The information gained while interviewing patients and bystanders is of the highest value, yet very little time is spent training in this area. As ED personnel do not have the benefit of seeing the patient prior to arrival at the hospital, it falls on the shoulders of prehospital providers to obtain any necessary firsthand information from the field. In cases where a patient's mental status deteriorates, EMTs may be the only medical providers in a position to gain valuable information from the patient. While experienced EMTs know what questions to ask, many providers could benefit from learning how to more effectively communicate with those they serve. The following 10 tips can be incorporated by providers with any level of experience on almost any run.
1. Establish rapport
In a typical healthcare situation, a patient interacts with a doctor or nurse in a controlled setting with office staff they have known for years. Patients share private information with them based on trust that has developed over time and understanding that these individuals have their best interest in mind. In the prehospital environment, patients are expected to entrust their physical well-being and private medical information to those they have never met before, and to do so merely seconds into the patient-provider relationship. While it is sometimes important to gain information very quickly, in many cases you can spend a minute or two getting to know your patient and the situation. Rapport is most easily established by providers who are confident and professional, and who take the time to communicate with their patients.1
2. Respect patient privacy
When it does come time for those more difficult questions, patient privacy must be considered. If others can hear, it is often unwise to ask very private or touchy questions if an honest answer is the goal. Failure to respect the patient's privacy in this way also demonstrates to patients that they may not be able to trust you or your judgment. Before asking about things like the possibility of pregnancy, potential substance use, or psychiatric conditions, it is worth considering the environment and the patient. These questions can often be addressed in the privacy of the ambulance rather than a home crowded with family or in the patient's workplace.
3. Recognize face value
Paying attention to patients' facial expressions may give clues regarding things they are not saying, as well as alert you to pain and severity of pain. Facial expressions may also allow you to see to what degree you are connecting with your patients.2
Your own facial expressions also matter. When in conversation with others, people have a tendency to watch facial expressions.2 Consider whether your facial expressions show concern for your patients. Did you give a comforting smile? Do your eyes convey interest in what your patient is saying, or do they wander? Facial expressions that show interest are linked to reported better rapport.3
4. Move to the patient's field of vision
When possible, approach a patient from a direction where he will be able to easily see you. For those with limited mobility, make sure to position yourself in a way that is comfortable for the patient to communicate with you. For example, if your patient is a wheelchair user, standing directly in front of him and perhaps crouching will make it easier for him to communicate with you. Some individuals with hearing impairments will understand you more easily if you position yourself so they can see your mouth as you speak. Looking down directs your voice away from the patient and may be perceived as a lack of attention to what the patient is saying.
5. Consider how you look