Where to assess the patient

The patient needs to be placed at her maximum advantage to provide clinical information in whatever setting the assessment takes place. This has to be stated explicitly because the doctor is often required to take active steps to ensure it. Account has to be taken of special sensory impairment. Poor vision may need lights to be switched on so that the patient can see who is asking her questions. Distracting noises will make it even more difficult for someone with hearing impairment to grasp what is said. Surprisingly often, this may require a request that the television be switched off. Most importantly, examiners need to sit facing the patient with the lips visible, to speak slowly, and to enunciate words carefully. The patient should then be asked if she can hear properly. Simply shouting at her is not a substitute for these simple steps.

Social customs vary within and between societies. For instance, in the United Kingdom and the United States the use of first names is much more acceptable with younger adults than it was 40 years ago. With the current generation of older patients it is not. For them to be called by their first names unbidden is disrespectful and infantilizing. Even if nurses and other non-medical staff do so, doctors should not use first names, unless specifically invited. Instead, the surname plus appropriate title (Mr, Mrs, etc.) is correct.

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