Patient Rapport Land Mines

Patient rapport is something we can easily overlook in our quest for better medicine. Our book never touched on it. It was barely mentioned in class. It doesn’t make its way to the EMS conference circuit very often – outside of a few exceptional lectures by Thom Dick. So how important could it possibly be to good patient care?

Patient rapport is one of those foundational skills in EMS. When we improve this one skill, it supports everything else we do. You’ve heard me talk about ways to break through the initial patient / caregiver barrier and develop rapport in the past. Now let me talk about the other side of the coin.

Let’s discuss the things that we do that break down rapport or prevent it from ever forming. It’s much easier to break down rapport than to build it up. Here are some of the landmines that can break a good rapport into bits. We’ve all stepped on these a few times in the past and, unfortunately we’ll probably do it again. The best thing we can do is recognize these awful habits for what they are and try to avoid them at all costs.

Here are my top six patient rapport killers:

1.) Cutting the Patient Off Mid-Sentence

This is an insidious habit and I find that once we permit ourselves to do this it begins to pervade all of our conversations. It can be hard to avoid in emergency care when we are trying to get as much information from the patient as we can in as little time as possible. You’ve had this conversation before;

You: So when did you first start having this pain?

Patient: Well it was ….

You: Earlier today?

Patient: No …

You: Yesterday?

Patient: No … it was … last …

You: Week?

Patient: No …

On and on it goes. It would have been faster to let the patient finish the sentence in the first place. And as a plus they would feel more respected in the process. You’ll never hurry the patient’s cadence by playing 20 questions with their sentences. Unless you’re in the middle of a brainstorming session, have the courtesy to let the other person finish their own sentences.

2.) Talking Around The Patient

We do this particularly often with the elderly and children. There they are in the middle of the room having their pain or fall or syncopal event and we become consumed with all the helpful bystanders and forget that they are sitting right there.

I know it can be tough to just ignore helpful family and friends but there are some things you can do to keep the patient at the center of the conversation. You can make sure you keep looking back at the patients eyes to reengage them in the conversation. Gently nod to look for affirmation from the patient. I find this helps me to not only listen to the speaker but assess what the patient thinks about what the speaker is saying.

You can also ask the patient things like, “Does that sound right to you?” This lets the patient and everyone else know that the patient is the primary reporting party, not the helpful bystander.

3.) Standing Over The Patient

This one is a real pet peeve of mine. I just find it annoying to watch. Sometimes it is appropriate to maintain a position of defense and a posture of authority on calls. Some patients need to be addressed with physical authority, but most don’t.

You don’t need to stand over a little old lady with your arms crossed. The dude having chest pain in his recliner doesn’t need you to remain in a position of authority. Get down on one knee and look at your patient in the eye. It’s far easier to develop rapport while on the same visual plane as the patient. Rapport without eye contact is nearly impossible.

4.) Not Introducing Yourself

We’ve all been guilty of this from time to time. We fumble in and start asking questions and before we know it we’re off to the races and we never even got our names strait. Make it a habit to always start with your name and, I’m asking please now, remember the name they give you. People like to be called by name. Once you know the patients name, use it.

5.) Thinking about Other Stuff Instead Of The Patients Words

In the intense, multitasking world of EMS we rarely mention the times when multitasking can do us harm. I’m probably guilty of doing this one more than any other rapport breaker on the list. And, while I try hard to break the habit it pops up again and again.

I ask the patient a question. “So how long ago were you diagnosed with diabetes?” And then I begin my internal dialogue. “I’m going to need Jesse to  strip out an IV. Where did he go? I should get this guy on a monitor. Should I do a twelve lead?” Then I realize that I have no idea what the patient just answered. Now I have to make a decision. Do I go on without the important piece of information or do I make the rapport breaking admission, “I’m sorry, could you tell me that answer again?”

I might as well just say, “By the way, I’m really not listening to you right now.” It’s a horrible habit and if you have a good idea for how to break it please let me know.

6.) Using Cute Names

If you’ve read my previous patient communication posts you probably know that this is a particular annoyance of mine. This just comes down to pure laziness. Instead of learning and remembering the patients name we make up cutesy nicknames for the patient.

Sweaty, honey, dear or whatever favorite cutesy name you’ve chosen to call the patient, so you can dodge that annoying little part were you learn the patients name and then address them appropriately with it, need to go. I could have found a way to say that without the long run-on sentence but I’m sticking with that.

You know what to call the patient. If you need a hint, read number four again.

So what other patient rapport land mines have you stepped on in the past. What else should we avoid when trying to maintain that critical patient trust?

Related Articles:

Connections

Coping With Grief And Tragedy

Unconventional Thoughts On Emergency Services

   

 

Comments

  1. Where to start???
    1) pre judging a psychiatric patient and obviously not giving them the time of day as you have already decided that they are just attention seeking.
    2) answering your mobile phone in the middle of an assessment (honest, I have seen it done)
    3) hands in pockets whilst assessing the patient
    4) missing out the personal touches i.e telling them that you are going to look after them, that they can trust you etc etc

    Just a few to start the discussion.

    Great post!

  2. I love the post! It is so true that if you are just nice to people you will not only be a better medic you might just find out something about their medical condition that you may not have learned.

  3. Hi Steve,
    I thought that I would confess, and let you know that I am very guilty of one of your points.
    That of calling people ‘love’,’honey’,’petal’,’flower’,’mate’,’boss’ etc etc.
    I never really thought of it as lazy though, its always been a think that geordies (people from the north east of England) do.
    However, you have made me reflect on what I say and do, and I realise that it is just lazy, it takes a little moment of effort to commit someones name to mind, but it really does make a difference!
    I have been calling patients by there name for the last 2 shifts, instead of using the usual phrases, and I have noticed such an immediate difference. All of a suddent, they are calling me ‘Mark” too. It makes the time together seem like much more of a shared experience and I believe it really does enhance the patient/medic relationship.
    I meet one man on Sunday, when I started making sure I would call my patients by their name, and the job had a real impact on me. We really seemed to ‘connect’ and developed a great rapport (maybe this would have happened anyway, but I think it was greater by the use of our first names). I am writing a post about him at the moment as he had such an impact on me.
    Anyway, just wanted to make you aware that what you write about sometimes affects a change in us paramedics (even over here in the UK!) Thanks for the post and thanks for making me look at myself a little bit harder.

  4. Steve Whitehead says:

    I think most of us are guilty of one or two (or all) of these from time to time. The important thing is that we recogize when it serves us and when it works against us.

    Alway glad when you guys like the posts. Thaks for the comments.

  5. Paramedic Pete says:

    On a lighter note. One patient rapport landmine that hasn’t been mentioned. Me” Is this your mother?”, Patient “No thats my wife”. It suddenly turned very cold in the room and tumbleweed started drifting by.

  6. Steve Whitehead says:

    Ohh, that one’s a landmine at cocktail parties too.

  7. It is so true what you guys have been reflecting on. For years I trampled through “minefields” until I gave active listening and open questioning a go. As Chris clearly pointed out…it is truely remarkable what folk will tell you if you treat them with empathy and respect. Oh..yeah..made that “is this your mother” comment way too many times. Great post Steve…keep them coming.

Trackbacks

  1. […] ‘boss’, ‘honey’, ‘petal’, ‘flower’ etc, etc but a recent post on ‘the emt spot’, got me thinking about why I do this, and I came to the conclusion that it is just laziness on my […]

  2. […] 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 want to stop by […]

  3. […] Whitehead frequently talks about building rapport with patients. A greeting, stating your name, and asking a simple question should be part of every patient […]