What Should We Do?: Patients who can't speak

Question: Every now and then we may have a cognitively functional patient who just can't speak. Is it acceptable to identify them using leading questions? For example, let's say the patient’s DOB is April 10, 1999. You could ask him if the month of his birth was January. Then ask if it's in March. Then ask if it's in October and so on, eventually offering April. If he answered no to all except April, would that be considered positive confirmation? Then you could follow the same track for date and for the year. I am only referencing a patient with the wherewithal to follow this line of questioning, i.e., trach patient, laryngeal dystonia, etc. What about reading their lips? I want to be able to properly identify all patients, and it seems like this could be an acceptable form. What should we do?

Our response: This is a fantastic question, and a very interesting approach. We're assuming a caregiver or family member is not able to provide the patient's ID on their behalf, which would be preferable. We've mulled this over a good deal, but can't get comfortable with the kind of multiple choice dialog you're asking about.  It's still having the patient affirm something the collector speaks. We don't think the standards will ever split the hair that way. However, we are in favor of creating three charts: one lists the 12 months of the year, the second displays the days of the month from 1-31, and the third lists years, perhaps in columns that go from 1900 to 2010 or similar. Then have the patient point to the day, month and year of his/her birth. That's not affirmation. 

However, you still have the problem of getting them to provide their name. For that, you could simply provide a fourth chart with the alphabet and have the person spell their full name by pointing at each letter sequentially. 

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