Patient Rapport

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FlyerAce128

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Hello EMTLife!

It's been awhile since I've been around, but I passed my NREMT and am State certified as an EMT-B! The journey begins. The big question I have so far is about building rapport with patients. I'm in a fire district so when we're the first on scene and since we're somewhat rural it can be some time before the ambulance crew arrives to transport. In that time we're assessing the patient, taking vitals, getting info, etc to pass on to the ambulance crew. I saw it mentioned in another thread the importance of building rapport with patients and making them as comfortable as possible with you given the circumstances. I've noticed that with my patient contacts I can get the info I need, vitals, etc but I'd like to be able to build a better rapport. Is this something I will just learn over time with experience or do any of you have pointers or tips for a new guy looking to improve his bedside manner? Thanks!
 
1. dress professionally, no one will trust someone to treat/examine them if they do not look professional

2. always introduce yourself and ask the patient what they would like to be called "Hi, my name is bob, Ill be the EMT taking care of you"

3. Look at the patient when you talk to them and explain everything you are doing.

4. Talk with them to keep them comfortable, silence can be awkward. Ask more questions to them, sneak in a harmless joke or bit of humor if you can and feel it would be appropriate.
 
I am by no means a veteran around here, or in the field. I just got certified myself, but have been a driver for 8 or 9 months, and have ridden in the back a ton of times to help out in anticipation of my EMTB certification.

I seem to be pretty good with patients i think. I try to put myself in their shoes....they want to know they're in good hands. Even if you're scared :censored::censored::censored::censored:less, act calm and reassuring. Think of it as being strong for them. but never tell them everything is going to be ok, if it's not or if you're not sure. Everything from the way you move, the way your voice sounds, to the expression on your face can make them feel anxious.

I also find that distraction techniques can be very important...questions..about anything..
 
frdude1000 said:
1. dress professionally, no one will trust someone to treat/examine them if they do not look professional

2. always introduce yourself and ask the patient what they would like to be called "Hi, my name is bob, Ill be the EMT taking care of you"

3. Look at the patient when you talk to them and explain everything you are doing.

4. Talk with them to keep them comfortable, silence can be awkward. Ask more questions to them, sneak in a harmless joke or bit of humor if you can and feel it would be appropriate.
Click to expand...

Thanks Gabe!
We have a standard uniform but I'm always making sure I'm clean cut, shaved, etc before starting my shift, and I make a point to introduce myself. Sometimes those awkward silences happen and I'm not sure how to break that silence. Like you were saying a harmless joke if appropriate but sometimes I find it hard to figure out if it's appropriate or not :unsure: I try to let the patient know what I'm doing but sometimes I feel like what I'm saying would be confusing to someone if they don't know what I'm talking about (i.e. "I'm going to put this pulse oximeter on your finger"). Maybe explain what it does as I do it? One of the fulltime FFs in my district has such a great bedside manner he could be best friends with any of his patients at the end of each call, I don't know how he works his magic haha.
 
Very solid ideas have already been given.

I always ask the patient what I can do to make them feel better. Even if you can't deliver, they feel like they are in control. I try to involve other family members in the process of patient care. Just before I break contact with a patient, I ask them if they have any questions.
 
You have already been given some good suggestions. Keep in mind that part of it is just gaining experience though, too. Once you no longer have to constantly think about every single question so you don't forget anything, and you have a routine/flow to what you do, you will find you will be able to chat more and find it easier to put people at ease.
 
A few other things to incorporate:

Reflective listening: Repeat what the patient says to you, which lets them know you're listening. It also gives you a chance to write anything down that you need to write down (either notes or on the PCR) and gives you a chance to think of what's next. An example would be, "So you have a history of high blood pressure and diabetes, how about any allergies?"

Empathy: Even though "I'm sorry to hear that" sounds canned to you, it doesn't to the patient.
 
frdude1000 said:
4. Talk with them to keep them comfortable, silence can be awkward. Ask more questions to them, sneak in a harmless joke or bit of humor if you can and feel it would be appropriate.
Click to expand...

Humor is definitely a good thing, as long as it's not offensive or could be hazardous to their health (don't tell your patient with an abdominal injury or illness something funny for example.

Talking is also good, but learn that silence can be beneficial (something I myself am working on). It's awkward, but silence can teach you a lot about the patient and can even be helpful to them!
 
Thanks a lot for the replies! I think as I gain more experience it'll probably come more naturally. I really appreciate the insight you all have given!
 
I try to call every patient sir or ma'am at first. Many patients will ask you to call them something else, which is a good start at building rapport. If they don't, you're just showing them proper respect.

If you think the patient is scared or needs reassurance, talk them through what your going to do so you don't startle the patient; "I'm going to go ahead and take your blood pressure now ok? You'll feel the cuff getting tight now." If it's more complex than that (like the pulse ox example), definitely try and give a brief explanation on why your doing what. Telling them what you're doing in question form is good too since the patient will feel more in control. Say please and thank you too. Try and make small talk with nervous patients if you have time and you think it's appropriate, silence can let them start thinking too much about what's going on and then they'll be nervous.

Above all, try and exude some confidence.If you sound nervous or are overly aggressive or authoritative it'll freak the patient out.
 
FlyerAce128 said:
Thanks Gabe!
We have a standard uniform but I'm always making sure I'm clean cut, shaved, etc before starting my shift, and I make a point to introduce myself. Sometimes those awkward silences happen and I'm not sure how to break that silence. Like you were saying a harmless joke if appropriate but sometimes I find it hard to figure out if it's appropriate or not :unsure: I try to let the patient know what I'm doing but sometimes I feel like what I'm saying would be confusing to someone if they don't know what I'm talking about (i.e. "I'm going to put this pulse oximeter on your finger"). Maybe explain what it does as I do it? One of the fulltime FFs in my district has such a great bedside manner he could be best friends with any of his patients at the end of each call, I don't know how he works his magic haha.
Click to expand...
He treats them like a decent human being, how he'd like to be treated. Seriously. He appears calm and confident.

Me, I start with something along the lines of "Hi, I'm Akulahawk, and I'll be your medic today. What's going on?" Somewhere very early on I'll also ask what their name is, what they like to be called, ask what I can do to make them feel better... stuff like that.

Reflective listening and showing empathy like JP says is HUGE. Part of treating someone decently...

Never "just" stop talking. If you're anticipating a quiet moment, (like you're doing paperwork) just tell the patient what it is you're doing and they'll not think you're just sitting/standing there doing nothing. Always leave an opening for them to interrupt the silence.
 
It also helps to tell them what to expect and how long it usually takes.

Many patients do not understand in the hospital, no news is good news.

They are afraid, do not know what is going on, and while an ambulance ride is a normal part of your day, it is usually not a normal part of theirs.

Especially older patients have a very negative association with ambulances. Often the last they saw of a friend or relative was them getting put in one.

It goes a long way to ask them if you can help with their concerns, like making sure the house is locked, lights turned on/off, etc. They often also worry about how much things cost.

While you may not know, try to avoid saying things like "it doesn't matter" or "it's worth it" because it trivializes their fears.

It does matter to them and it may not be worth the long term consequences.

Condition permitting ask them if they need to call somebody.

Remember, not every patient, and in fact most, are not time critical life and death emergencies.Take a small amount of time to help with little things.

A lot of people, especially those who think that EMS is all about emergencies get caught up in worrying about the system.

Worry about the call you are on. If another comes in, then the next available help will be sent.
 
Veneficus said:
They are afraid, do not know what is going on, and while an ambulance ride is a normal part of your day, it is usually not a normal part of theirs.

Remember, not every patient, and in fact most, are not time critical life and death emergencies.Take a small amount of time to help with little things.
Click to expand...

If nothing else, if you remember these two things you will have positive dealings with your patients. Your patient is likely not comfortable with being in an ambulance. Take every step you can to remedy this if their condition makes this possible.
 
Why are you there?

Once the data is collected to assure a smooth transition of the patient to the next highest link in the chain of recovery (the ambulance medics) does that mean your job is done?

You came to help which means being an active participant in identifying immediate problems and helping to releive them. Once you've isolated the problem, taken immediate and necessary actions, and done what's needed to relay that info up the chain then all you're left with is the human being (and family, etc.). Now, it's all about figuring out how you can keep the overall situation stable, if not improve it.

Professionalism communicates that you're not casual and every action you choose to take will be based on the welfare of the patient. From that point on, you are just you and -- as you would for a friend -- make yourself available to make things more comfortable for the patient and others on scene.

The trick is, in non-emergent situations you're going to be on the scene for about 20 minutes. I really don't think you have to worry about entering into a lifelong, bonded relationship with the patient. Get all the professional stuff done and then use the remainder of your time with the patient to strengthen their belief that you're part of a team that is dedicated to helping the involved get through a crisis. In many cases that means utilizing your humanity as a tool of healing.

Remember; in those first crucial minutes with a patient, you are doing more than intervening in an emergency. The impact you leave can do much to set the very course of recovery of your patient!
 
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Don't loom over the patient if you can help it. If they're sitting kneel or pull a chair up and sit facing them. Try to get at their level (within reason). This is especially useful with kids and the elderly.

Look them in the eye when you talk to them. This is a lost art in modern medicine. The computer has created an environment both in the pre-hospital and Hospital where we tend to speak to patients while entering data into a computer. Nobody likes talking to another persons back. This is also something to keep in mind on the ambulance. If you really want your patient to trust you sit on the bench seat where the patient can see you rather than in the captains chair where all you are is a voice yelling over road noise and the beeping of the ekg.

Hold old peoples hands. Sounds corny I know but it calms them down, especially the folks with dementia.

Smile. You would be amazed at how effective a smile can be in earning a persons trust. I see medics and EMT's all the time who think their game face should be Clint Eastwood when in reality it should be, well almost anyone other than Clint Eastwood basically.

EMS is basically just customer service. All the same rules apply.
 
I had a patient named Rappaport once.







What!? :mellow:
 
I once had a well experienced RN pass on this bit of his wisdom: "You can't help someone who is hurt, scared or angry." Many of our patients fit somewhere into one of those categories. Attempt to ease those issues and many times your patient will allow you to help them, not just tolerate what you do to them. Your patient might just end up thinking the world of you simply because you cared about them and helped ease their fears. Take a minute and turn lights off, shut and lock doors, check the stove and oven to make sure they're off... it's the little things that don't take a whole lot of time to do. Ask them if there's anything you can do for them... Just that one question (and following upon it if possible) can make a patient feel much more at ease. Thus your patient feels less hurt, less scared, and/or less angry.
 
I have been inside many ambulances around the world and I can tell you that there is are all types out there. Being professional is not something that is difficult to do, but does need attention to maintain (especially when its near the end of a very long shift). Explaining the procedure (required for informed consent anyway) and ensuring that the patient is part of the process is vital. Calling them "Sir" and "Ma'am" is something that may not be noticed by the patient but creates a very professional atmosphere. When comparing Canadian versus American services with my colleagues, I couldn't figure it our until someone mentioned it, but that was a huge part.

Never, ever bad mouth your service, colleagues (or anyone for that manner). It will get picked up by the patient as well.
 
We tend to be a bit more casual in general here, so you might want to take what I say with a grain of salt.

Firstly I have a persona that I've built from a combination of things that I liked in other paramedics. Its not fake so much as it emphasises, to a great extent, parts of my personality that are more conducive to putting smiles on faces.

In short I hope that it conveys energy, a certain respect for blokey stoicism, supreme confidence and a good deal of humour. I also hope that it offsets my baby face, naturally formal standoffishness and tendency to ignore small talk. You might like to do a little reflection on what your interpersonal strengths and weaknesses are and what you might like to do to improve any weaknesses.

"G'day, I'm Melclin, and this is (INSERT PARTNER), before we crack on, whats your name mate/love/other familiarity depending on appropriateness?"

"I'm Tom, how are ya?"

"Better than you by the looks of it mate. What can I do for ya?"

"Well I've had this chest pain you see."

"Oh no worries, so how long has that been going on for? etc etc."

I'll take their pulse pretty much straight after the introductions. Just for a second or two while we're talking. Fast normal or slow and extremity temperature. Good info to get early on. Means you don't spend 10 mins talking to them before you put the monitor on them and find they're in VT. Bit of human contact helps too. For your elderly types who have fallen, I'll often just hold their hand during the whole interaction. Old ladies love it. We say that these pts need, "Fifteen minutely there-theres". Alternatively, a few carefully chosen swear words, tactfully inserted can really put people at ease. Skater with broken ankle, "Ahhh it hurts wahhhh". Me, "Mate stop your whinging, I'm ganna fill you full of morphine and you'll be :censored::censored::censored::censored: faced in a tick, so its your lucky day".


The initial casual interaction puts people at ease, but I find I have to follow up with more intelligent language. Less jovial. More jargon, but with explanations. Reminds them that while you can shoot the :censored::censored::censored::censored: with the plebs, you're also an expert in your field.

I don't take any :censored::censored::censored::censored:. I'll sternly reprimand anyone who pisses me off in what I call, "Nurse voice". Its something I've copied from nurses I know who have a great ability to be simultaneously authoritative and stern but without letting you question their compassion. Stern humour combined with a reminder that we're on their side and that it is very unappreciative to be rude to someone who is trying to help you.

Then this:

Veneficus said:
It also helps to tell them what to expect and how long it usually takes.

Many patients do not understand in the hospital, no news is good news.

They are afraid, do not know what is going on, and while an ambulance ride is a normal part of your day, it is usually not a normal part of theirs.

Especially older patients have a very negative association with ambulances. Often the last they saw of a friend or relative was them getting put in one.

It goes a long way to ask them if you can help with their concerns, like making sure the house is locked, lights turned on/off, etc. They often also worry about how much things cost.

While you may not know, try to avoid saying things like "it doesn't matter" or "it's worth it" because it trivializes their fears.

It does matter to them and it may not be worth the long term consequences.

Condition permitting ask them if they need to call somebody.
Click to expand...

Keys, wallet, phone, lock the house, someone to take care of the pets, make a few phone calls. Brilliant. We spent an extra 20 mins on scene with a bloke once, organising respite care for his frail wife before we transported. This stuff really matters. You can't just ignore it.

Talking to pts about what to expect and generally educating them is important. I get so frustrated with how little they know about their condition so I like to explain things in quite a bit of detail. So many of my pts say things like I took a turn and had to go to hospital for 3 days and nobody ever told be what was wrong. I'll often print off a copy of their ECG, write a few things down and have them stick it on the fridge for next time, write notes to GPs/home care nurses etc. You know, all that pt advocate crap that we're supposed to do sometimes.
 
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