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Patient Care

The Midlife Medic: The Lost Art of Conversation

My grandmother went to a ladies “finishing school” in New England in the early half of the 20th century. It was a Victorian-era holdover where young women learned social graces.

What did this mean for us as children? It meant that there were no elbows on the table, ever. You stood up straight, everyone was addressed properly and you never, ever interrupted.

One of the things taught in charm school is the art of polite conversation, where you are able to sit at a table with a complete stranger at a dinner party and engage them, even when you know nothing about each other. This is where rules like “never discuss politics or religion” come into play, but weather or travel are always safe subjects. My grandmother was exceptional at this. She would direct the conversation like the conductor at a symphony, steering it this way and that with carefully chosen phrases or polite inquiries. As I grew older I noticed how deliberate she was in her speech and the effect it had, how she could spark a lively debate and just as quickly defuse it, all with perfect posture.  

Verbal communication is a crucial component of not only patient assessment, but scene control as well. How many times has a misunderstood question or statement, made by either provider, patient or family, escalated a scene beyond easy management? In an environment that is already amped up due to the stress of the call, how can we effectively use polite conversation to our advantage?

Consider whom you invite to the table. Reduce the size of your audience, otherwise known as divide and conquer. If a tree falls in the woods, does it make a sound? If a drama doesn’t have an audience, is it worth being dramatic? Usually not. Politely maneuver the patient into a private setting if possible, and remove extraneous people from the immediate area—including the back of the ambulance. It’s your dinner party, you pick who gets to come.

Watch your tone, young lady (or man). People in stressful situations are hyperaroused so be careful in how you speak. Is your tone of voice condescending or incredulous? It does not matter what your opinion of the call is, try not to let it leak into your voice. A calm, neutral or otherwise pleasant cadence can do wonders for calming a scene down and eliciting information. Eye contact and head nodding in agreement with the conversation will encourage positive responses.  

Use small talk. Distraction can be an effective technique in reducing stress and mitigating symptoms. It is also a good method to help draw out those minor details like medical history. Ask patients about fine details and let them engage in talking about a personal tangent, then steer them to the question you need answered. This back-and-forth will help you develop a rapport with the patient. This is a conversation.

Don’t speak geek. Be careful with terminology as the average person does not speak “medicine” and both of you will become frustrated with each other if you try to drag a history out of them when they don’t know what you’re asking. Re-ask if they aren’t getting it. Maybe they don’t have hypertension, but they’ve had “high blood” for years. Don’t express assumptions via your terms. If your version of asking for insurance goes something like, “Where’s your Medicaid card?” do not be surprised by a negative response.

Be polite. Always. This can be especially helpful when dealing with hostile patients, family or bystanders. Say nothing without a please or thank you. Counter the negative with a blanket of professional courtesy and it will carry you much further, not only in the field, but when interacting with other agencies as well.

Talk to them. Patients are often scared and feel helpless and out of control. They may be defensive, embarrassed at the situation or simply confused about what to do next. Asking about themselves distracts them and allows you to focus on what you are doing while they form a response. People like to talk about themselves, it’s how you can get to an additional layer of history that may be significant—like my patient yesterday who mentioned that she’s the longest living female in her family at 52. Plus, people are fascinating. Without realizing it I’ve met a boxer who trained with Joe Frazier, a professor who taught Martin Luther King, Jr., and a woman from Belgium who smuggled small arms to American soldiers during the Battle of the Bulge. Talk to them, invite them to the party.

Just don’t ask them whom they voted for.

Tracey Loscar, NRP, FP-C, is a battalion chief for Matanuska-Susitna (Mat-Su) Borough EMS in Wasilla, Alaska. Her adventures started on the East Coast, where she spent the last 27 years serving as a paramedic, educator and supervisor in Newark, NJ.  She is also a member of the EMS World editorial advisory board. Contact her at or

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