I was recently referred to a physician specialist I’d never met before. After the medical assistant came into the room, took my vitals, and had me sit on the paper sheet, the physician entered, pushing a standing desk with a laptop on it. She began to ask me questions about some symptoms and hurriedly type the responses. She didn’t look up from her laptop once and, to my further dismay, didn’t even smile at my poor joke about feeling like an item from the deli counter sitting on a piece of butcher paper. It got me to thinking about my time on the ambulance and a trend I’ve seen, especially with younger partners: a rise in reliance on our technology devices and the lost art of patient conversation.
Ten years ago we called someone so focused on their PCR boxes that they never really acknowledged the patient “Captain Clipboard.” Nowadays, with most agencies using computer-based PCRs for patient information and billing, the updated version is “Lieutenant Laptop,” that provider so busy entering information that their patient communication is limited, much like my specialist. Perhaps because folks are so intent on entering information, once it is entered, I have often noticed unfortunate silence in the patient compartment beyond the clacking of laptop keys.
Patients call EMS because they are having a bad day. They look to EMS for a ride, treatment, and hopefully some caring behavior. If the patient isn’t critical, once your assessment and vital signs are complete, the call may simply be a “monitor and transport.” This presents a great opportunity for nonmedical conversation, which is a form of caring behavior and can be seen as a treatment. It also allows the EMT or paramedic to continually assess the patient’s mentation and response to verbal stimuli.
Consider the acronym TAP ACE as a way to engage some of these patients during the ride to the hospital:
T = Tell me—Not sure how to start a conversation? “Tell me…” is a great lead-in:
“Tell me about that photo I saw on the table in your apartment.”
“Tell me how long you’ve lived here.”
“Tell me your favorite meal.”
“Tell me something you like to do for fun.”
Everyone likes to be listened to. By asking open-ended questions, you let the patient decide what they wish to share. You’d be amazed what you can learn from simple open-ended questions.
A = Active listening—Active listening is a way to show people you’re engaged in the conversation. Some ways you can show active listening include demonstrating concern, paraphrasing statements back to show understanding, nonverbal cues such as nodding, eye contact, and leaning forward, and brief verbal affirmations like “I see,” “Sure,” or “I understand.” Active listening is nonjudgmental. Looking at one’s phone, laptop screen, clipboard, or watch while someone is talking is not active listening.
P = Patience—Have patience with your patients. Some, especially senior patients, may have a hard time hearing. You may need to speak up and face them. Some may have a hard time speaking or speak slowly. Some may have memory issues. Allow them to engage the way they can and show respect by giving them time to do so.
A = Avoid judgements and jargon—When the patient shares information, avoid judgements. Never say things like “That was a bad idea,” “Why don’t you take better care of yourself?” or “You shouldn’t have done that.” Further, much like family get-togethers, avoid talking politics or religion. Additionally, use plain language and avoid EMS jargon and acronyms, including 10-codes and abbreviations.
C = Curiosity—You have an opportunity during your encounter to leave an impression that you care about the patient. Be curious—you should want to know more and ask questions to uncover medical and social details about your patient (see “tell me” above).
E = Empathy—During a ride to the hospital, you may wind up giving the patient the most one-on-one attention they will receive from any single healthcare provider. Use this opportunity to demonstrate empathy—the ability to hear and relate to their feelings. Listen to the fear they have about going to the hospital, the worry they have about needing surgery, or perhaps the anger they have at being careless and having an accident. Be a good ear! You’ll be amazed how many people just want someone to listen.
Rather than an awkward or uncomfortable silence on the ride to the hospital, take the opportunity to talk to your patient. Find common ground by using the right amount of self-disclosure, empathy, tact, and TAP ACE. You also might hear a good story and, more important, help your patient on what is a not-so-good day.
Barry A. Bachenheimer, EdD, FF/EMT, is a frequent contributor to EMS World. He is a career educator and university professor with more than 30 years in EMS and fire suppression. He is currently an EMT with the South Orange (N.J.) Rescue Squad, a firefighter with the Roseland (N.J.) Fire Department, and an instructor at the National Center for Homeland Security and Preparedness in New York. Reach him at email@example.com.