The Wrong Way to Ask Questions

when a patient is experiencing subjective cognitive decline or partial amnesia.

Psychologists and doctors will often use “open ended questions” rather than focused questions when beginning an interview. Questions such as …”what brings you here” or what would you like to discuss today, etc…This will usually bring out polite or vague answers from a patient experiencing partial amnesia or SCD [subjective cognitive decline] because they are having a great deal of difficulty verbalizing what is happening to them. If they are mildly impaired, they will be able to answer a direct question that is put to them.

It takes relatively intact abstract thought and relatively intact memory to be able to answer an open ended question. The patient’s subjective cognitive decline [SCD] will impair their answers to any open ended question. They cannot explain what is wrong with them. That is why they are seeking help, if they are even able to seek help. Often someone is seeking help for them because their behavior has become worrisome.

A much better question to ask a new patient with mood or behavior changes is to question them directly about their memory and their thinking. If Paula’s doctor had asked her whether she was experiencing memory problems, we are pretty sure that she would have responded yes, because the doctor would have supplied her with the words that she was missing. She recognized that she was having memory and thinking problems, she simply had lost the words to say so. Luckily, Paula still retained some insight .

In her first session, she did say she could not read or understand what she read anymore. It took her a lot of effort to be able to retain that thought in her head and then to be able to retain it long to put this thought into words. The doctor did not realize how hard it was for her to say this and missed the significance of what she said. He looked at her educational level and said that she only thought that she could not read because she was depressed. Paula told him that she was not depressed. The doctor thought she was embarrassed about being depressed and was trying to reassure her. But Paula was not depressed; she was upset about her loss of memory and trying to convey this. Paula did not have the strength to correct him. It took months before she was able to try to explain her loss of memory again, [she kept forgetting].

Unfortunately, loss of autobiographical memory in what looks to be a mental illness, is not widely known by doctors, since the patient cannot easily complain of it.

Asking a number of concrete and focused questions at the beginning of any doctor – patient discussion would help patients to be able to bring it up more easily.

Paula would have liked her doctor to ask her the following; ” are you able to think like you usually do? are you having memory problems? can you do your job like you used to be able to? can you carry on a conversation with others like you usually do? ” Paula knew she could no longer do any of these things anymore.

What is the next step? Clearly not psychotherapy or even antidepressants, unless they bring back normal mental and cognitive status. And this has never been the goal of psychological or psychiatric treatment. But maybe it needs to be….because loss of autobiographical memory may be reversible…with the correct treatment.

This is what needs more research; ….

Bringing back working autobiographical memory I think, is the key to bringing the patient back to normal.

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