Connections

Sure you communicate with your patient, but do you make connections? The difference may sound like semantics … but it’s not. The difference is extraordinary.

Do you remember James Burke? He was the plucky, dry humored narrator of the 1970s BBC TV series “Connections”.  James would begin each episode with some historical event like the invention of the catapult and show how it was related to the way we make billiard balls or some other impossible sounding connection. His message was simple and profound. The big idea was that we are interconnected in ways that are complex and impossible to predict. Reality doesn’t flow forward in a perfect linear timeline.  An intricate web of human connections drive history and innovation forward.

Without one minor connection another crucial event becomes impossible. Alter one seemingly insignificant event and you change the course of history.

There is something vital in the way we are interconnected. When we connect, we change each other in ways that we can’t predict. If we simply communicate with our patients and coworkers but never reach out across that gap and connect with them, our work can become dull and routine. On the other side of the gap the patient / caregiver / human relationship is far more fulfilling.

If that sounds worthwhile, let me give you a few tips for making conscious connections with your patient.

1.) Smile. I know, it doesn’t always seem appropriate to smile at someone in the midst of a medical emergency but I rarely run across circumstances where I can’t pull of some form of a heartfelt smile the first time I address a patient. Give it a try.

The first few seconds of patient contact are critical in establishing yourself as a trusted caregiver. Don’t blow it by standing over your patient with your arms crossed and talking like you the commander of an aircraft carrier. Walk right up, get on their eye level, look them right in the eyes, smile and say, “Hi I’m ______ what’s your name?” That simple question will tell you a tremendous amount of information about their mental status and situation. And it will help you establish a connection.

2.) Once you know their name, use it. Formally or informally, a patients name is always preferable to sir or ma’am or any of those other universal names we use to avoid the trouble of calling our patient by their name. Oh, and for the love of God drop the honeys, sweeties, buddies and dudes. Some folks may try to convince you that those ridiculous terms of endearment help build rapport. They don’t. They make you sound obnoxious. You’re patient has a name. Find it and use it.

3.) Learn to recognize your patient’s identity. People surround themselves with things that represent who they are. Learn to get a sense of these details and what they tell you about your patient. The Buddha figurines on the shelf, the Michael Bolton CD playing on the car radio, a military photograph, all those little bits of minutia are launching points for conversations about your patient. Their life is a story and many people are more than happy to tell it if you ask.

If your patient feels that you really care about who they are, they’ll trust you more when you need to ask the hard or embarrassing questions. They’re more likely to listen when you say, “Mary we need to take you to the hospital.” or “David I’m going to need to start an IV in your arm.” And you get the reward of caring for people instead of medical presentations. Medical presentations get old after a while. People are infinitely interesting.

4.) Say goodbye the way you would say goodbye to a friend. It can be easy when you’re in a hurry to dismiss with the formality of saying goodbye to your patient. Try not to drift off into the emergency room crowd without somehow telling your patient that you’re leaving them.

My habit is to address my patient the instant I finish my report. Hopefully before the ER staff has started in on them with a myriad of admission details. If I have made a positive connection with the patient I say goodbye the way I leave a friend. I take their hand in mine and say, “It was very nice meeting you today. These folks here are the best and they are going to take great care of you.” Regardless of their disposition through the course of their care, it is the rare patient that doesn’t shake my hand earnestly and thank me for my help.

This can be a crazy job. It can wear you down. Many of the people we encounter are living through acute or chronic tragedies. We become bit players in the tragedy of their lives. In that environment, it isn’t hard to convince ourselves that it is healthy to disconnect from the patient / caregiver connection. Many of us master the art of patient disconnect.

When we chose this path we need to consider the cost. When we deprive ourselves of the authentic human connections offered to us each shift we deprive ourselves of a critical element of our own enrichment. When we connect we not only allow the patient the opportunity to be changed by us, we open ourselves to the opportunity to be changed. Sure, change involves risk. Isn’t that what life is about. Didn’t you hope that this career would change you somehow?

You begin by letting go of the sterility of communication and, instead, you chose to make a connection. The result is unpredictable but will undoubtedly change you forever.

  

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Comments

  1. Excellent post! All too often I’ve see fellow providers just skip over this crucial connection with their patients, and then wonder why they’re burned out.

  2. Very nice. Made me recognise my failings communicating with patients, let alone seeing things in colleagues. Think I’ll be passing this one along…

  3. Steve, I’ve been working on some of the skills you’ve mentioned here, but I still don’t feel like I completely get it. I think I’ve almost got the hang of walking into the call, giving the patient my best, somewhat fake smile, and saying “Hi, I’m Liz from EMS…” and then asking either first what’s wrong or what’s their name depending on how the patient looks. I say “somewhat fake” because I still get nervous getting every call, walking onto every scene, until I start talking to the patient and get an idea of what’s going on.

    I just stopped being a probie with my college service but I’m going on 4 years now of riding in an ambulance, since during high school I was allowed to assist with my local organization (carrying bags, getting supplies from the rig, etc.) so I feel like I shouldn’t be this nervous at this point. But I am a naturally shy person, so maybe this is why I don’t completely get it. Because I still don’t know how to just talk to people, of any age, background…etc.

    With my college students I find it pretty easy to strike up a conversation: I ask about classes, how their semester is going, etc. And then I go from there, and maybe ask what music they like, complain about the winter weather or dining hall food with them, or find something else to talk about.
    But back home it’s different. Sometimes I can get in the back with the patient and strike up a conversation, but this is rare. The other member in the back with me (I’m still a probie) can get in the back of the rig and just talk. They don’t try to start up a conversation, they don’t search for an ice-breaker, they just begin talking to the patient as if the patient were their neighbor or best friend, and they talk to them all the time. I can’t even really describe it, it just seems so natural.

    So basically in this long-winded post I’m asking for tips on how to just talk to your patient, about anything, without needing to ask a question or do something to start a conversation. If you have any tips (besides “ride more”) I would greatly appreciate it :).

Trackbacks

  1. […] you’re developing your patient rapport skills I recommend reviewing Connections, Patient Rapport Land Mines and You Can’t Give Away What You Don’t Have. You may even […]

  2. […] advice. At two AM it can be hard to let patients define their emergencies. Sometimes I fail to make connections and I’ve even been caught whining from time to time. These standards were my personal […]

  3. […] believe that you can treat people with great effectiveness and still connect with them on a personal, human, deeply compassionate level. And I think the people who say you […]

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  5. […] So why do I bring up Joshua Bell and the subway performance here? I bring it up because in EMS we do this all the time. We are busy. We are rushed. We are focused on the task at hand. And, in the midst of our call, we miss some truly remarkable people and we pass by some extraordinary possibilities for human interaction and connection. […]

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