Dealing With A Patient With Learning Difficulties

Dealing With A Patient With Learning Difficulties
Patients with learning difficulties use the healthcare system more than the general population. Unfortunately, many healthcare professionals have little experience with these patients. However, understanding common illness patterns and using different techniques in communication can result
in a successful consultation.

Patients with learning difficulties often have complex health needs. There are many barriers to assessing health care, which may lead to later presentations of illness. Patients may have a high
tolerance of pain — (importnat to remember when examining them.)

Associated health problems
Patients with learning difficulties have a higher incidence of certain problems:
• Visual and hearing impairment.
• Poor dental health.
• Swallowing problems.
• Gastro-oesophageal reflux disease.
• Constipation.
• Urinary tract and other infections.
• Epilepsy.
• Mental health problems ( incidence of depression, anxiety disorders, schizophrenia, delirium, and
dementia), with specific syndromes having their own particular associations (e.g Down’s is associated with depression and dementia; Prader–Willi with affective psychosis).
• Behavioural problems (eg Prader–Willi, Angelman syndrome).

Leading causes of death
These include pneumonia (relating to reflux, aspiration, swallowing, and feeding problems) and congenital heart disease.

The patient’s perspective
Past experiences of hospital are likely to have a big impact on the patient’s reaction to his/her current situation. Most patients have problems with expression, comprehension, and social communication. They find it diffi cult to describe symptoms — behavioral change may the best indication that
something is wrong.

Tips for communication
• Explain the consultation process before starting.
• Speak first to the patient, then to the carer.
• Use open questions, then re-phrase to check again.
• Aim to use language that the patient understands, modifying this according to comprehension.
• Patients may have difficulties with time, so try to relate symptoms to real life temporal events (eg ‘did the pain start before lunch?’)
• They may not make a connection between something that they have done and feeling ill (e.g several questions may be required in order to establish that they have ingested something).
• Take particular note of what the carer has to say — information from someone who knows the patient well is invaluable.