A friend of mine who is the EMS coordinator for a small regional hospital was recently charged with putting together an EMS conference. Her hospital administration thought it would be a nice way of saying thanks to the local EMS squads, the majority of which are volunteers who have to travel quite a distance to get continuing education and keep their certifications up.
For six months she worked at getting everything put together, then I received a frantic phone call. It was three weeks prior to the conference date and by the tone of her voice, I could tell her stress meter was pegged all the way to the right. She told me that her goal was to get approximately 100 attendees, but at present they had only 11 and may have to cancel the conference. After I calmed her down, I explained to her that my experience had been that she would get her numbers, but she just needed to sit tight and be patient. I continued my explanation with my theory that EMS providers are last-minute people. I mean, why register two months out when you can wait until two days out? Sure enough, over the next couple of weeks the registrations came in-10 here, 12 there, seven more there. In the end, she got 165 attendees and the conference was a success.
As EMSers, we respond to other people's crises every day, so why shouldn't we live our lives in a fast-lane mode? We like challenging calls that make us think and react fast. We drive our vehicles fast, and we like fast food. The "fast" list goes on and on...
One of the odd side effects to this passion for fast is that it can actually impact patient care, especially when getting a history from a patient. One of the first questions we generally ask when we meet our patient is the bread-and-butter, "So why did you call 9-1-1 today?" Usually that will get you an answer lickety-split. Usually...
But after that, the history-taking process slows down, possibly for a number of reasons. But what if WE don't slow down and we stay in the "fast" mind-set? Ever think why it takes a while for you to get answers to those rapid-fire questions? Consider the following.
No Time to Answer?
The first and most obvious reason for a lag in information flow occurs simply because some providers don't give the patient time to answer. The provider has the clipboard in hand and is working down the list, often at a speed that leaves the patient little time to say more than "uh-huh." Keep in mind that you know the basic question list because you work through it many times a day with every patient. This is most likely the first time they've been through the list, especially with YOU.
Having a conversation is a taxing event for the human brain. You have to be able to both hear and understand the question that is asked. Then you need to come up with a response in your head, put your thoughts into words and speak your response.
A number of significant pathophysiologies can derail a person's brain train when question-and-answer time is going on. Hypoxia, a head injury, low blood sugar, and alcohol or drug impairment are just a few examples of the many conditions that can impact both the speed of content delivery, as well as the quality of the content.
Don't Want to Answer?
In the course of trying to figure out what's wrong with someone, our questioning often leads us down some personal roads. Many people still attach a huge social stigma to mental illness. Alcohol and drug abusers weave a fabric of deceit to hide their actions. Child abuse and domestic violence are difficult topics to discuss.
As you work through your history taking, take into consideration that there is a natural tendency for people to be hesitant or unwilling to share health-related information with you (whom they've known for all of five minutes), when they can barely, or maybe not even, share it with their personal physician.
Can't Find the Answer?
Just like when you are working on your computer and get an "Error 404, file not found," maybe the reason you aren't getting an answer is that the patient honestly doesn't know or can't recall the answer. While there may be a physiological reason an answer to a question isn't forthcoming, the simple truth may be that the patient just doesn't know. While you need the information, if the patient doesn't know, you sometimes have to accept that and move on.
The bottom line is that we need to work at being slow listeners in order to give our patients the opportunity to communicate effectively with us. It's one thing to recognize that information is coming slowly, but it's also worth considering the "why" behind the slowness. Taking time to listen patiently and carefully helps ensure that we get the information we need to make valid patient-care decisions. So the next time your history taking seems to be moving at a glacial pace, think about some of the points listed above and downshift out of fast into slow.