The Cognitive Load of Everyone Else: How Understanding Your Reader Makes You a Better Clinician

In this episode, we're looking at collaboration through a functional cognition lens and making the case that effective communication isn't just about what you're transmitting. It's about the cognitive state of the person receiving it.

Whether you're writing to an NDIS planner at the end of a saturated workday, creating instructions for a support worker who'll pull them out in an emergency, or trying to build genuine trust with a client who's already exhausted from navigating the system — the information alone isn't enough. You need to understand who's reading it, what they're carrying, and how to structure your communication to actually meet them there.

We cover:

• Why your NDIS reports aren't landing (and it's not the clinical content)
• A real example: writing two completely different hoist transfer documents for the same client — and why that was the right call
• The hidden cognitive load your clients are carrying before you even walk in the door
• Practical strategies: email summaries, decision tables, equipment portfolios — and why these are functional cognition interventions, not just admin tools

This is the clinical skill we weren't trained in. Let's fix that.

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Transcript

SPEAKER_00 0:00

Welcome to Cognitive Capacity Chat. This is the podcast for the therapist ready to think beyond the therapy room. I talk about our cognition as our foundation, not just for our clients, but for ourselves. Because the way we think, organize, and live directly shapes our clinical work, our capacity, and longevity in this profession. I'm Imogen, an OT, here to bring you practical conversations that fit into real life. This podcast is for the therapist who wants more depth, more clarity, and more life. Welcome. Welcome back to Cognitive Capacity Chat. I'm Imogen, and today we're talking all about collaboration, but not in the fluffy communication is important kind of way. We're talking about it through a functional cognition lens. Because here's the thing: you can write a technically excellent report, design a thorough care plan, or give a perfectly clear set of instructions and still completely miss the mark. Not because your information was incorrect, but because you weren't thinking about how to communicate in a way with the person who is on the receiving end of that report or that plan. And I think that this is one of the most underrated skills in community OT practice. And I think it's something that as occupational therapists, we should really be taking into consideration. So when we think about functional cognition as a clinical framework, we spend a lot of time thinking about it from ourselves, from a workflow, or applying it to our clients. So their capacity to plan or to sequence or to manage information in the context of their daily life. Maybe we need to deliver information in various different ways to actually take our support to the next step, our service to the next step. But how often do you truly think about and apply that in the same lens as to the people you are writing to, presenting to, or collaborating with? So this could be your NDIS planner, your TIC support coordinator, your NDIS support coordinator, your client support workers, the builders, the equipment suppliers, or the client themselves. And so every single one of those people is walking into your communication with their own cognitive load already running, their own context, their own pressures, their own competing demands, and their own intellectual understanding of the service that we're providing. And if you don't account for that, if you treat communication just as an information transfer rather than a cognitive process, you're just going to find barriers when you are trying to collaborate with these people. Because, yes, the information is correct, but it didn't land because we are writing to ourselves. We're writing to the person receiving the information. So this is what this information is all about the communication piece of cognitive load. So I want to start with NDIS planners because I do feel like this is a common spot for OTs to land and often commonly complained about by OTs where they feel the most sense of frustration. So you can write a really thorough report, you can document everything, and you feel like you have articulated the functional impact and you're really proud of that. And then the funding comes back and it doesn't reflect what you are really recommending. And my concept is, and I remember at university how lecturers would often say, you need to get into the person's shoes, you need to have empathy. And it was all this concept about you need to actually consider what your client is experiencing. But we also need to figure out what the reader is experiencing. So if you think about an NDIES planner's day, they are going to be reading a high volume of reports across a huge range of clients, disabilities, severities, funding types every single day. You think about your caseload, which is likely 30 clients, you're not sitting in front of a computer the whole day, though. They're also navigating policy changes, internal pressure, and most likely, and I like to think positively, the human need to want to support a person that is in front of them, but also being in a workplace where they need to apply a framework which doesn't always make it easy. They're learning about your client from your report. And they're likely reading it quickly because we just talked about them being overwhelmed. And I can only imagine their cognitive load, how overloaded they are. I work in a niche area because I'm very aware that the complexities of various disabilities is overwhelming in itself. Imagine doing that every single day and having to make legislative funding decisions. So, what does it mean for how you write and how you communicate your clients' needs? You need your clinical reasoning to be immediately legible. It needs to be clear, concise, and not assumed from context. You need to be really clear with the functional impact. It needs to be explicit and it needs to be connected directly to the disability. It needs to be clearly articulated the exact interventions they need and the direct funding that they need to support that clear symptom. And it needs to be really logical. It needs to be if you agree with this symptom, this functional impact, this is the recommendation. Because then they can clearly also step out if they say, we don't agree to this symptom, then they can clearly just sort of scratch out that rather than scratching out the entirety of your recommendations and the report. Because the person reading it doesn't have the bandwidth to do that interference, the multi-step contextual problem solving in their brain because they're just doing so much work. They've just got such a volume of work that they need us to articulate really clearly in line with the framework that we are supposed to from a perspective that they can make a clear decision on. And so when you write from this functional cognition lens and you anticipate what your reader's cognitive capacity is going to be, you can structure your communication to meet their capacity. And it doesn't mean that you are not writing in a therapy language or from a lens of your clinical perspective. It just means that you're writing it in a way that makes sense for the reader. So when you think about another example, you might think about writing to support workers and providing guidelines that actually the support workers need to read. Now, I recently did two quiz transfer guidelines. And within these are two diff varying guide varying transfers. One was an everyday transfer and one was an emergency transfer. So the clinical information underpinning both of them is the same, right? They need to do the equipment, that the support workers need to know the equipment, the person's presentations and key considerations. But the instruction documents look really differently, and it was intentional because the everyday transfer instructions are going to be used by support workers who do it regularly. If they work with this participant, they are going to do it ongoing. And they are likely going to become familiar with the steps, they're going to build that procedural memory over time. And the document can be really thorough, really educational, because it's likely going to live in a care manual that is going to be reviewed at the initial engagement of the support workers, at the annual review of our transfer guidelines, but it's likely not going to be something that's going to get pulled out regularly. But then the emergency transfer instructions were a little bit different because that document is going to live where an emergency is happening. So a fall, a medical event, something urgent. The person using it in that moment is going to be under a lot of stress, and probably their nervous system, their capacity is going to be reduced, right? So they need clear directions fast. They don't need paragraphs. They need to know what do I do right now? What are my clear steps? And how do I get it right? So it's the same information, but you can see how clearly it's a completely different context, and they're going to have completely different cognitive capacity in that moment. So this is where we see functional cognition being applied as a communication aid, as a skill to help us educate our support workers and our environment. Then there's the clients. So specifically the ones who get often get labeled as difficult. I guess I want to offer an alternative view for what we call complex clients or difficult clients, because in my experience, the clients who come across as really guarded or resistant, maybe even a little bit combative, are not being difficult just to be difficult. Usually they're the ones that haven't felt heard or who've had important decisions made about their life without them being included. It's not being a collaborative approach. They've sat in rooms where things have been discussed about them and not with them. And by the time they get to you, they're just carrying this enormous amount of fear, this enormous amount of cognitive load where it's not even related to you as a therapist. It's related to the overwhelming amount of information that they've had, the unfortunate experiences that they've had with previous therapists. And additionally, just the amount of capacity it takes just to be a person living with disability in the system that we work in. Think about what it takes to live an ordinary life. You need to get your daily needs met, you need to eat, you need to engage in personal hygiene, you need to tend to your home, pets, children. You need to have interpersonal relationships of family members, friends. You need to know your finances, all of those activities of daily living that I should know off the top of my head. You need to know them all. But think about a person with a disability also needs to manage carers coming in and out of their home every single day. That's a so social and a sensory demand. And then you've got all of those people coming in, and they've got multiple health professionals, all who need something from you. That annoying therapist that needs to ask you all about your daily life and makes you work really hard. You've got insurance companies or funding bodies requesting reassessments, requesting more reports, changing their policies and procedures. And you've got multiple, you've got equipment suppliers needing information coming in, you've got equipment breaking down or needing maintenance. You've got medications to monitor. Your GP is likely giving it new medication, then you've got to monitor the symptoms. That's not related to the funding body, so you've got to try and know how you're going to pay for it. And then you've got any reviews that come up as well. And I would also anticipate you've got sensory sensitivities. It's common for a person to have sensory differences with a person with disability, but particularly how our sensory threshold can be met so quickly if we're having people in and out of our home or information flying at us from all different directions. So the cognitive load of being a person with a disability who is actively trying to manage their care is very substantial. And so when we walk in as a person who is assessing them, we're just adding load. And so, do we create an environment where clients are generally collaborated with, or do we just feel like they're on the checklist? And so we need to think about if our client is having all of these people come into their home, they're feeling overwhelmed, you're likely asking them a lot of questions. I know for me it's a lot of complexity around wheelchair scripting or home modifications or comprehensive hoist transfers or care guidelines. And it's all well and good that they've discussed this with us, but we need to think about how they're going to remember that. Because we go away and we write our case notes, and that's great because we can reference, go back and reference them. What do they have that to reference? Can we create a health journal for them? Can we create an email summary after the session so they don't have to feel like they have to rely on their memory to recall everything? Do we need to link in their external stakeholders like their support coordinators or their next of kin or their significant other so that everyone's across the same points? Because it it takes steps, it takes cognitive load away from the client when we are able to help them with that compensatory strategy. It turns an overwhelming conversation and meeting into something that they can reflect on and engage with. And when their significant other comes home from work and says, Hey, how did your occupational therapy appointment go today? They're able to pull up that email and clearly articulate it. Or when you say, Hey, what did you think about your different wheelchairs that you trialed after a night? They can pull up that email, they can pull up that summary and go, Oh, this is what I thought, or this is what I was looking for. I just need clarification. So consider how we are actually delivering that information that we write in our case notes to our clients that they need to remember. So another example of this is uh equipment matrix. So we gather all the information related to the equipment that they have and we put down when it was supplied, when they should get maintenance, when they should have an equipment supplier, equipment repair, review maintenance. So that one, they are able to follow up if the equipment breaks down without having to come through us. We have also given them more control over their own equipment needs so that they're not feeling like they're really dependent on that on us. And that also helps us. It takes away the cognitive load for us. I also use it all the time. When my clients say, Oh my gosh, my bed has needs, it's not working, it needs a repair, pulling up that AT matrix, clearly seeing where that bed is supplied from, when it was supplied, if it would be under warranty, and quickly order organizing a service is so much easier than scrolling key search terms in my case notes to try and find out when that bed was delivered. So in that notion, that's another form of communication. And it's just not just about the information that you are giving, it's about the conditions under which you are delivering it to the reader or the listener, how they receive it, process it, and act on it. So when you truly step into other people's cognition capacity, when you truly step into their shoes, how are you actually delivering the important information that they need to know? We were trained to write well and to document thorough thoroughly and to cover our bases. But what about actually applying being functional to all of those document pieces? Or how do we go the extra step to make what we quote unquote call difficult clients be less difficult because they're more likely to understand what's actually happening because they've got a paper trail, they've got their health journal. What I really would like you to step away with today is how when you're writing a document, when you're communicating with someone, what is something small that you can do that will help them? Is it an email summary? Is it writing a report that an NDIS planner can clearly read and articulate what you're trying to request and why? Disability, symptom, functional impact, intervention. That's as easy as it needs to be. But you can see how we are reducing the amount of information that's coming in to allow them to actually understand that. So thank you so much for listening. And and if this episode resonated and thank you so much for listening and checking in, I will see you next week. I would love to hear if this episode resonated with you. You can email me Imogen at onot.com.au or my Instagram and LinkedIn DMs are always open. Please do not hesitate to reach out to me. I would love to hear you. And if the whole concept was overwhelming or felt like something that you want to do, but you don't have capacity to do it. It's going to be released to my newsletter first. And jump on that because it's gonna be a little bit more than a little bit.