I just got my *** chewed by my preceptors partner today for being too quiet with patients. I will admit, I have trouble coming up with more questions to ask, or even just stuff to BS with patients, but it's not like I don't get a good history and can develop a treatment plan from it. Either way, has anyone else had problems with coming up with questions to ask your patients? If so, how did you over come this? If not, do you have any suggestions?
Medic student here, did anyone else have trouble thinking of enough questions to ask patients?
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PotatoMedic
Has no idea what I'm doing.
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I'm still working on my line of questioning. My preceptor has a good one that I'm trying to learn. Pretty much goes like so (in a very short hand manner since I'm on my phone): Any seizure, stroke, history? Any history of asthma, copd, bronchitis? Cardiac history? CHF? Heart attacks or stients? Any liver issues? Appendix? History of diabetes?
I'm missing a few things but it goes from head to toes with possible issues that the pt might not remember. And when you have no more questions just tell the patient what the plan is. Example: well sir/ma'am were on the way to the hospital, were going to keep watching your vitals, I'm just going to work on some paperwork for the hospital. If you have any questions or if you feel any different, better or worse let me know. Also I may have a few more questions, and we should be at the hospital in xx minutes.
That way you know what is going on. The patient knows what is going on. And your preceptor knows what is going on.
I'm missing a few things but it goes from head to toes with possible issues that the pt might not remember. And when you have no more questions just tell the patient what the plan is. Example: well sir/ma'am were on the way to the hospital, were going to keep watching your vitals, I'm just going to work on some paperwork for the hospital. If you have any questions or if you feel any different, better or worse let me know. Also I may have a few more questions, and we should be at the hospital in xx minutes.
That way you know what is going on. The patient knows what is going on. And your preceptor knows what is going on.
PotatoMedic
Has no idea what I'm doing.
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Also I just noticed it was your preceptors partner that chewed you out. Are they a medic as well? If not I would consider telling him or her to pack sand and if they have concerns to funnel it through your preceptor. Also I would ask your preceptor about your line of questioning and what they think of it and what to improve.
NomadicMedic
I know a guy who knows a guy.
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I do the same sort of thing... My question line always goes;
Do you have any trouble breathing? Any problems with your lungs, like asthma or emphysema? Ever have fluid in your lungs? Any problems with your heart? Beat to fast or too slow or did yor doc ever say you have an irregular hart beat? Ever have a heart attack? How about your brain? Ever have a seizure, stroke or aneurysm? Any problems with your belly? Have all your organs? Kidney, gallbladder? Anything else hurting you or not normal right now?
That's enough to give me a good idea as to major stuff (usually) and I ask almost everyone these questions and I always do them in the same order, so I don't leave anything out.
Do you have any trouble breathing? Any problems with your lungs, like asthma or emphysema? Ever have fluid in your lungs? Any problems with your heart? Beat to fast or too slow or did yor doc ever say you have an irregular hart beat? Ever have a heart attack? How about your brain? Ever have a seizure, stroke or aneurysm? Any problems with your belly? Have all your organs? Kidney, gallbladder? Anything else hurting you or not normal right now?
That's enough to give me a good idea as to major stuff (usually) and I ask almost everyone these questions and I always do them in the same order, so I don't leave anything out.
Ewok Jerky
PA-C
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What was the complaint about? Are you missing pertinent negatives? Focusing on a single Dx? Or not chit chatting enough?
The thing is that different precepters have their own way of doing things. If your assessments are disorganized that seems like an easy fix. OPQRST and SAMPLE hx just like you were taught. The opqrst part arent going to be the exact some questions for every complaint obviously, but it works perfectly for possible cardiac problems and at least the OST for every complaint along with some questions and a physical exam that is specific to their exact complaint.
If you have a medical complaint that is vague or it seems like it could be a lot of different things then their med list becomes more important, especially with older patients with dementia. My biggest problem starting out was not so much knowing the questions to ask but figuring out how serious their problem really is and not wasting too much time on scene. I had some precepters who flew through stuff on scene and would get impatient quickly if they thought I was wasting time.
Someone else made a good point about EMT intermediates and Basics. I remember doing some rides where my precepters partner was one or the other and a lot of them were kind of know it alls and would be the most impatient. Just because someones been working the road for a long time as a Basic or AEMT doesn't mean they know how to do things right. In many cases they are working ALS because they are good at driving the ambulance, navigating, lifting, and things like that, not for their assessment skills, but throw a medic student on their truck and suddenly they become road physicians. It can be pretty annoying.
If you have a medical complaint that is vague or it seems like it could be a lot of different things then their med list becomes more important, especially with older patients with dementia. My biggest problem starting out was not so much knowing the questions to ask but figuring out how serious their problem really is and not wasting too much time on scene. I had some precepters who flew through stuff on scene and would get impatient quickly if they thought I was wasting time.
Someone else made a good point about EMT intermediates and Basics. I remember doing some rides where my precepters partner was one or the other and a lot of them were kind of know it alls and would be the most impatient. Just because someones been working the road for a long time as a Basic or AEMT doesn't mean they know how to do things right. In many cases they are working ALS because they are good at driving the ambulance, navigating, lifting, and things like that, not for their assessment skills, but throw a medic student on their truck and suddenly they become road physicians. It can be pretty annoying.
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gotbeerz001
Forum Deputy Chief
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Do NOT tell your preceptor's partner to do anything. I have known several interns who have been bounced off their internship because of the way they reacted to a pushy partner. A pushy partner is part of the job. If your preceptor is allowing this, they probably want to see how you handle a less-than-supportive atmosphere.... Which you will experience in this job. If this is your preceptors regular partner, the loyalty will fall with them, not with you.
If the feedback becomes counter-productive, mention your concerns to your preceptor and accept the course they follow.
jlw
Dirty cot jockey
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Everybody develops their own "flow" if you will in regards to questioning. Hang in there, take advice from the guys who've been at it a while and you'll be fine.
SixEightWhiskey
Forum Crew Member
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Ask questions that are pertinent to their current complaint. Especially if it's cardiac, you want to know as many details and associated symptoms as you can. Also consider things that your receiving facility might want to know. Details such as height/weight, do you smoke, etc etc save the nurse a little time during their triage. (Also as a bonus, asking them their weight is a good way to practice doing lb to kg conversion and calculating weight based med dosages).
If you've asked everything you can think of, and you still have a few minutes left before you hit the ER, try and make small talk! This is easier said than done for some people, but it honestly can put sick people at ease, and distract them from their current condition a little bit. Also always do your best to reassure them and let them know they will be well taken care of.
It all takes practice and a certain comfort level, but after awhile and enough interactions with people it will feel like second nature!
If you've asked everything you can think of, and you still have a few minutes left before you hit the ER, try and make small talk! This is easier said than done for some people, but it honestly can put sick people at ease, and distract them from their current condition a little bit. Also always do your best to reassure them and let them know they will be well taken care of.
It all takes practice and a certain comfort level, but after awhile and enough interactions with people it will feel like second nature!
medicaltransient
Forum Lieutenant
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Opqrst
Then
Any headache or blurred vision
Maybe look in their eyes mouth look at neck
Any chest pain or difficulty breathing
Listen to breath sounds every time is a good practice!!!!
Any abdominal pain nausea hx of vomiting, diarrhea painful or difficulty urinating?
Palpate abdomen.
Any weakness or trouble walking at all
Then I look at their ankles.
That is the short and sweet that most every medical pt I see gets.
If i get someone cool or maybe an inmate or someone that wont get pissed off, I try to elaborate as much as possible just for practice and to form good habits.
Then
Any headache or blurred vision
Maybe look in their eyes mouth look at neck
Any chest pain or difficulty breathing
Listen to breath sounds every time is a good practice!!!!
Any abdominal pain nausea hx of vomiting, diarrhea painful or difficulty urinating?
Palpate abdomen.
Any weakness or trouble walking at all
Then I look at their ankles.
That is the short and sweet that most every medical pt I see gets.
If i get someone cool or maybe an inmate or someone that wont get pissed off, I try to elaborate as much as possible just for practice and to form good habits.
NYBLS
Forum Lieutenant
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I find asking "Do you have any trouble breathing? Do you have any pain?" and other questions along those lines to be very leading. "Are there any changes in your breathing?" May get you more details. Asking "Do you have any discomfort?" may get you a different answer then if you had to ask about pain, pressure, aching, etc.
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One big thing about making small talk, as difficult as it is at first, is that it allows you to gauge a patient's mental status pretty quickly and continuously. It's very possible for a patient to be completely alert & oriented, but after making some small talk, you might realize that the patient really is out well beyond left field and isn't truly able to comprehend what's going on. Or you might pick up that the patient is rapidly declining before you might even see it "objectively" on the monitor and very quickly change your treatment plan. This might just keep you from having to make the dangerous leap to warp III because your patient did a "surprise" crump on you as you might have detected it early and stopped a problem from developing.
COmedic17
Forum Asst. Chief
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No. But I'm on the extreme end of being an extrovert. I can pretty much talk to anyone. I have had partners who had has this problem, though.
My advice has always been pretend you are talking to a friend. Be comfortable and confident.
Then ask anything you can think of that includes their complaint. That part comes from time and experience, though.
My advice has always been pretend you are talking to a friend. Be comfortable and confident.
Then ask anything you can think of that includes their complaint. That part comes from time and experience, though.
DWR
Forum Probie
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I've always based my questions on the call and the patient personally. But to be honest I don't run out of questions to ask. Once I get all of my pertanant information I "explain and entertain" as my captain said in one of my quarterly reviews. If I'm starting an IV/blood labs I explain why in simple terms. If I'm giving a medication (non criticle type of call) I explain what it does and why we give it. I essentially talk through the call. I also have relatively short transport times so it's not that big of a deal. And then entertain. Now hear me out. Last week I had a gang shooting, 17 year old male GSW to the LRQ. For the most stable (minus what could be going on inside) and no exit wound. I'm not going to try toake light out of the situation with that type of patient or tell a bad joke too. The 34 year old male that crashed on his moped and has cats on his socks? We'll make light of stuff.
The key is to get ALL OF THE INFORMATION YOU NEED to properly care for your patient. You'll learn overtime what works, what doesn't work, what's worth while asking and what's not. You learn to clean everything up with experience. After that? Try to make your patient comfortable. If you think you have all of the info you need, talk to them! You're both humans, make small talk. As a bonus I try to follow up with everyone of my patients when I go back to the hospital. It goes a long way.
The key is to get ALL OF THE INFORMATION YOU NEED to properly care for your patient. You'll learn overtime what works, what doesn't work, what's worth while asking and what's not. You learn to clean everything up with experience. After that? Try to make your patient comfortable. If you think you have all of the info you need, talk to them! You're both humans, make small talk. As a bonus I try to follow up with everyone of my patients when I go back to the hospital. It goes a long way.
TheLocalMedic
Grumpy Badger
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I had the same issue when I was starting as a paramedic. The best way to look at it is that you want to know everything about them and question everything. If you start running out of medical questions, start asking about family health history, social history and then just chat. Ask them what they do for a living, kids, etc.
If your preceptor's partner is giving you a hard time, but it's not coming from your preceptor, then take their advice with a grain of salt and look for ways to improve. If you're uncomfortable with what they are saying, then take it to your preceptor.
If your preceptor's partner is giving you a hard time, but it's not coming from your preceptor, then take their advice with a grain of salt and look for ways to improve. If you're uncomfortable with what they are saying, then take it to your preceptor.
gotbeerz001
Forum Deputy Chief
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Maybe we should start (or revive) a post about pertinent positives/negatives.