# good way to start a conversation w/ patient



## Naota_X (Jan 27, 2011)

hi im a newbie and the company i work for does mostly transports all day and i not really very talkative to begin with but i was just wondering what are a few things you say to your patients to get them talking with you because the guys that are mentoring me dont really talk with them much either thanks for any advice in advance


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## medicRob (Jan 27, 2011)

Naota_X said:


> hi im a newbie and the company i work for does mostly transports all day and i not really very talkative to begin with but i was just wondering what are a few things you say to your patients to get them talking with you because the guys that are mentoring me dont really talk with them much either thanks for any advice in advance



Usually if it is an older man, I will say something along the lines of "What is a young man like you doin hitchin a ride with the Tenn care taxi?" 

The key is, don't try too hard... just strike up conversations with them. For instance, sometimes "Hello, my name is Rob, can you tell me any issues you may be having" is all it takes..


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## Melclin (Jan 27, 2011)

*I hear you*

One of my pet hates is small talk. I love quality conversation over a beer more than anything else, but conversation with no purpose s**ts me something fierce. If it doesn't happen by itself, I've no interest in forcing it.

But I think conversation with patients is immensely important to building a rapport, alleviating anxiety and facilitating better communication of important info. So I've had to learn how to create conversation. 

Obviously I'm still very much a student and I've got a lot to learn but here are some of the things I try.

In general I try to use my questions aimed at the social/nutritional/psychological/family history to create conversation that is both good for the pt and good for my history. Eg, 

"You had a stent 4 weeks ago did you? And what hospital was that at? Oh yes the nurses their are good aren't they." 
"Oh yes just lovely, I asked one too...." 
"Oh did they? Hahaha, yes my mate is a nurse and once he *similar story*...".  etc etc.
"Good, and how have you been traveling since, all that lying about probably doesn't suit a bloke you you eh?
"Nah mate, can't bloody stand it, been a bit down actually, not firing on all cylinders"

You get more info (the hospital you should go too etc) and I've picked up a hx of various surgical complications that weren't mentioned otherwise (PE in a pts with SOB for example), as well as starting a conversation.

Try complimenting their home/garden. When its nice of course. Then I compare them to my grandparents (ex grandfather ex-navy, grandmother ex-airforce, WW2...I'm sure u can imagine, set a watch by the haircut types), we have a bit of a laugh and I work that into my standard line about them seeming like the kind of person that doesn't complain too much, but this is their time to be a wuss RE pain relief (stoic cardiac pts, trauma pts etc).

What they do/did for a crust, again, good for social hx and for conversation. War service when the have DVA cards or service medals/photos. A lot of olds we see live by themselves and enjoy have a young person who knows a bit about history that's interested in their experiences.  

Kids if they there is an appropriate segue. Everyone wants to show pics of their kids. Esp people about whom people don't usually care. I made good mates with a heroin addict who was arcing up a bit talking about his kids.

I've found most people are keen to chat with me and often ask about my degree and why I got into prehospital care.


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## Rotor Talker (Jan 27, 2011)

*Just bwe aware and..*

Don't ask "leading" questions, keep it all open ended:

"So, what's goin on here?"

"what made you call us"?

Maybe not word for word, but you get the idea, keep your eyes open and don't get tunnel vision, yeah, that's a big laceration on their thigh, but where is the "object" not necessarily a weapon, that caused it?

Situational Awareness, learn it, love it, live it.

And if there is an Elvis shrine, that doesn't hurt either.

HTH

Bob


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## lampnyter (Jan 27, 2011)

How bout' them jets?

Always works.


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## harryb714 (Jan 27, 2011)

so... do you come here often?


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## MediMike (Jan 27, 2011)

Seriously a simple "Hey! How ya doin'?" goes a long time to opening up a conversation.  My personal pet peeve is people that aren't able to talk to the pt. on a personal basis.  I consider taking care of the pt. mentally/emotionally just as much a part of my job as plugging any holes they might've developed recently.  If all you do is stick to your OPQRSTs you normally end up with a much less detailed hx.

Mel hit it right on the head with a lot of his questions, oftentimes the older folks will love to talk about where they came from, ask them about the changes they've seen through the years after living in the city of X for half a century, kiddos I'll ask about sports/school subjects...being able to maintain a conversation does wonders for keeping your pt. at ease.


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## Veneficus (Jan 27, 2011)

*The art of efficency*

There is not really a specific formula for talking to patients that can be memorized so it really depends on the situation. 

A patient I am seeing for the first time I like to start with:

"hello (socially/age acceptable title) my name is (what I expect to be called) what is your name?" (this is where they tell you what they want to be called)

It also yields a good amount of information. Do they readily respond? Do they know who they are and what I am doing there? If they can form a cohesive sentence I know broca's and wernike's areas are intact. 

Are they more concerned with their complaint than with looking at me?

Do they respond in one breath or does it take several?

Since I am left handed, I often have to cross over the patient to work. Do they follow me with their gaze? Turn their head? 

Did they make an effort to shake my hand or wave? (physically acknowledge my presence) If they did, was the movement fluid? Did they have trouble? Start with one hand and have to switch? Did they have trouble getting their hand to find mine? Did they succeed or give up?

"(What they wish to be called)what brings you here today?" (why did you call if responding to them) Psychologically they will give the most pressing complaint first. and we are off... I listen to every detail, analyze not only what they tell me, but the words they choose as well. I look at their general appearance, are they freshly bathed? hair combed? Teeth brushed? Are the trying to hide part of their body? Are they distracted? What are they wearing? Is it in good repair? Seasonally appropriate? Visible injuries or global signs? Other body language I find interesting or lack of body language I find significant? Skin color? Eye color?(the sclera, specifically) Nutritional status? Body symetry? If others are present how do they respond to them? Mood?

Probably some things i forgot to type that I notice. 


If it is a patient I saw before, i usually forget their names. So I refer to social/age appropriate address. If the name is on the chart, I use that with Mr. Ms. etc. But then I start with:

"How are you feeling today?" before asking why they came.

With time and experience you will create your own style. In the meanwhile, you may want to have something to refer to so you don't forget anything. 

As for small talk, it is an art. If the patient is quiet, I try to get them to interact by asking "what is going on? Do you have any questions? Is there anything I can do to help you?" "How long have you been here?"

There are obligatory questions: "Do you feel safe at home?" "Is anyone hurting you?" etc.  

In addition to explaining what is being done, I also like to tell them how long it usually takes. It reduces their anxiety. I also usually tell them that as far as healthcare providers go, no news is good news. Don't worry if your labs take an hour. Worry if there are 5 providers in here with all kinds of gear. Especially worry if we are calling people to come and see you. (that is probably the worst sign)

If you are doing IFT, you can ask what they are being transported for and to where. Ask them how their treatments are going. Pass off thier concerns with your report. ask them if they are comfortable. Temperature, incline on the cot, maybe o2 settings too high? Position causing pain or discomfort?

Remember, medicine is first about helping people. If you can't cure their illness, focus on what you can do. Even if it is getting an extra blanket or glass of water or ice chips. Ask them what you can do to help. Sometimes you have to tell them it is not in your power or not possible. (like you have no pillows) But do your best to improvise. 

A very wise preceptor of mine once said: "Be nice to your patients, even if you don't like them. You wouldn't think about suing your friend, but you will gladly sue your enemy."

Forget about sue, subsitute with "compliment" "cooperate" "offer" "complain" "withhold" etc.


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## medicRob (Jan 27, 2011)

You can always make it feel super impersonal by using Microsoft Text to Speech to fill in the details.. 

Like this:

http://vocaroo.com/?media=v65BEtZlCCb8esgA1
(Click link to listen)


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## LucidResq (Jan 27, 2011)

As far as small talk, I've always found people's studies and work (and/or former work) to be fascinating. I've had interesting conversations with a veterinary student, a retired famous ballet dancer, female truck drivers, and even waitresses. 

People always love talking about their kids. 

I often asked people about where they've come from... that was particularly interesting with the numerous immigrant and refugee patients I saw in the clinic.


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## LucidResq (Jan 27, 2011)

I'd also like to point out that it's a fine balance. You don't want to interrogate your patient or talk their head off about yourself. It should end up somewhere in between... in which you are expressing genuine interest in them, learning about them as a person, and also exposing just enough of who you are and your story to build rapport and show you're a human being.


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## medicRob (Jan 27, 2011)

When it comes to old men, you can never go wrong with mentioning something along the lines of, "How bout this weather we've been havin?"


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## Lady_EMT (Jan 27, 2011)

For transfers it'd be a little tougher, but I know when I pick up a patient at their home, I can't help but look around me. Are their pictures of grandkids on the wall? Is there a dog playing in the back yard? Is there a football game on? 

Just finding something that the pt cares deeply about can be all it takes to start up a conversation and get the patient to feel more comfortable. Try to relate to the patient. It gets easier, trust me. Eventually you'll find yourself automatically looking for cues and starting an offhand conversation. =)


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## enjoynz (Jan 27, 2011)

Re small talk with your patient...kids/grandchildren and sport have all been mentioned.
Something close to my heart, which never seems to fail to start up a conversation is, pets and animals.
Did you notice if there was a pet around, when you arrive at the address? Bird or goldfish will even do.
It's one thing that always seems to break the ice.
Have you ever noticed at a park that folk will tend to talk to a dog, before even noticing it's owner.
Not everyone loves animals, but there are not that many that don't!
I had a very long trip to hospital once with an elderly gentleman suffering from smoke inhalation.
We spent a good part of the trip talking about his two cats and dairy farming (He was a retired farmer). 

P.S. Sorry Lady EMT...I missed your bit about the dog...we are on the same wave link though.


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## Naota_X (Jan 27, 2011)

thank you all for your advice it will be very helpful


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## slb862 (Jan 28, 2011)

I just wanted to add that I do alot of reading online, especially newspapers.  Even if I don't read the article I scan the headlines or breeze through the article.  Sports, news, weather, and whatever you find.  This way I can talk with the pt. about anything, even if it's a "yeah, I read that in the paper or saw it on the news".  Talking about kids, grandkids, etc., pets, retirement, and hobbies are wonderful.  

The first thing I do is introduce myself and my partners, I also tell the pt. my level of care I bring (Paramedic).  I also tell them I am glad that I'm here to help them.  

Good Luck and Be Safe out there!!  Peace!


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## Tanker299 (Jan 28, 2011)

lampnyter said:


> How bout' them jets?
> 
> Always works.


 

Why !!!!!!

:wacko:


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## dmc2007 (Jan 28, 2011)

My last job was working for a rental car company that offered customer pickups.  When picking up customers, I'd always start off with "how are you doing today?".  For some, that would be enough to get them going.  If that didn't really get things going, but if the person seemed like they were willing to converse, I would move on to asking about why they were renting.  I had an advantage in that I've been a car guy all my life, so I could very easily strike up a conversation with customers whose cars were in the shop or were looking to get a new car, etc.  Talking about the weather always worked too.  If nothing else, asking about grandkids, dogs, etc., is always effective if you pick up on such clues.  However, if a customer didn't have an interest in talking, I just let it be.  Same goes for patients or anyone else.

I start with an IFT company within the next week and I'm hoping that these techniques, if not slightly modified, will work well.


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## cmetalbend (Jan 28, 2011)

I really think age plays a key factor here. To the adolecent that just broke his arm skateboarding who asks" How bad is it?" Don't sweat it, do you think Tony Hawk never fell?" Besides, Scars are tatoo's for the brave.  Just try to relate to the patient.  To the elder war veterain= Thank them for their service.  To the woman with children= "Be strong mom, your babies need you."   To the father= "Be strong Dad, your family needs you."  IMAO if you can make them laugh, you have just releaved alot of tension.


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## abckidsmom (Jan 28, 2011)

I had a patient in a-flutter last week who was very carsick on the way to the hospital.  She moaned, "I don't think I've felt this bad since that boat ride across the pacific."

I gave her some zofran, and asked abotu the trip.

Turns out, in January of 1953, this lady, her Army hubby of 68 years and their 3 kids (18 mo, 5 yo and 8 yo) took a 2 week boat ride in a navy cargo ship from san diego to Japan, stopping once in Hawaii.  She puked the whole time, and her sweet, romantic hubby bought her a limo tour of the big island when they were there.

History, a temporary vacation to another place and time, and a connection with a BTDT mom whose marriage lasted 7 decades.

People like to talk about themselves.  Ask a couple of questions, figure out what they care about.  Don't make assumptions about what they are into.

Listen to the stories they tell and picture yourself there.  Find common ground.  

I recently transported a ghetto-punk 20 yo in labor with her 4th kid.  We got a laugh about how much the baby daddies in our lives both hated pregnancy.  There's commonality throughout the human experience, and that's what you can talk about.


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## firetender (Jan 28, 2011)

*Honesty and Door-Openers.*

If you really look over a person, I mean really look at what's there, somewhere on them -- it can be clothing, personal belongings, jewelry, even an expression in the moment or a movement -- you will find something that interests you. It can be related to the person's complaints of the moment or have only to do with stuff that makes them different from you.

Comment on it and then ask something to learn more;

"That's an unusual necklace, where did you find that?"
(DON'T ask about expensive jewelry, they'll think you're casing them!)
"Your slippers remind me of ones I had as a kid. Were they a gift or did you buy them for yourself?"
"You grimaced. Did I jostle something sensitive?"
Since you're a medic, why not ask about a fairly benign scar?

The point is, something that honestly interests you AND opens the door for the person to speak about themselves, as mentioned earlier in the thread.


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## Phlipper (Jan 29, 2011)

You could do it like almost everyone at my station and just walk in, tower over them with your hands crammed in your pockets and a disinterested look and say "Haaaay sug/sweetheart/honey/buddy/brotha whaz going on today?" and when they answer you can reply "Weeeelll when did all dis start, sweetie/buddy?"

I know I am still new to EMS, but let me beg you now, for the sake of the profession and how we're viewed by pts and peers ... please do this part at least sort of by the book?  Please?  :sad:

Every Medic at my station is competent, patient, and caring.  A couple of them are awesome.  Simply awesome.  And some of them will bend over backwards to teach motivated Basics, too.  I love them and I know I am lucky.  But daaaaayum our bedside manner needs an update.


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## Hockey (Jan 29, 2011)

Sir/Mam, good Morning/Afternoon/Evening, I believe you meant to call ABC Taxi.  


> Can you walk?  
< Yeah kinda...
>Get in, last one in the truck gets stuck with the bill

:lol:


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## Simusid (Jan 29, 2011)

I had an 82 YOF last week who had a problem with her home O2 and was clearly upset about it.   I saw that she had a Boston Terrier.  Working with the "hey we have something in common" angle, I started talking about how my father in law used to breed them.

Well it only took me a few seconds to realize that I was talking too much.   And I had to silently remind myself that the whole reason I brought it up in the first place was to hear from her not me!


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## Veneficus (Jan 29, 2011)

firetender said:


> If you really look over a person, I mean really look at what's there, somewhere on them -- it can be clothing, personal belongings, jewelry, even an expression in the moment or a movement -- you will find something that interests you. It can be related to the person's complaints of the moment or have only to do with stuff that makes them different from you.
> 
> Comment on it and then ask something to learn more;
> 
> ...



This is also a good skill for getting a date.


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## firetender (Jan 30, 2011)

Veneficus said:


> This is also a good skill for getting a date.



Some of my best patients have been dates!


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## Akulahawk (Jan 30, 2011)

How do you strike up a conversation with a classmate or just someone at a local coffee shop? You're both people... you just happen to be at the same place at the same time and you just happen to have a provider/patient relationship. Conversate and do your medical conversation as you come to it. 

I usually just introduce myself and "I'm your friendly neighborhood Paramedic for the day..." Then I confirm their name... and conversate from there. 

It's an art form, really. There's no real set rule about how to do it... just don't do it badly. Well, even that could be a way to start a conversation.  "Hi... I'm really horrible at remembering names... including mine. What's yours?"

If you need a conversation boot camp, find a local comedy sportz team or comedy club. Take a class in improvisational comedy... seriously. Improv is a great way to learn about striking up conversations. Barring that, hang out a your local coffee shop. Get some coffee, talk to people waiting for their coffee while you wait for yours... or while you're putting cream/sugar in your brew... stuff like that. You'd be amazed that people will respond to you, usually in a good way. They're people too...

Bad ways to strike up a conversation... Just like Clint Eastwood reminding the Orangutan in "Every Which Way but Loose"... No kissin, cussin, or picking your @**. Don't do it in front of someone you want to meet or talk to...


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## saycarramrod (Feb 6, 2011)

Talking with a pt. is a very important thing to do. It makes the pt. think of you as a human being and may become more comfortable with you and be more willing to give you information about their ailment. It also tells your pt that you care about them and don’t just see them as another transport. It may also make the pt. more relaxed and take their mind off what’s happening if only for a moment. The best way I have found to start a conversation with a pt. is to just ask them how they’re doing or what they do for work or where they go to school. I have found that having a conversation with your pts really works to your advantage.


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## tazman7 (Feb 8, 2011)

In some of ouR paperwork it will give their job description before they retired or whatever. So if they are alert and the elderly mans paperwork says bricklayer, I will say something along the lines of: With hands as torn up as yours, you must have been a bricklayer... And they will get excited and tell me all about how they worked from 1959-1973, took a year off and started working again in 1974...yada yada yada....

Or if they are a VA patient, I will ask if they were in the Navy, most will sit up, get mad and say hell no I wasnt a p**** sailor, I was a Marine...haha No offense Navy guys!

Usually strikes up a convo.


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