To tell the truth

mikeylikesit

mikeylikesit

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There often comes a time when, during a call, your patient ask you a question out of fear or concern…so how do you answer them? For instance I had a call where a little boy lost half of his arm in a boating accident, on the way to the hospital with his arm packaged up next to me he looked up and asked me “is my arm going to be ok?” I told him “Yes” now I didn’t lie, he just didn’t ask the right question. Mind you that the transport was 30 minutes from the hospital. He next asked “are they gonna put my arm back together?” given the cut at the elbow and our time I told him “yes” still not the right question of “will I be able to use it again 100%. Now we all have instances of “is it going to hurt” which we are told and do answer truthfully but what about the other situations like listed above? What about if the patient was going to die? What would you tell them? The truth? Or something else?
 
Well as you know every situation is different. However if someone is circling the drain and they ask me if they are going to die, or be ok I tell them what I know. If I don't know I will be blunt, but polite and let them know that I don't know the answer. I found that avoiding the question, or lying to the patient often does more harm then good. Espically if a family memeber is sitting there in the ambulance with them. If I have a feeling that they are gonna code before getting to the hospital, or even in the hospital I will reassure them, but never give them false hope.
Now with the littke kid, what you did was what I would of done, answer his questions that he asked me and just answer those questions. But like I said every situation and call is different and there is always a different way to answer those questions.
Just don't ever lie.

Mitch
 
I strive for honesty with all of my patients, which can often mean answering that I'm not sure exactly what will happen to them. It's usually not too hard to outline likely courses of action or possible outcomes, though.
 
Depends... Often my answer is that we "are going to do everything we can".

If it is a code, and the family is asking... I might be more pessimistic... for example:
-Is he going to be OK?
"Right now, he isn't breathing on his own and his heart isn't beating. We are giving him medications, but he doesn't seem to be responding. We are doing everything we can, but it doesn't look good".

Lying, or being optimistic and vague, isn't going to help the family accept what is happening... The last thing we need is to call the code at the house and have family fighting us saying that we said we'd save him.
 
There's always a way to tell the truth. We're going to do everything we can, or you will get excellent care are two of my favorites. I've also told patients, "I'm only an EMT, I can't diagnose your illness, but we're going to get you to the ER as quickly and safely as possible. The staff there will do the best they can to determine what's wrong with you and how best to treat it" Then I toss in some raves about the staff at the hospital, who's on duty that night etc.

I have had a patient flat out ask me if they are going to die. My generally response to that is "We're going to do everything we can to prevent it"
 
Sometimes one would think it may be best to tell a little "white lie", and moreso with kids. Honesty goes a long way, whereas dishonesty will cause the inability to win the patient's trust (as you may contradict yourself).

There is not much to add to what has already been said, maybe just to say that telling another version of the truth (but averting to directly answer what the patient has asked) is not a lie!! Such as saying: we are doing everything we can, in response to the patient's question of: will my arm be ok?.
 
both in the field and in management the honest truth with knidness has always been my standard.

I did work in a con home in admissions for a bit and had a patient as me if he would die there, I responded "most likely" since he was talking to the doc about hospice.

He said "good I can trust you now ......I know it and I know you know it, I was just testing you"

I think that happens often, with kids as well. When I needed to start an IV i would say " this is going to hurt more than you want it to but you will be OK" that way if you have to stick them again they will help.
 
Im just a first responder but...

generally, i try to be honest but optimistic. I never make a to a patient that promise i can't keep, and when in doubt, i just say: "I don't know, but I'm doing all I can." (unless im working with another responder, but thats just a grammatical change.):ph34r:
 
I have been in the back of the ambulance twice as a pt. Once after getting shocked by a capacitor from a strobe system. Second after I starting have a anxiety attack.

On the first one I met the ambulance at a cross street. The EMT gave me some water to drink, I was extremely lethargic. I have heard people say giving water to drink is bad. Anyhow, he hooked me up to the EKG and looked at my read-out. I flat out asked, do you think I need to go to the hospital, I really didn't want to leave my work truck on the side of the road. He said I just needed to calm down, I signed one of those refusal forms.

The second time I was transported, I waited on the ambulance outside some apartments I lived at, at the time. I got in, they hooked my up, I said i think I am having a anxiety attack. I asked do you think that is what it is. She said it could be. She started a IV, then asked me is it my first time in the back of a ambulance, which i said yes. She said it would be a bumpy ride. I guess my EKG just showed a very fast normal rythm, I think it was around 180bpm, very high BP as well.

Riding in the back of one, when you think you may die. You are really counting on those people to help you. The way she responded to me, not being all scared about the situation helped me to calm down. What about calls where you adrenaline gets really going and its hard to remain calm?
 
This is not something that I was either aware of or able to say when I was in the field, but I can tell you what I say today in response to questions of such importance and heaviness.

"Just keep your focus on the moment and (healing...life...getting better...building strength)"

and when they drift...

"Just keep your focus on the moment and (healing...life...getting better...building strength)...I'm right here."

...and don't be afraid to look him/her in the eye.
 
Look 'em close and straight in the eye, look serious....

"OK, we're going to take care of you" and keep talking as you press on.
And if you drop something or forget to do something, give a little shrug, look chagrined with your self, as you FIX IT.

The fellow my coworker cut out of the car with a Buck knife...His wife was sitting next to him in the front seat, without a scratch, dead. (Told us later on C1 fx). Her side of the car was less damaged, and the FD gently moved her out while we worked on the driver. I got myself between him and them.

"How's my wife?". He was somewhat obtunded, trapped, and needed care THEN.

"Stable" I said. (Don't ask me where THAT came from. Later on the trip to the hospital I told him she didn't make it).
 
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