Posted by: medicblog999 | June 8, 2009

Its all about how you say it!

caringWEB

Rapid Response Doc over at “A life in the day of a BASICS doc”, will be hosting the next edition of “The Handover” EMS blog carnival at the end of the month. The theme that he has us all racking our brains over is ‘Communication’

Now this is a HUGE topic to consider. I have been trying to think of a decent story to illustrate the importance of good communication skills, or rather, the negative impact that poor communication can have on a patient and their family. It could be something as simple as a misunderstanding, a phrase taken out of context, or a paramedic not making his plans and interventions absolutely clear to the patient that they are caring for.

I class communication as important as any other tool that we have in our kit bag or ambulance. Good communication skills can ease someones stress, allow them to make a critical informed decision or most importantly,give our patients faith in us as professional health care providers who know what we are talking about.

At present, with the change in focus from always taking patients to an Accident and Emergency department, to instead, referring on to appropriate care providers or even informing the patient that they do not need any ’emergency’ care and will not be taken to hospital, it has become even more important to have the verbal skills to negotiate a satisfactory end disposition for someone who has called 999, who was expecting transport to a local hospital.

To give an example of when communication has been somewhat lacking, I remember back when I was a student nurse and was working alongside a staff nurse in A&E who had for more experience than I. For the purposes of this discussion I will call him Michael.

Michael was highly academic and knew his theory very well. He was however, very trauma/critical care focused. Everything was time critical, everything had to be done efficiently and with haste. He found it very hard to switch to a lower gear for the old dear who had just had a syncopal episode, or the patient with chronic COPD who has having a bit of an anxiety attack.

He was competent at looking after the multitrauma patient or the patient with a life threatening illness, but the little things were still missing. I honestly cant remember ever seeing him just hold someones hand and say

“dont worry, everything is going to be alright. We are here now and we are going to look after you”

I cant recall ever hearing him tell someone to take their time and tell us what happened.

Now, dont get me wrong, there are always times when speed is of the essence and can make a difference in a clinical outcome for a patient, but I honestly feel that there is always time to take a moment, even if its just a couple of seconds, to make a connection with your patient and/or their family/carers or loved ones, and that is what can make a difference in someones experience of the NHS.

One day I was working with Michael. We were having a busy shift and we were upto the 6th or 7th patient of the shift. Michael had assessed all of the patients and with a number of them, you could tell the patient and their family were getting a bit annoyed and frustrated with how they ‘perceived’ they were being spoken to.

Michael had a habit of asking a specific question and wanting a specific answer. There was no time for small talk or ‘generalised’ history taking. He wanted to know the answers to his questions and he wanted to know them NOW! If a member of the patients family tried to add something to the conversation, they wold be told not to interrupt as he needed to hear the information ‘from the patient’.

I honestly believe that Michael felt that he was doing the absolute best for his patients. When we discussed things he used to tell me that his priority is to get all of the essential information he needed to make a clinical decision as quickly as possible. Anything else is irrelevant and he didn’t want to hear about it.

After assessing a couple of the patients, the family members had asked for his name after he had left the room, apparently with the intention of putting a complaint in. I tried to explain that even though Michael may have been coming across as a bit abrupt, this was only because he had concerns for their family member, and he was trying to work as quickly as possible. I managed to avert the first two complaints, but with the next patient the same thing happened. Again, I explained to the patients family that he wasn’t being intentionally rude and only had the best interests of the patient at heart.

After this, I decided to speak to Michael and asked him if he realised that I had deflected three possible complaints regarding his communication styles. His answer:

“Bring it on, let them complain!”

What can you say to that?

We had a number of discussions about it over the next couple of weeks, but he never changed the way he conducted his assessments. It was inevitably frosty, but he honestly and truly believed that the way he assessed his patients was the most effective way of doing it. I have no doubt that he probably used to pull his hair out when I used to take my time and provide some TLC in the appropriate situations, when there was no time critical element to the job.

Bedside manner is not something that comes naturally to all people. It is there in the VAST majority of paramedics, because lets face it, if you are in this job, you have an inherent ability and need to care for people and to try and put them at ease.

Its not all about cannulas, tubes and drugs. They are the minority of what we do.

It is all about talking, listening and being open and receptive to the concerns and fears that our patients have. (or at least, thats what I think!)

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Responses

  1. Very true. I have had calls for minor complaints and that the patient will be an elderly couple who for the most part are just concerned for their wife/husband and maybe just need a little reassurance that they are okay.

    There is nothing worse than a big burley fireman (the engine usually will show up first) standing over the patient in an almost condesending tone clearly stating that this is NOT a true emergency therefore should not be calling 911.

    Lets remember who pays our wages, its the citizens we serve. Yes I understand that you were in the middle of dinner or your favourite episode of House, but its your job and im sure McDonalds is hiring if you are getting tired of EMS. A little bit of caring goes a long way and its absolutly free of charge.

  2. Never underestimate the theraputic effect of a smile or a joke. Sometimes the word “ambulance” is enough, but the other bits do have a synergic effect with it.

  3. Mark, you said it just right, communications skills should be taught and assessed on a regular basis, if only to bring certain peoploe down from their self built pedestal….. Also to allow the public to realise that the Emergency Services really do care about what happens to them, even if the senior management don’t!!

    Hope your keeping well and will be in touch soon,
    Cheers,
    Eamonn


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