STOP PRESS: We don't all make tea the same way (and not all men like football!)

This is a somewhat old post that I had been taking my time to finally post it so here goes..it is based around two letters that were submitted to the Telegraph way back about a year ago:

“Tea test

SIR - Office juniors are not the only people who have no idea how to make real tea (Letters, July 15). My mother was assessed last year by an occupational therapist as to whether she was fit to return home after a stroke. The OT considered she was not fully compos mentis. Why? She warmed the teapot with hot water, then poured it away before putting leaf tea in the pot and adding boiling water.

I was not believed when I pointed out that this method was correct and she had not been making the tea twice over.

N. Beale London, SE3”

Telegraph 18 July, 2006

I can’t of course speak on behalf of the OT in question but I know this complaint, if not directly the same, is not unheard of (from both patients and staff). The therapist in question has not been able to reply to these letters but there could of well been a reasonable reason for saying these patients in question were not “compos mentis”. Or of course they never actually said those things but hinted towards it. Whatever the case its simply not on.

So why is it that this sometimes occurs? Well the problem lies with that little thing called activity analysis which OT’s are supposedly fantastic at. The problem in particular is that we all have our preconceived idea of how a person should do something. Tea making is a classic example used by OT’s as a every day activity and as James suggests it is a somewhat subjective measure:

“One of the main criticisms of kitchen assessments in hospital - usually in the hospital OT kitchen, is that it isn’t actually the same as in the person’s own home, where they will probably be returning to. Someone might quite happily manage to do all sorts of things in their own kitchen, but appear to be confused and unable to the OT kitchen”

With much regret to my workmates I regularly provide an example of getting this activity “wrong” and that’s simply because I don’t make tea. Actually scrap that - I don’t drink tea. Infact my friends and family ban me from trying to make tea because I’m so lousy*. Yes, I am a total social outcast! God forbid the day if I have a brain injury and someone asks me to make a cup of tea - I would invariably fail with the above example.

Here’s a little side story which will let you into a little about me. I spoke to an old computer programming friend the other month and completely unprompted (regarding my current role as an OT) he said the following:

“I had to write a program for a job interview to simulate making a cup of tea. do you know it had about 200 steps?! a cup of tea is hard you know! … the worst bit was working out which order to put it all in - I’m a milk before tea man myself but realise its not the common method”

Aye, I certainly do.. there are more coincidences between computer programming and OT but that is for another post. The point is that OT’s sometimes forget the complexity of the task and more importantly the route in which it is taken. There is also another thing to remember we all have cultural differences between the way we do things. George Orwell recognises this issue when he talks about the “Russian style” of tea drinking in his essay “A Nice cup of tea”:

“Lastly, tea—unless one is drinking it in the Russian style—should be drunk without sugar. I know very well that I am in a minority here. But still, how can you call yourself a true tea-lover if you destroy the flavour of your tea by putting sugar in it? It would be equally reasonable to put in pepper or salt”

Unlike George we need to be understanding of these cultural differences, and some would argue this means learning about them. If you aren’t aware, the strange technique of warming the teapot is not unusual and infact it has been declared as the scientifically best way of making tea:

“Yesterday, he said the keys to producing the perfect cup were using soft water, warming the pot before filling and allowing the tea to brew for three minutes. It was also essential to use loose-leaf Assam tea rather than tea bags - “they slow down the infusion”.” From the Guide to the perfect cuppa starts a storm in a teacup

And now for the second letter in this posting.

“World Cup Revision

SIR - I was interested to read Neville Beale’s letter (July 18) about his mother who failed her stroke recovery test because medical staff did not understand the old-fashioned way she made tea. It does not Surprise me.

Eight years ago, during the World Cup, I had a stroke. The nurses were going to write me off because I could not answer their questions on football. They would not believe my wife when she told them I had no interest in the subject. “All men know about football” the said.

It took a visit to the hospital by my boss, to converse with me about nuclear engineering, to convince them I was actually compos mentis.

Since then, the joke every World Cup has been that I have to do my revision in case I have another stroke.

Richard Chester-Browne. Warrington, Cheshire.”

Telegraph 25 July, 2006

So what about the second letter writers experience? What can be the excuse for that? Lets imagine for a moment that the writer meant “OT’s” rather than “nurses” which could well have been the case*. Well, if that’s the case then I have to say there isn’t really any excuse - and even if they were nurses that’s still no excuse. OT’s *should be skilled in being client-centred and at the heart of this, working out what it is that engages & motivates individuals. We realise that no-one individual is the same and we are all different. Or at least we should.

In certain environments mistakes do happen and the reasons are often so numerous and complex that no one person is to blame. The football one is a classic mistake that I have kind of witnessed when you run a group five times a week, every week and your mind goes blank when trying to think of a current affairs topic to discuss and the general group seems to like football - but on a one-to-one basis? The mistake is perhaps borne out of routine and to a certain degree the human trait of stereotyping people. It can be difficult to assess a persons interests if they cannot easily communicate or their friends & relatives are not around. You could argue that if you take the average OT, their understanding of nuclear engineering would be quite limited (or perhaps “we were never taught that at college!” would be the response) - but now I’m stereotyping right?! So if you have been in this situation buck this worrying stereotype; What trouble would it take to google “nuclear engineering” and spend 5 minutes over lunch discovering that the man may be interested in that MRI scan you have recently taken of his brain! (if you haven’t worked it out, “nuclear engineering” covers a whole range of topics - one of which is nuclear medicine/physics read wikipedia for more info). What, do I hear you say “We don’t have time to look on wikipedia what nuclear engineering is!”?? Im afraid that I would equally say “this isn’t a luxury - its part of your job!”

* My Brother believes that there is a more sinister reason for me not being able to make tea: that it gets me out of making the tea. A clever approach that can get you out of doing all sorts of things but I have to say in this example its simply not true.

** I admit I hold onto this line of thought for quite sometime. If they were nurses then it could be more of an argument for OT’s on that ward which turns the argument into something entirely different..!