Get Anyone to Go With You to The Hospital

I’m going to share with you a very powerful technique to convince just about anyone to go with you to the hospital, and I’m going to ask a favor of you. Please only use this technique in the patient’s best interest. This isn’t a technique to drag out when your service pressures you to increase transports or you’re not in the mood to call in for a proper refusal. This is a technique for when you really honestly believe that the patient needs to go, but they refuse.    -Steve

                

It’s an interesting contradiction in prehospital medicine. The people who don’t really need an ambulance insist on transport and the really sick folks refuse to go. Sometimes the people we could really help dig in their heals and just refuse to go. It’s frustrating. It can be maddening. And occasionally it means that we have to pull out our paper work and sign a potentially really sick patient out against medical advice. (AMA)

In these moments we implore the patient to reconsider, hand over the paperwork for signing and then we say something about calling us back if things change. Now let me give you one more technique to try before you pack up and walk away.

This is a simple, three-part technique. 

Step One: Establish a rapport with the patient. Hopefully you’ve been working on this from your first contact. Fair warning, don’t try to skip over this step. If you haven’t established a rapport with the patient this just isn’t going to work. The patient needs to trust you and be willing to consider what you say.

If 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 Patient’s Define Their Emergencies.

Step Two: Bring someone whom the patient loves and cares about into the conversation. This is easiest if they are on scene, but they don’t necessarily need to be present. If the patient’s wife, child, husband or other loved one is on scene, make a reference to them. “Is this your wife over here John?” “Mary, is this woman your daughter?”

If there’s nobody who fits the bill on scene, look for pictures next. If you’re in the patient’s home look around for the pictures they display of loved ones. Pick a prominently displayed photo of someone who you sense the patient cares about. Ask about the photo. “Are these your grand kids?”, “Is this your husband?”

If there’s no family or loved ones on scene and no easily accessible photos, simply ask some questions about the patients close relationships. Try, “Joanne, are you married?” or “Do you have kids Tom?” Find that close relationship that’s going to give the patient pause when they’re asked to consider what that special person might think.

Bonus Point: Make some reference to the bond between this person and the patient. “Your kids must love you a whole bunch.” or “I’m sure your wife loves you and worries about you.”

Step Three: Instead of focusing on what the patient wants to do, ask the patient what that special person would want them to do. This forces then to switch their focus on what their decision might mean for them and think about what it might mean to the people they love.

This might sound like, “Mary if your husband were here right now what would he want you to do?” or “”Alex, if your kids knew that you were having trouble breathing and could have a dangerous medical condition, what would they want their dad to do?”

It’s amazing to watch how dramatically this can cause a patient to re-frame their condition. Isn’t it true that most of us are far more willing to do something unpleasant or inconvenient for someone we love than we are to do it for ourselves? this also allows the patient to feel that they aren’t seeking help for themselves, they are doing it for the peace of mind of someone else. Instead of feeling weak or powerless by conceding that they need help, they feel empowered to do something for the benefit of someone they love.

You can follow up on this idea. “I know you’re not willing to go get checked out for yourself, but will you do it for your wife. So she doesn’t have to worry that something serious might be wrong with you?” This is a hard question to answer no. Especially if the loved one is in the room.

If you’re short on time, there’s even one rapid fire way to wrap the whole thing into one question. “Sir, I see your daughter standing over there and she understandably looks worried about you. Let me ask you, if she was experiencing the kind of pain that you are in right now, what would you tell her to do?” when the patient concedes, “Well … I’d tell her to go to the hospital.” I smile and reply, “Of course you would. Sometimes it’s easier to make good decisions for the people we love than it is to make them for ourselves. Let’s go to the hospital.” This is a tough argument to refute.

        

OK, let’s put it all together. Here’s a conversation with Jim. Jim is home with his family and he’s been having an aching pain in his chest. He refuses to go. Let’s give him one last push.

Jim: “Look I know you need to tell me all those risks but I’m sure this is just from all the pitching I did in the softball game yesterday.

You: I understand where you’re coming from and I can see why you might think that. Jim if I could ask, is that your wife helping us collect information in the kitchen there?”

Jim: “Yes that’s Mary, my wife.”

You: “I’m married too and I imagine that you love your wife every bit as much as I love mine.” [note: You’d only say this if you were truly married.] “Let me ask you, what do you think your wife would like you to do right now?”

Jim: “I don’t know. She tends to worry more than I do. She’d probably want me to go to the hospital.”

You: “I agree. Jim I know your a tough guy and you’re not to worried about this pain but, if you won’t go to the hospital for yourself, will you at least go for your wife? Just so she doesn’t have to worry about you for the rest of the night?”

Jim: “I don’t know. I really don’t think I need to go.”

You: “What if it was your wife sitting here in this chair and I was concerned that there might be a problem with her heart. What would you want her to do.”

Jim: “I guess I’d ask her to go get checked out.”

You: “Of course you would. Let’s go to the hospital.”

Sold.

What techniques have you found useful in this situation? Before you click away, why not leave a comment and tell us your best trick.

        

Related Articles:

How To Make Sure Your Hand-off Report Gets Heard

Six Techniques to Nail The IV Every Time

Patient Rapport Land Mines

Is What We Do A Science or An Art?

 

Comments

  1. Sometimes, the only thing that can work is some harsh reality.

    For someone to refuse legitimately, they have to be told all of the facts that their refusal entails and the risks that they are taking.

    Someone who has taken a paracetamol overdose is rarely prepared for hearing how their death with unfold.

  2. A parawhatamol? Must be a British thing. It could be an analog to tylenol?

    I agree with you on getting personal and making it about the loved ones. I use that technique, although I have to say that this rarely happens to me.

    As always, excellent stuff

  3. That’s a common technique I’ve also used in the past. Of course, it also depends on the setting and whether or not a “loved one” exists… because there are those disgruntled patients who feel completely alone and isolated in the world.

    I think the best method remains finding something to connect with a patient on other than their condition. If I take the time and can connect on some level… whether it be reading, music, family, television… any level for that matter, the sell for transport goes a bit easier. Some connections take longer to build than others, and that’s something everyone has to recognize for themselves.

    I am curious however why you offered the situation, using the leverage of marriage and then side noted it to use if only doing that if you are married?

  4. Paracetamol (UK) = Acetaminophen [Tylenol] (USA), well deduced Ckemtp.

    Whilst I do see the merits of this technique, and its importance in some situations, I do have to question whether it’s actually ethically sound? If you go down the beneficience & non-malevolance (primum non nocere) side of things, then you’re covered, but I do wonder whether this conflicts with the 3rd and 4th pillars, justice, and most obviously, patient autonomy. Could this not be seen by some as manipulation?

    I’m not saying which way I lie, purely because I don’t know. I’d be interested to hear everyone’s thoughts.

  5. Steve Whitehead says:

    Medic999 I agree that an honest and concerned review of what types of things might occur due to the patient’s condition is warranted before we go down this road.

    Understanding the risks means really understanding. And we hope that, for the rational individual, that’s enough.

  6. Steve Whitehead says:

    Ckemtp I’m with you. It isn’t a technique a pull out of the tool box every day. Fortunately most folks make reasonable decisions about this stuff. … But not always.

  7. Steve Whitehead says:

    Dave, it my experience, I havn’t found this technique to be “common.” I’m glad to hear that other caregivers are willing to go down this road.

    I agree that the connection is essential. This won’t work if you haven’t established a solid connection.

    With the marriage comment, I was referring to the phrase in quotes ““I’m married too and I imagine that you love your wife every bit as much as I love mine.” I was emphasizing that you’d only tell the patient that you were married if you really were.

    I don’t advocate ever lying to the patient or trying to pretend that you’re someone whom you are not. I’ve spoken in the past on the importance of being authentic in your interactions with a patient. If you’re not, they will sense it. Tell the truth.

    Thanks for the question.

  8. Steve Whitehead says:

    Halden, I completely see where you’re coming from. I thought about posting this technique a long time ago and I hesitated to put it out there for some time because I have the same concern. Hence the preface to the post.

    I agree that there is nothing medically inappropriate about doing this. It doesn’t outright violate any tenant of medical ethics that I’m familiar with. But I could see it being abused to get people to go to the hospital who don’t really need to go.

    I’m not familiar with your third and fourth pillar comment. It sounds like you might be talking about the governing pillars of the European Union and I don’t know enough about those legal tenants to speak on them.

    As with any powerful tool, it could be used appropriately for the benefit of the patient and it could be used inappropriatly as well. We have to assume that it’s being used by ethical providers in the patients best interest. (Like everything else we do.)

    Having said that, I’m still not 100% convinced that I should have shared it. Like medicine, sometimes we proceed in uncertainty.

  9. Like this post and the comments!

    When time is of the essence and ive educated the patient as much as a lay person can be educated lying on the floor – I do like just about any tool that allows me to convey my concerns at a level the patient / family can quickly and absolutely understand and relate too – especially a tool that has a lot of plain English. Symptoms are something we understand, loss of loved one is something everyone understands.

    In this sense I see a positive “technique” that could save someones life. If you look at it as a “trick” then thats what it is to you and its probably not a good idea… Semantics?

  10. It’s not semantics at all 13Zebra. I agree with you. In my mind, the difference is authenticity. If you genuinely believe that this person needs to be seen in the ER and they are taking an unaccptable risk by signing AMA, this is a tachnique that helps them reframe their decision in a powerful way.

    If you’re selling the ride like a used car salesman, you’re using this as a trick. That’s unaccptable. The difference may be subtle, but it’s real.

  11. I could see the conversation going like this:

    Sir I see your mother standing over there, wouldn’t she want you to get this checked out?

    That’s my wife!

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