I learned a lot about observation from Phil Rigardo. Phil was the brother of a friend from high school. When he learned I was in the EMT class at our local community college he invited me on a ride along. Phil was working for the local 911 provider. A company called Santa Clara Valley Ambulance. I remember riding backwards in Phil’s ambulance, I had a feeling that Phil was the kind of provider that I wanted to be. He was relaxed and casual on scene. Friendly with everyone and well liked by his patients and his partners.
The thing that impressed me the most about Phil was his ability to observe. I didn’t recognize this immediately. It was only through many conversations about the calls we were running and the patients we were interacting with that I came to the conclusion that Phil was simply seeing much more than I was.
After leaving the house of a woman who was bed ridden from a chronic illness I asked aloud, “I wonder How long she’s been unable to get around?” Phil answered casually, “She’s lost a lot of her mobility in the past three years.”
I briefly considered that perhaps Phil had run on her before. “What makes you say that?”
“There was a picture of her in the hallway with her son on the beach. Her son was about five in the photo. That was her son sitting in the kitchen. He’s no more than eight now.”
In that moment, I realized that Phil was seeing so much more while he was on scene than I was. My brain was still to occupied with the mechanics of taking an accurate blood pressure to recognize people in photos or observe the age of their family members. At that stage Phil’s ability to take in these details seemed superhuman. In truth their was nothing really amazing about Phil’s observation. He was a care provider with enough unconscious competence in his job that he was able to free his brain up and pay attention to the details of the scene.
It took me years of conscious effort to develop my ability to focus on the details of the scene around me and I still find myself occasionally missing the obvious but I’ve improved considerably since that day.
It’s unfortunate that the skill of observation often has to wait for our other skill sets to develop. The practice of paying attention to the detail of the scene can improve our safety, our patient rapport and our patient history. The skill takes years to develop, but there’s no reason why we can’t start right now.