At medical school and certainly in training for general practice we were taught about non-verbal communication and its importance in a medical consultation. However, understanding the significance of body language is one thing, being able to interpret it is entirely another, as is being able to convey empathy and understanding with one’s own non-verbal signals. These are skills that come naturally to some but cannot be easily taught and are usually acquired with years of practice. After fifteen years as a GP I would like to think that I can work out what kind of mood many of my patients are in during the time it takes for them to cross the waiting room – clearly if they are being wheeled towards me in a full body cast with extensive bruising and facial trauma I may perceptively deduce that they’re feeling a bit pissed off – but that is just because I am highly skilled in these matters. I can also use simple non-verbal techniques such as a smile and open posture to deflect the considerable anger that builds up amongst patients sitting in the waiting room for more than half an hour assuming their doctor is doing little more than twiddling their thumbs rather than attending to their urgent needs (don’t deny it, you’ve all thought it).
Outside of work I’ve been honing my skills with mum and I can now often understand what she is trying to communicate from very limited information. Since she has all but lost the power of speech the family have had to rely on interpretive skills far more. We take into account the context of the situation, the timing, the facial expressions and level of agitation without even registering that we are doing so as the following examples illustrate:
- When discovered shivering in our corridor at home wearing a small hand towel with hair sopping wet and I ask her about her bath she shakes her head and tells me that the water had been“White” = ‘Actually the water was freezing because you had neglected to put the boiler on but I have forgotten any of those convenient adjectives to describe cold so can only tell you about a colour that one may associate with snow and hope that you’re going to know what I mean.’
- At lunch mum is presented with a bowel of tomato soup, she raises her eyebrows and enquires “Green?” in a hopeful voice = ‘Do you have any of the pea soup we had last week because ideally I would prefer that but if not don’t worry, tomato is fine.’
- When out walking in the bluebell woods an increase in huffing and puffing, an anxious knitting of the brows and repeated glancing in the direction of the car = ‘I’ve had enough now. I know we’ve only walked thirty yards but I’m tired and I’ve seen these bluebells before and I’m a bit concerned about slipping over in this mud and to be honest I’d quite like to go back home.’
- Repeatedly plucking at a part of her body or face whilst pursing her lips = ‘I’m a bit concerned about this spot / itchy bit of skin / broken vein but I don’t really need you to do anything to reassure me other than look at it and nod’.
Suffice to say, my sister and I are now relatively competent at deciphering the signals. However, we are nothing compared to the Jedi mind reader that is my dad, a point beautifully illustrated a couple of months ago.
My parents had driven over to our house for coffee and everyone was in the kitchen. Mum actively sought me out in the hall and had that look on her face that suggested she had significant information to impart. She grabbed my arm and looked urgently into my face. “In the car..” she said and then paused and shook her head. “You know!” she laughed, smiling at me, “You know!!” She paused, thinned her lips and shook her head again to indicate that something sad had occurred.
I was COMPLETELY baffled. “Something happened in the car??” I asked bewildered. She shook her head again and raised her eyes to the ceiling in a briefly out-of-character display of exasperation.
“Dad!” I shouted. “Need your help. Mum’s trying to tell me something!”. We walked back into the kitchen and mum went over to dad and repeated “In the car!!!” with an emphatic little push towards him.
He looked at her and thought for a few seconds. “In the car when we were listening to the radio?” he asked.
“Is it about Terry Wogan?” he asked.
The relief was immediate, “Yes!!!” she replied triumphantly.
“About Terry Wogan dying?” I asked incredulously and turned to dad “How ON EARTH did you know that was what she wanted to say?” He shrugged as if it was entirely normal for him to be able to extract the significant death of a national radio legend from this limited information.
“You should be on ‘Give us a Clue’” I said. And I meant it, they should – imagine the scene, Lionel Blair jumping excitedly in his seat as dad manages to work out ‘The Count of Monte Cristo’ from a limited number of mum’s eyebrow gestures. They’d have cleaned up.*
In fact, now I come to think of it – perhaps there is a niche market out there for gameshows involving people with dementia and their spouses:
- Supermarket Sweep – several rows of a foodstuff that you didn’t actually need.
- Antiques Roadshow – people bringing in items that have become imbued with some strange significance and nobody knows why.
- What not to wear – Trinny and Susannah asking mum repeatedly “Are you sure?? The blue cardigan again? Even though it’s not the weather for winter knitwear and it is four sizes too small and has egg on it?”
- It’s a Knockout! (for carers) where you have to navigate a shopping centre escalator, a public toilet, a crowded cinema and swimming pool changing room before the time runs out on the parking meter.
I could continue but I feel it is important that I get these ideas in to the head of comissioning at the BBC so must crack on.
* Those of you who were born before 1985 and are UK resident will be familiar with this particular panel show. For those who live elsewhere it was a TV programme loosely based on a charades format screened during the eighties and for those of you who are too young to remember it, I feel your loss).