I’d like to return to the topic of “people skills,” with a personal example of how people skills and cognitive skills might play out.
My father lived to be close to 91. In the last three months of his life, he was classified as having dementia, due to his responses to the Standard Dementia Questionnaire (a made-up term, but real questions). I visited my father often during that period, and I would have said that he was cognitively clear.
What his primary care physician seemed to miss was the fact that my father was almost completely deaf, by that point. He had been a B-17 pilot in WW II. On his last mission, his plane was hit by flak, and it developed bad fires in two engines, which maneuvering did not extinguish. He gave the order to his men to bail out, and kept flying the plane so that they could get out. The bomb bay, which would have been the normal exit for several of the men, was in flames. Of the 8 men with him, 7 got out of the plane successfully before it exploded, and they parachuted to the ground. Of those seven, 6 lived into old age; but one died that day, evading capture. My father survived because the plane blew up twice. The first time, he lost consciousness briefly and then came to, pressed against the windshield, with the plane spinning nose down. The second time the plane blew up (there were two 500 gallon fuel tanks, both a little more than half full at that point), he found himself in the air, largely uninjured. B-17 pilots wore their parachutes in a backpack at all times while flying (unlike the crew men), so he had it. He parachuted to the ground; he was taken POW, but survived.
However, this event did affect his hearing. It was always somewhat sub-par after that, but worsened as he aged. The hearing loss that not infrequently accompanies extreme age, combined with the earlier hearing damage, took its toll. He became moderately skilled in lip-reading, but did not have any formal training in it. Nor did we think to suggest that he (and we) learn ASL.
So, if one asked my father, “Who is the President?” or “Who is the resident?” he probably could not tell the difference. Some conversational interactions he could guess, relying on a word or two that he picked up and some general context (if there was nothing that came out of left-field).
A week before he died, I was able to communicate with my father successfully by Morse code, which he had learned in pilot training and had not forgotten. (I googled Morse code on my cell phone.) So I am reasonably sure that he did not have dementia, in the common understanding of the term.
So, long story, what is the point? I would not expect any physician to learn my dad’s personal history far enough to know about the WW II experience. Someone who had good people skills could probably have recognized the extreme hearing problem, given enough time. But managed patient care apparently did not allow for the time. Or a person with good people skills might have listened to the nurses and nurses’ aides, one of whom might have recognized the problem. Someone might have entered it in his medical records earlier, but apparently no one did. The family’s input about the hearing problem did not seem to be considered.
For accuracy, I’d take the physician with good cognitive skills, who might think beyond the surface appearances of things, and identify the actual problem.
