We all need to have critical conversations with our family members and friends from time to time. For some caregivers, critical conversations pertain to hot-button issues like driving safety and the need for additional help with complex activities like finances, medication management, household chores and meal preparation. For other caregivers, critical conversations might pertain to the caregiver’s own need for respite or a need to delegate specific caregiving responsibilities. As you are reading this, if the phrase “critical conversations” creates a pit in your stomach you are not alone. After all, synonyms for the word critical include words like serious, perilous, and precarious. On the other hand, a critical conversation that finally addresses the elephant in the room could also be viewed as an opportunity for meaningful change or a pivot point – a point that creates clarity and reduces stress for everybody. Critical conversations at their best result in positive change and enhance wellbeing.
As a neuropsychologist I am honored to frequently participate in these critical conversations between patients and caregivers about level of care, driving safety, and other daily issues. I know that primary care physicians, neurologists and other medical professionals also readily participate in these critical conversations. It is part of our role as healthcare providers. We like to help caregivers emphasize what is healthy and safe because in the end it improves quality of life and patient care.
Every family and caregiving situation is unique, but over my career I have concluded that two issues most commonly emerge as caregivers prepare to have a critical conversation about driving or the need for additional help with activities of daily living, or any other important topic pertaining to wellbeing. The first issue is the need for support and validation. Emotions can run high during critical conversations, and often the need for critical conversations brews for a while before finally embarking on the topic to be discussed. Objective input from a healthcare professional can be extremely valuable if strong emotions need to be validated and diffused. For example, caregivers often tell me what a relief it is to know that they are not the only ones who are concerned about their loved one’s driving safety and that it is helpful to bring a professional into the conversation from the start. They feel validated knowing that a professional with objective testing data shares their concerns.
The second issue is the very real need for resources, behavioral strategies, and other ways to manage daily life. With professional support it is often easier to develop meaningful compensatory strategies for hot-button issues. These practical strategies are the bulk of what is discussed when we review the complete picture of cognitive strengths and weaknesses from a neuropsychological evaluation, but they are easily discussed during a regular checkup with a physician as well. All providers can share bits of expertise or tips that are helpful to address the “now what?” questions that inevitably emerge during critical conversations. For example, once it is decided that your loved one needs extra help to keep living at home, what actual steps should be done in the upcoming weeks to make that happen?
If in your caregiving role you need to have a critical conversation, or if there has been a critical conversation brewing in your mind that you are not sure how to start, remember that you are not alone. Physicians, neuropsychologists like myself, and other medical professionals are not just helpful for diagnoses and care planning. As members of your community we are here to help brainstorm, to provide comfort, and to remind you that you don’t have to reinvent the wheel when it comes to obtaining community resources. Come on in. Let’s chat.
— Jennifer Geiger PhD ABPP-CN