It is important
to know who has intellectual disabilities in Primary Care. There are ways of
identifying someone without embarrassing them. These tips may be helpful from
the moment the person with intellectual disabilities contacts the GP.
People with
intellectual disabilities need to have sufficient time to allow them to speak
for themselves.
TIP ONE: Offer the first appointment to someone who has
intellectual disabilities.
Some people
with intellectual disabilities, because of the nature of their disability, have
difficulty with crowds, lack of space or waiting for a long time. They may get
distressed and upset other patients.
TIP TWO: Offer double consultation time
Take your time
with the person with intellectual disabilities if this is necessary. People
with intellectual disabilities need to be encouraged and empowered to speak for
themselves. Try and work out how much understanding someone has at your first
meeting, and talk to them in a way that they can understand. When you meet a
person with intellectual disabilities who is unable to communicate, ask the
supporter if they have any special ways in which they communicate. Use these
special ways if you can. Also if there are relevant pictures that the person
would recognise, use them.
TIP THREE: Speak to the person with intellectual disabilities
first, and only then check out with the carer if something is not clear. Be
sensitive to the person's feelings and be encouraging.
Try and talk to
the person with intellectual disabilities rather than to their carer or
supporter. Sometimes the supporter takes over and answers questions for the
person with intellectual disabilities. This should not happen; the person with
intellectual disabilities should be allowed to answer for themselves unless
they ask their supporter for help. It is OK for the person with intellectual
disabilities to ask for help.
TIP FOUR: Try asking open questions or changing the question
round to check out if you still get the same response.
People with
intellectual disabilities may not understand the process of the consultation
and therefore have no idea of what to expect or know how to participate. If the
person cannot speak, ask the support worker how the person communicates and use
their method or equipment.
TIP FIVE: Explain the process of the consultation before you
start
• I need to listen to what you say about why
you have come to see me
• I may need to look at the part of you that
hurts
• I will think about what is the matter with
you
• I will tell you what we will do next
People with
intellectual disabilities may, because of previous experiences, be frightened
of some of the equipment used in medical examination. Before you do anything to
the person with intellectual disabilities, show them what you are going to do.
Tell them why you are going to do it, and why you are using the instrument that
you are going to use on them. Tell them if you think it might hurt. Then ask
the person with intellectual disabilities if they understand what you are going
to do.
TIP SIX: Use language that the client understands at a simple
level, or use a communication aid, i.e. pictures or symbols.
Many people
with intellectual disabilities will want to appear as if they understood what
you have said to them and may well be able to repeat back what you said. This
does not necessarily mean that they have understood! People with intellectual
disabilities may understand common words in unexpected ways: e.g. for many
people if you ask about their body, they think of their torso. If you fail, let
the supporter answer, but always direct the question to the person with
intellectual disabilities. The person should always be present if you are
asking questions about them.
TIP SEVEN: Sometimes it may be useful to get information from
supporters as well
Sometimes it is
good to get information from the supporter as well as the person with
intellectual disabilities. You can then see if you get the same information.
There are often differences in the information that you get. It is good to hear
both points of view.
TIP EIGHT: Always check out that the client has understood by
asking them to explain to you in their own words.
People with
intellectual disabilities are very unlikely to understand jargon or medical
terminology, e.g. "Have your bowels worked today?". Some people will
respond to closed questions by saying "yes" because they want to
please. Keep explanations simple. Do not relate them to other ideas (like
plumbing!) as the person may take this literally.
TIP NINE: When you are talking about time, use events that the
person might understand
Some people
with intellectual disabilities have little or no understanding of time. This
may challenge you to explain things to them in different ways, e.g. explaining
how often to take medicines may need more than "twice a day". For
example, it is better to say: take this medicine with breakfast and supper.
TIP TEN: Do not assume that the person will understand the
connection between the illness and something they have done or something that
has happened to them.
People with
intellectual disabilities may not make connections between something that has
happened and their illness or their body and feeling poorly.
