In my world, there are four basic communication possibilities with patients: statements, demands, questions, and requests. Prodding the patient to clarify which is intended simplifies interactions considerably, especially with kiddos.
- Statement: "I have a headache."
- Demand: "Give me medicine."
- Question: "What causes headaches?"
- Request: "May I have medicine?"
Labeling communications helps tremendously. Even adults often do not have a point when they start talking, and labeling what they're saying helps them to formulate one.
I'm amused by this constellation of communication habits I have because after I work around a group of kids for a while, I start hearing my own words parroted back from them ("I know, I know, that was a statement!").
As a typical example, consider the 12-year-old boy with behavioral issues and an inability to communicate with any degree of respect. He walks up to me and yells, "Nurse X forgot my goddamn Tylenol!" My emotional reaction is, "Don't walk up to me and start yelling about something another nurse did!" But I've figured out a truly workable system for teaching these kids how to communicate better, and it reduces frustration all the way around.
In this case: "OK, that's a statement. You've given me information." This is usually initially followed by more of the same ("I TOLD him I had a headache, and he SAID he would bring me something, and he forgot!"). At first, this step can last a long time ("You're still just giving me statements. Do you have a request?").
Eventually the kid learns that "Can I have some Tylenol?" is the way to get the job done.
They learn. You just have to help them label statements and demands versus questions (needing information) and requests. Things go better for everyone.
I'm surprised at how many people, even most adults, speak in subtexts. It's no wonder communication is difficult. They'll tell long stories from which I'm supposed to guess what they want or need. Sometimes when directly queried they have no clear idea what the goal of the communication is. Most memorably, my old boss four times removed brought me in once and told me the same story four or five times. I finally asked her if the visit was purely informational or whether she was asking for further input or had a request for a behavior change from me. The conversation ended there, and I learned a valuable lesson about the importance of, shall we say, aiding our opponents in constructing their own arguments.