EMS Revisited is an exclusive column that offers reprints of various columns and articles from our archives that are not currently available in electronic format. In the January 2003 issue of EMS Magazine (now EMS World Magazine) we began a year-long series on customer care in EMS. Here we will reprint the series in its entirety.
Paramedic 4 responds to a large corporate headquarters for a syncopal episode. On arrival, the crew is escorted by security to a conference room with six people around a large table. One of them, a 23-year-old female, is the patient. She explains that she felt dizzy, stood up and passed out. There is silence as all eyes are on the patient and crew. Manuel, the paramedic, asks, "Would you folks mind stepping outside for a minute so our patient can have some privacy?"
No problem--they get up and leave. Everyone is happy. The patient has her privacy, her coworkers are not insulted, and the crew is able to talk freely with her. Do you think she would be comfortable answering questions about birth control pills, drug use or her HIV status in front of her colleagues? Probably not.
In this case it was pretty obvious that the other people were not family or friends. It's not always so easy. When assessing and interviewing a patient, look around and determine who is listening. Don't be afraid to ask someone if they are family. If they are just a concerned bystander, be nice and ask if they could give you and your patient a little privacy. Most people won't be offended and many patients will be visibly relieved. They are embarrassed enough already.
We are all aware that there are many personal questions a patient will be embarrassed or reluctant to answer in public. If you are in a public place, try to stake out a small private area, if possible. If that is not possible, sometimes the best bet is to move the patient to the ambulance.
We know that a patient's medical history is just medical fact, but to the patient it might be a source of embarrassment. In many EDs, the med radio can be heard by anyone passing by. Patient beds are a few feet apart, separated by a curtain. When passing along information that a patient might be uncomfortable about, be discreet. Keep your voice low, write it down or call in your report on the phone instead of the radio.
Asking the Hard Questions
Don't let this concern for a patient's feelings prevent you from asking the difficult questions, however. Personal questions sometimes need to be asked. Be sensitive and, if necessary, tell the patient why you need to know. Communication and understanding will lead to cooperation.
If you need to ask your patient about drug or alcohol use, be diplomatic. "Sir, I don't mean to insult you, but I need to ask:?Have you taken any recreational drugs tonight?" is better than, "You took cocaine, didn't you?" If you accuse, the normal reaction is to deny, regardless of the truth. Your goal is to recruit your patient as your partner in treatment.
Not all patients want to be treated or will cooperate. You should always give your patient the benefit of the doubt. You, at least, will feel better if you treat patients with respect. I know you will feel bad if you are rude with a patient and realize later that he or she is a nice person who was simply not him- or herself.
Remember that if there is a family member (or police officer) within earshot, you may not get an honest answer to some questions. Whisper them, write them down or wait until you're alone. Give patients a chance to answer honestly without getting "busted." Explain why you need to know, and you have a better chance of getting the truth.
Have you ever heard the phrase "There is no sex in EMS"? This means that the sex of our patient should not in any way affect our assessment or treatment. But patients don't know that. Cutting the blouse off a young woman at a bus stop so you can properly assess her breathing may be medically defensible, but how will it affect her hyperventilation? Probably not too well. Use common sense and try to protect modesty where appropriate.