What we say...
by Adam Thompson, EMT-P
I have been reading quite a bit lately, in EMS trade journals, about professionalism in our industry. A couple of the articles have really stuck with me, and made me think. Sometimes in our illustrious profession, we begin to make the motions without even thinking about what we are doing. This may be a result of experience and confidence, and indicates assertiveness. For instance, you respond to a patient complaining of atraumatic chest pain, you ask if they are allergic to aspirin or if they have any bleeding disorders, then you administer the medication. This probably use to take you a bit longer to do, but after doing it so many times, you can do it without even thinking. This development, however, may be a little too disconnecting. What I mean by that, is the relationship between you and your patient.
PATIENTS ARE PEOPLE
Think about your training labs in EMT and paramedic school. How do we first practice our prehospital skills. The use of training mannequins has become almost universal. We shock them, splint them, chest decompress them, crich them, and intubate them. Not once, did we have to introduce ourself to these inanimate objects, or ask for permission to perform procedures on them. There has been advancements, and they even have Sim-men hat even talk back, but they are still a far cry from the real thing.
Now think about running a bad call. An unconscious patient, whether it be as a result from a traumatic event, or cardiac arrest. Do you still treat these patients as if they are mannequins in training lab? I'm sure you're not kicking them to check for arousal, like you may have done to rescue annie, but do you let it set in that you are dealing with a real person? If you're like most of us, probably not. We tend to disconnect ourselves from the reality, and severity of situations like these as a coping mechanism. Psychologically, no one could deal with the storm of emotions that would arise from getting too involved on every call.
The problem with the above method of coping, is that it is only beneficial with a patient that can't comprehend what is going on. With our everyday patients, it is better to treat them like people. I know this sounds pretty basic, but I think it may be overlooked more often than not.
PHRASING IS EVERYTHING
One of the most important phrases to be said on a call is "hello, how are you, what is your name?", a nice follow up to this is "my name is ___ and I am your EMT/paramedic". This simple greeting does so much. Next I would say something like "so what brings us here today" and follow it up with "well I am here with some of the best in the business, and we are going to make sure everything is going to be okay". Is everything going to be okay? Maybe not, and I know what the texts say about false reassurance, but so what? I don't think it has harmed a single person to try and put them at ease. In fact, if you are on scene with someone having the big one, a reduction in stress could result in a reduction of morbidity. While greeting the patient with these phrases, you may want to hold their wrist. You may put them at ease even more, while obtaining a few vital signs (ie. pulse rate, rhythm, & quality, skin condition & temperature).
I don't expect that any of this information is shockingly new to anyone reading this. It may, however awaken at least one reader who has, maybe, let their empathy fade over time. I have to constantly remind myself about this.
OUR PATIENTS ARE IGNORANT
Well, medically-ignorant, not ignorant-ignorant; most of them anyhow. This is extremely important to remember. We know the medical phrases, they don't. We know most medical conditions in more depth than they do. We have seen more people with many more pathologies than they have.
So because of this, what comes out of our mouths is immensely important. It is very possible that they called 911 because they were scared and had no idea what to do. They expect a professional to show up and tell them what to do. When you show up on scene, you are an expert in the opinion of your patient, until you open your mouth. It is your job to keep them thinking you know everything there is to know, even if you don't. If you start out by using a variation of one of the phrases I made mention to above, you are on the right track to keep their confidence.
Don't make your patient's feel dumb. This is something I commonly see, "so you took your insulin and you didn't eat anything?", or "you have a fever, why didn't you try taking Tylenol?", or "if you take anti-inflammatories on an empty stomach, you are going to have belly pain.". Say those phrases with a condescending, patronizing undertone to get the full effect. If you don't want to run needless calls, get a new job. They are inevitable, and allow us a chance to educate, not punish our
patients customers. Don't get me wrong, I have my moments of frustration. They easily fade away when I consider the unemployed alternative.
MAKING THE DECISION FOR THEM
We know our patients are medically-ignorant, and that they probably called us out of fear. It is then easy to assume that the decision to go to the hospital for further treatment is most often predicted by what we say and how we say it. I would venture say that over 90% of our patients are going to go to the hospital or refuse transport based on what we tell them. The rest probably didn't call us themselves anyhow.
Don't believe me? Put yourself in the shoes of the patient and think about how you would respond to the following questions:
- So, do you want to go to the hospital for this by ambulance?
- Since I'm not exactly certain there isn't something more serious going on, why don't we go to the hospital and get this checked out to put your mind at ease?
I think it is safe to say that the first question would most likely get you a signature and a wave while the second may get you a transport.
There are a ton of these phrases that we have all learned to use; hopefully in the right way. It is important not to abuse this power that our patients give us. I'm not saying to talk every person you come across into being transported, just be careful to not talk them out of a transport. It is always easier to explain why you did than why you didn't.
MORE FOOD FOR THOUGHT
- Say "your welcome", or "my pleasure"
- Avoid the giggles (laughing on scene may be construed as immaturity)
- Always explain the consequences of refusing transport
- Keep the bystanders (eavesdroppers) in mind when treating the unconscious patient
- Avoid the medical terminology (one of the first lessons taught)
- Use welcoming body language. Open arms, eye-level stance.
- Talk to the less severe patients during transport. I like to ask where they are from or what they did for work, it is easy to bury your face in your PCR and just watch the monitor. Holding a conversation with the patient may clue you into a change in symptomatology such as breathing patterns or neuro-deficits like short-term amnesia.
- Wish the patient well before leaving the hospital. First and last impressions are important.