Good questions to figure out if a person is well oriented

May 9, 2019 2:25 PM

I’ve been trying to revise the questions I use at work to get a general idea of how clear a client is on what’s going on.

Just brainstorming this a little, so while it will look like a question that shouldn’t be tossed to internet strangers, I’m just kind of getting ideas.

The general idea is to get an idea whether a person is “oriented x3” ie oriented to person, place, and time. Often you get a sense in conversation, but it can be a good idea not to leave it at that.

Ordinarily for what I think of as a very informal mental status exam (I’m not a psychiatrist or otherwise qualified to make a real assessment) I had been asking

1) What’s your address?
2) What day of the week is it?
3) Who is president of the United States.

Question 2 has started to seem a bit unreasonable to me because my clients have mostly been retired a long time and may have no real reason to know if it’s Tuesday or Thursday.

Question 3 runs the risk of turning into a conversation that’s really outside of my role, these days, because almost no one is just going to answer it and leave it at that. (On the one hand I don’t want to contain my feelings if the answer is enthusiastic, because that’s exhausting; on the other, bonding with clients about the flames on the side of our face etc is not a great boundary.)

I could and will do more serious research into this but I’m curious if anyone else does similar work or just has IDEAS.

posted by Smearcase to Human Relations (9 answers total)

For time, maybe "what month is it?"

I'm not sure which of the three orientations #3 is attempting to assess, actually. Wouldn't "person, place, time" be more like "what's your name, where are you right now, what day/year is it?"
posted by showbiz_liz at 3:39 PM on May 9, 2019 [1 favorite]

“What was the weather like when you came in today?” might be a fairly neutral way to assess whether they are keeping track of their surroundings. Name of the facility they are in, how they arrived and when they were at this place last (if they are traveling and not being assessed at home) would all be easy enough to confirm.

Month, season, year, last holiday they celebrated might all be reasonable ways to orient in time.
posted by tchemgrrl at 4:31 PM on May 9, 2019 [2 favorites]

What did you eat for your breakfast?
When did you last go to the toilet?
Who was the last person you spoke to?
posted by Middlemarch at 4:38 PM on May 9, 2019 [1 favorite]

I’ve heard season, but the nurse then was actually wrong because it was something like June 20, which the patient correctly identified as spring. The nurse then told her it was summer. So seasons can be tricky. Months are better than days of the week, but people could easily be confused if it’s near the first or last day.

I’ve also heard patients asked to identify the person who came in with them.

I’m also not sure how the president question works with what you’re trying to assess, but could you ask what city you’re in?
posted by FencingGal at 5:01 PM on May 9, 2019 [1 favorite]

Best answer: I have given the mini-mental exam as part of work (ages ago) and getting the date wrong by one day or saying "Oh, is it the 19th or the 20th?" was counted as correct. But I do think the month would be fine and useful, and if it's the first or last day you might give them credit.

What town/city are we in, or what floor of this building are we on?

Do you need to replace the president question with another cultural touchstone type of question (like, not only can they say the date but their working memories are of the current time)? Or could you go with "What month is it? What city are we in? What floor are we on?"
posted by gideonfrog at 5:23 PM on May 9, 2019 [1 favorite]

As a speech therapist, these are all tricky questions because a lot will be failed due to failures in memory (either verbal - address! Or episodic - floor of building! ) or language skills. You are never going to get perfect questions that probe just orientation because it is a combination of skills. Maybe asking their name, where we currently are (accepting "hospital" or "day centre" etc) and time of day (accepting "morning" "before lunch" etc)
posted by kadia_a at 7:49 PM on May 9, 2019 [6 favorites]

I have been on the receiving end of such questions and apparently got the prime minister one wrong, but not to any great conclusion because in my country that could just mean you weren't paying attention this week.

What would have been more definitive:
Where are you now? ie, what street, perhaps what suburb, etc
Where were you before you came here?
Can you unlock your phone for me? This apparently was a particularly clear indication I was severely concussed as I had no idea.
What did you do today or yesterday?
posted by deadwax at 8:10 PM on May 9, 2019 [3 favorites]

Is it morning, daytime or evening?
How did you get here today?
Can you tell me why we are meeting?
posted by Iteki at 10:40 PM on May 9, 2019 [1 favorite]

I was recently in a very fine and satisfactory hospital, and was mostly asked the showbiz_liz question set.

When I was asked about the US president a couple of times, I was irritated at having to even think about that, and that's not what you want to do to a sick person.

A couple of times I was also asked something like "Do you know what procedure you're here for?" or "Do you know what the doctor is treating you for?" These questions create anxiety, because the patient may not know the precise name of the procedure or diagnosis and may be concerned that the wrong answer may interfere with treatment or cause confusion about the diagnosis.
posted by JimN2TAW at 11:12 AM on May 10, 2019