by Charly Miller, EMT-P

This page was originally published in's March, 1999 issue.

Emergency Crisis - both traumatic and medical - causes patients to become hypersuggestible to all perceived stimuli. Additionally, Emergency Crisis brutally rips away a patient's sense of control.

Feeling a loss of control results in several negative patient responses:

To reverse these negative effects, we must speak and act in a manner that restores a patient's sense of control. Previously we discussed some simple, basic ways to begin restoration. A couple more techniques for restoring a patient's sense of "control" are:

Ask permission before you touch or expose parts of the patient's anatomy!

Too frequently, emergency care providers simply dive in without receiving any kind of permission to do so. In any other life situation, such actions would be considered assault and battery!

Asking permission to touch someone, or otherwise invade their privacy gives them a sense of control and shows respect for them as a human being. These are things that every patient deserves. So how do we get permission without specifically asking for it (and risking refusal)?

Begin by asking permission to care for them, and to help them feel better by saying something like;

"May I take care of you and help you feel better?"
The patient wants to be taken care of - they want to feel better. So, they'll respond, "Yes! Please take care of me. Please help me feel better!"

You've just received permission. Now, it's time to explain to them what they've just given you permission to do.

"What I need to do now is to touch and examine you, so I'll be taking off some of your clothes. But don't worry! I'll keep you as covered-up as possible. I'll protect your privacy."
Now you've given the patient a sense of control, you've gained permission to touch and strip them as needed, you've demonstrated an understanding of their fears and concerns, and you've reassured them that you'll maintain their dignity and privacy as much as possible.

That's accomplishing a lot with just two or three sentences.

Another means to restore a patient's sense of control and improve their condition is to offer continued and repeated acknowledgment and congratulations. What does this mean?

"Continued and repeated acknowledgment and congratulations" is using the three Magic Words of EMS:

It also means using them as often as possible - they cannot be said often enough!

Please: It gives the patient a sense of having a choice, without really giving them a choice. Having a choice is like having control, which promotes an improved emotional and physical condition. It also gives the patient a sense of acknowledgment because it's polite and demonstrates your sense of respect for them.

Good: This is a verbal reward or congratulations for a performance well done. Every time a patient does something you've told them to do, you should reward them for doing it! Even simple things like answering a question should be rewarded. When people are rewarded, they become more and more eager to gain additional reward. In turn, they become more and more eager to do everything else you tell them to!

Thank You: This provides the patient with both acknowledgment and congratulations. By thanking someone, you give them the sense that they had the choice not to do your bidding, and rewards them for having done it.

A good example of Magic EMS Word use, is using the following dialogue while listening to breath sounds:

Every activity and procedure we engage in should be accompanied with excessive use of
please, good and thank you.

These communication techniques may sound "hokey" to the unenlightened! These unenlightened, fellow-care-providers think we sound hokey only until they realize how much better our patients become. Once they realize that our patients feel better and improve in condition without us doing anything but "sounding hokey," they'll start singing a different tune. In fact, they'll start to adopt these "hokey-sounding" techniques themselves!

Even though they may sound redundant or repetitive to us or other providers, remember the patient's state of awareness. All patients respond positively to continued and repeated acknowledgment and congratulations. "Please-good-thank you" can be a "magic mantra" for all emergency care providers! They are magic words that we cannot say too often.

To recap these techniques to Restore The Patient's Sense of Control (and improve their condition) from Parts Five and Six of this series:

In Part Seven of the "Foundation of Patient Communication" we'll discuss the enormously successful technique of using explanations to repair loss of control anxieties. Explanations improve the patient's physiological condition and enhance their response to medical treatment. Everything we need to do has a purpose. And, every purpose can be positively explained - simply and in English!

If you wish to, Email's Editor with your feedback:
Make sure you title your response:
"Feedback About The Foundation of Patient Communication - Part 6"

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