Not One Word Is Said vs. Dialogue

Not one word has been said to the patient! Why? The patient is comatose.  We don't think of not talking with patients, otherwise. Why don't we talk with comatose patients?

•  They don't seem to hear or respond.
•  Speaking with these patients doesn't seem to affect their outcome.
•  Time spent with them appears to take time away from other, more viable, patients.
•  Some feel foolish talking with unreceptive and unresponsive patients.
•  Such conversations don't seem like natural dialogue between two people.

Nevertheless, there is some preliminary--but unverified--data suggesting that comatose patients may actually hear. They do have normal auditory evoked brain stem responses, regardless of the level of coma. 

We do have reasons to speak with the comatose patient:

• Suggestive evidence that comatose patients do hear.
• We do speak with non-responsive patients when only one party speaks:  both in the nursery and in the operative recovery room.
• Other health professionals may learn respect for helpless and vulnerable individuals from our examples.
• We speak to reinforce our role as dependable care-givers, both for the patient and for those who are still able to participate in health care decision-making. 

There is no evidence, however, that talking with patients is time consuming.  I recommend:

• Recognize the patient by name.
• Inquire about the patient's overall state of health.
• Identify yourself.
• Tell the patient the reason for your visit.
• Briefly, clarify and explain any procedures planned.
• Say words that are comforting, but not misleading.
• Talk with the patients because:
  • Some of them may hear.
  • Some of them may get better.
  • Because we are caring, humanistic professionals that care about patients regardless of their comatose state.
  • Physicians feel good caring for patients and want to let others know that.
  • We still care for patients as human beings, even when we cannot affect their care.

Physicians feel good caring for patients and want to let others know that.  We still care for patients as human beings, even when we cannot affect their care.

For further related articles see Answers for Families and Patients:

• Comprehensive Psychiatric Evaluation   (Open New Window)
• Normality   (Open New Window)

See also:

• Your Child (1998 Harper Collins)
• Your Adolescent (1999 Harper Collins)

Return to Answers for Families and Patients
Back to Home Page