As Emergency Medical Care Providers, we experience emergencies every day. "Normal" people do not!
Besides causing patients to become HYPERSUGGESTIBLE TO ALL PERCEIVED STIMULI, EMERGENCY CRISIS also brutally rips away a patient's SENSE OF SELF-CONTROL!
No matter how often they watch "emergency" TV shows, normal people aren't accustomed to dealing with emergencies. They don't know what to do. They feel lost, abandoned. They feel "out of control." (Indeed, if they had "control" over their lives - as they usually do - would they be having an "emergency?" No! Of course not!) Until we begin to restore that sense of control, the patient will only become more adversely affected by feeling the loss of it.
Feeling a LOSS OF CONTROL results in several negative patient responses:
In order to arrest and repair these negative effects, we must speak and act in a manner that restores a patient's sense of control.
Our very first contact with a patient affords us a fabulous opportunity to immediately begin restoring their sense of control. Introduce yourself appropriately! If well made, INTRODUCTIONS HELP RESTORE THE PATIENT's SENSE OF CONTROL.
Introduce yourself by first name, your title, and your purpose. Using your first name will immediately initiate an intimate rapport with the patient. Your title is what explains your "right" to be in the patient's face. Your title should be provided in English - not initials! "I'm an EMT" can easily sound like, "I'm an empty." Also, there are still many, many people who don't know what an "EMT" is! Identifying yourself, your title and purpose for being there, shows respect for the patient's interests (restoring a sense of "control"). It also indicates what you're going to do, reassures the patient, and encourages the patient's interest in trusting you.
"Hello! My name's, Charly. I'm an emergency care provider and I'm here to help you."Yes. To us, that statement sounds "hokey." To the people we work with, that statement sounds "hokey." To the patient, however, it sounds like music from heaven! (This is Charly! She provides emergency care and she's here to help me!) I'm immediately on a personal, first-name-basis with my patient. I've clearly identified myself as being someone who provides emergency care, and I've promised to help the person.
Notice that, although I'm a paramedic, I use the title, "emergency care provider." Just as not everyone understands what an "EMT" is, not everyone understands what a paramedic is - or does. Anyone who speaks English, however, understands what "emergency care" means. And anyone, with any "level" of emergency care training, can use this title to successfully communicate reassurance and hopefulness to their patient.
Next, ask the patient what her/his name is. Pay close attention to how the patient wants to be addressed and use only that address! If the patient replies, "I'm Mabel" ... call her Mabel. If she replies, "I'm Mrs. Smith" ... call her Mrs. Smith. If she replies, "I'm Mabel Smith" ... you have two options: Ask her specifically how she would like to be addressed ("Would you like to be called Mabel, or Ms. Smith?"), or call her "Ms. Smith." If you're going to assume something, always opt for the more formal address. It never hurts to be formally polite, especially when addressing someone older - or younger! - than you.
By addressing the patient respectfully, or precisely as the patient has indicated she/he would like to be addressed, you help to restore the patient's sense of control. You are verbally demonstrating that you've listened to the patient, heard the patient, and granted what the patient asked for.
Next, MAKE A POINT OF REMEMBERING THE PATIENT'S NAME! If you're like me, you have a terrible time remembering the patient's name. Guess what? You probably also have difficulty remembering the patient's answers, asking the same questions again and again. This is a common problem with all care providers - both prehospital and inhospital. Why?
I think it is because we're too damned preoccupied with doing the "right thing" to truly listen to our patients. We occupy our brain with two or more tasks, scrambling to "save time" by thinking of our next steps. While the patient answers one question, we are composing our next one, or we're performing a covert physical assessment - or both! We worry we're forgetting something, or we're thinking of "what comes next?" or "what does this look like?" or "what does this mean?"
By paying only half-or-less attention to our patient's responses, we forget them. When we ask the same questions again and again, we demonstrate that we're not listening - causing the patient to feel even more "loss of control!" Indeed, we end up wasting time and detrimentally effect our patients by not truly listening to them.
To save time and remember the patient's responses, you must STOP YOUR BRAIN from running amok and really LISTEN to the patient's response.
When you ask a question - any question - stop your brain and listen to the patient's answer. Once you hear the patient's response, you must make a mental note of it.
First, repeat the patient's name, or question-response, back to her/him. By verbally repeating this information, you immediately "cement" it in your memory. I promise, if you do this simple thing you won't have to ask again. Simultaneously, you are acting to repair the patient's loss of control anxieties! Verbally demonstrating the fact that you listened and heard the patient shows that you're paying attention. Someone who is paid attention to feels more in control.
To remember the patient's name, the second step is to use the patient's name as often as possible. Every time you address the patient, use their name. "Very good, Mabel. Has anything else been bothering you, Mabel?" ... "How does your head feel, Mabel?" ... "Thank you, Mabel. ... Mabel, how's your tummy feel?"
Yes - again - to us and our co-workers, such repetitious use of the patient's name will sound "hokey." But - again - to our patients, such verbal demonstration of listening and paying specific attention to them provides positive psychological support, restores their sense of control, and improves their physiological condition.
To remember the patient's question responses, the second step is to immediately repeat their response back to them. "Your chest feels heavy." ... "Your left arm has been bothering you." ... "Your breathing feels fine, Mabel? Good." Then, periodically "recap" what they've told you. "Let me get this right, Mabel. You've had a heavy feeling in your chest, and your left arm's been bothering you, for about an hour or so - but, you haven't had any problems with breathing. Is that right, Mabel?"
Every time we repeat a patient's response (and every time we use the patient's name) we restore their sense of control and improve their physiological condition by demonstrating our attention to them. Simultaneously, repeating and recapping the patient's information improves our ability to remember and successfully use it!
None of these things takes an enormous amount of time. In fact, these techniques save time in many ways! If you do these simple things, you will better remember information, and more quickly arrive at an accurate diagnosis and direction for physical care. If you do these simple things, your patient will feel better long before you've "done" anything to alter their physical condition!
Begin to RESTORE THE PATIENT'S SENSE OF CONTROL (and IMPROVE THE PATIENT'S CONDITION) BY:
In the next installment of this column, we'll continue discussing communication techniques to repair "loss of control" anxieties, improving the patient's physiological condition and response to medical treatment.
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