient may suffer from a
cognitive impairment, in this scenario,
there is no indication of such.
The written note provided by the patient’s wife is not a
barrier to the communication in this scene,
even though the patient’s visual impairment
prevents him from reading it.
Research indicates that geriatric patients become very
confused and frustrated when doctors use medical language
during consultations. Patients want doctors to explain
diagnoses and treatment plans using plain language. If the
patient clearly understands their diagnosis and treatment
plan, they are much more likely to willingly and actively
participate in treating and/or controlling their illness.
Only one more to go!
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1. What should a doctor do anytime a patient comes to a
medical consultation with a surprise visitor/companion?
a) Ask the companion to leave
b) Ask for a private chat with the patient
c) Ask for a private chat with the companion
d) Ask the companion to decipher the patient’s needs
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You are correct!
While asking the companion to leave is an option, generally
patients bring companions to consultations because they
need and want the support. Patients therefore usually want
the companion to be involved in the visit. By asking the
companion to leave, a doctor would be ignoring the wishes
of the patient to have a companion be present and
part of the consultation.
While asking for a private chat with the companion in the
form of an appointment to discuss the companion’s stress
levels can be appropriate at a later date (especially if they
are the primary care-giver for the patient), it is not an
appropriate course of action the first time a patient comes
to a medical consultation with a surprise visitor.
If the companion is not strictly there for translation
purposes, asking the companion to decipher the patient’s
needs would be extremely rude to the patient.
While companions can be a useful set of eyes and ears to
help the patient remember important information,
sometimes companions will insert themselves into the
medical consultation when they are unwanted by the
patient. Since the patient is your main priority, it is
important that the patient be consulted privately
regarding whether or not the presence of the
companion is acceptable.
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Sometimes patients will not feel comfortable having their
companion present during parts, or the entire, medical
consultation. Because elder abuse can be a potential issue
too, it is important to determine whether or not the
companion is a welcome presence. A private chat will also
provide the patient with an opportunity to discuss any
personal and sensitive issues they may not be comfortable
talking about in front of the companion.
2. What does the doctor do when she first enters the
consultation room?
a) She only greets the companion
b) She only speaks to the patient
c) She determines the companion’s credibility
d) She jumps into gathering medical information
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You are correct!
The doctor hardly speaks to the patient in this scenario.
Even when the doctor enters the consultation room
she fails to greet the patient.
The doctor does not determine the companion’s
credibility at any point in this scenario.
The doctor does not begin by gathering medical data.
Unfortunately in this scenario, the doctor fails to address
the patient from the start of the interview. Unless explicitly
stated by the patient, it is best to assume that the
patient is still the primary client with whom the
doctor should communicate.
3. What is the best way to proceed when a patient brings a
companion to the medical consultation?
a) Only address and speak to the patient
b) Only address and speak to the companion
c) Speak to the companion and the patient but direct or
verify all questions and information with the patient
d) Speak to the companion and the patient but direct or
verify all questions and information with the companion
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You are correct!
While only addressing and speaking to the patient seems
like a good option (the patient is the doctor’s number one
concern), companions are generally brought to consultations
by patients who need and want support. Patients therefore
want the companion to be involved in the visit.
Only speaking to the companion is never a good choice,
even if the patient faces considerable communication and
language barriers. The patient should be the doctor’s
number one concern and in order to preserve the patient’s
trust and dignity, the doctor should always attempt to speak
to both the companion and the patient and direct or verify
all questions and information with the patient.
Speaking to the companion and patient but directing and
verifying all questions and information with the companion
would demonstrate that the doctor trusts and is more
willing to deal with the companion than the patient. This act
may make the patient less inclined to participate in the
medical consultation, which could potentially hinder the
doctor’s ability to make an accurate diagnosis.
The presence of companions can be beneficial to the patient,
resulting in more information regarding diagnosis and
treatment, and higher levels of patient satisfaction.
However, when they are very assertive, companions can
hinder patient participation. Since the patient is the doctor’s
primary concern, the doctor should always attempt to
primarily speak to the patient. If the companion provides
information, be sure to verify their contributions with the
patient. The key is to respect the patient’s autonomy while
also welcoming the important support and
contributions of the companion.
4. In what way does the doctor fail to treat the patient with
respect?
a) She calls the patient by her first name
b) She auscultates the patient without warning
c) She speaks to the patient like she would a child
d) She raises her voice significantly when she speaks to
the patient
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You are correct!
Out of respect, a doctor should always address a patient
using a title and their last name (e.g. Mr. Goble) when they
are first meeting the patient. They should only call a patient
by their first name if the patient has requested that the
doctor do so. In this scene, the doctor seems to have
interacted with Pat previously, at which point, we can
assume Pat gave the doctor permission to
use her first name.
The doctor in this scenario actually tells the patient she is
going to listen to her lungs before she does so.
The doctor in this scenario doesn’t really raise her voice
much (if at all) when speaking to the patient.
In this scenario, the doctor adopts an ageist attitude,
speaking to the patient as if the patient cannot understand
healthcare information. Using elderspeak, i.e. talking to
elders as if they are children, is rude and belittling. While it
can be easy to accidentally fall into elderspeak, especially if
a geriatric patient automatically assumes a child-like role
(some do this because they frequently encounter people who
treat them like children), it is always in the doctor’s best
interest to speak to geriatric patients as they would any
other adult patient. The key is to remember that most
patients, geriatric or no, prefer information that is
presented using clear, plain language!
5. What does the doctor attempt to do that could have
demonstrated her concern for the patient had the doctor’s
communication been more genuine?
a) She explains next steps to the patient
b) She questions the patient about her bruise
c) She reassures the patient in response to the patient’s
fear of tests
d) She explains the patient’s diagnosis clearly
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You are correct!
The doctor explains next steps to the companion,
not to the patient.
Questioning the patient about the bruise demonstrates
medical concern for the patient, but not necessarily concern
for the patient’s overall well-being.
The doctor doesn’t make a diagnosis in this scenario. The
doctor speculates on the potential problem, however, she
recommends that the patient get an x-ray before a
diagnosis can be made.
The doctor does demonstrate concern for her patient by
acknowledging the patient’s fear of tests and by reassuring
the patient that she will not have to encounter another
needle as a result of this visit. However, though the doctor
attempts to demonstrate genuine concern, she uses the word
“test” when she is simplifying her explanation of next steps
for the patient. This forgetfulness causes the patient
significant distress, and negates any previous feelings of
being cared for that the patient may have experienced.
6. What does the doctor fail to do during this scenario?
a) She doesn’t provide the patient with treatment options
b) She doesn’t acknowledge the patient’s distress about tests
c) She doesn’t listen to the patient
d) She doesn’t address the patient’s confusion
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You are correct!
Since no diagnosis has been made by the end of the
scenario, no treatment options are available for
the doctor to provide.
When the patient mentions hating tests and needles, the
doctor attempts to reassure the patient. Thus, she initially
acknowledges the patient’s distress about tests.
When the patient speaks, the doctor does listen
attentively to what the patient has to say.
The patient becomes very confused and concerned about her
well-being since the doctor mentions a possible infection
and does not acknowledge or address the patient’s
confusion. The doctor’s poor word choice (i.e. the use of the
word tests) also confuses the patient—something that the
doctor does not address either. Doctors should always do
their best to convey information that is clear and
tailored to the patient’s educational level
(without sounding demeaning).
7. What percentage of geriatric patients would you guess
bring companions with them to the medical consultation?
a) 0-15%
b) 20-50%
c) 65-75%
d) 70-90%
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You are correct!
Research indicates that anywhere between 20-50% of
geriatric patients bring companions with them to their
medical consultations. In general, companions are either the
patient’s spouse or an adult child. Though there is some
evidence to suggest patients become more passive and less
involved when a companion is present, other research shows
that the presence of companions is beneficial to the patient,
resulting in more information regarding diagnosis and
treatment, and higher levels of patient satisfaction. As a
doctor, you will need to know how best to work with your
patient and their companion to ensure positive medical
encounters for both.
Great work! At this point, you should have a better
understanding of your own level of knowledge regarding
communication with geriatric patients.
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Before moving on to the next module, take some time to
review the information on the next slides to learn what
elders want (and what they don’t want) when interacting
with their physicians!
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Connect with the patient socially, not just medically
Listen carefully and attentively; try not to interrupt
Use open-ended questioning as much as possible
Sit close, face the patient, and make eye contact
Be aware of (and ask about) sensory and functional
impairments
Describe your process as the examination occurs
[Continued on next page]
Pursue patient-initiated topics
Keep patient goals, values, and context in mind
When possible, provide patients with treatment
options from which they can choose based on their
personal health goals
Explain using clear language adapted to the
patient’s education/cognitive level
[Continued on next page]
Verify patient understanding by asking the patient to
explain/repeat the information you provided
Write down instructions and next steps for the
patient to take home
Encourage the patient to ask questions (e.g. ask
“what questions do you have” instead of “do you
have any questions”)
Help patients become educated on their conditions
For full list of useful tips and pointers, please refer to the
Tips and Pointers PDF.
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Now it’s time to apply the knowledge you have gained.
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The following exercise will take you through another patient
scenario. During this scenario, you will be presented with
options on how the doctor in the scene should interact
with the patient.
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The choices you make will directly influence the outcome of
the medical consultation, for better or for worse!
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Good luck!
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SELECT ONE:
Greet Mr. Jenkins and introduce self to woman.
Greet Jack and introduce self to woman.
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SELECT ONE:
Ask Lizzy: When did the pain start?
Ask Mr. Jenkins: Are you in pain now?
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SELECT ONE:
Respond: Oh nothing.
Respond: Pain in left hip. I was just writing it down in your
file.
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SELECT ONE:
Repeat question and raise voice slightly.
Rephrase question and lower pitch slightly.
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SELECT ONE:
Inquire about the boys.
Inquire about the pain.
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SELECT ONE:
Begin physical examination.
Ask to begin physical examination.
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SELECT ONE:
Discuss treatment options and ask about patient goals.
Recommend testing and provide a treatment plan to patient.
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SELECT ONE:
Ask: Do you understand everything?
Ask: In your own words, can you explain what you’re to do?
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SELECT ONE:
Ask: What questions or concerns do you have?
Ask: Do you have any questions for me?
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SELECT ONE:
Say goodbye to the patient and companion.
Say goodbye to the companion and ask the patient to stay
behind.
Say goodbye to the patient and ask the companion to stay
behind.
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Oops! You forgot to ask Mr. Jenkins to stay behind for a
private chat! Don’t forget that when a patient brings a
companion for the first time, you should make time to speak
to the patient in private!
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Congratulations! You succeeded in navigating the
scenario with Mr. Jenkins!
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Now you should be ready to apply your skills to future
interactions with your geriatric patients. Be sure to refer to
your Tips and Pointers sheet regularly!
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Best of luck for your future studies in medicine!
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