Where Do You Put The Fear?

I once thought that part of the goal of being a competent paramedic was getting to the point where I no longer felt any fear or anxiety about running calls. After all, most of the folks I worked with appeared to be absolutely fearless. At least the competent ones did. They never go flustered or rushed. They smiled. They remained calm in the face of very real emergencies. I needed to be like that.

Eventually I figured out how to act like they acted, but I never really mastered the whole not-feeling-any-fear thing. It nagged at me for a long time. It took me almost a decade to figure out the secret.

Continue Reading…

The Illussion of Control

Part two of a two part series on scene presence. Part one is here.

While we’re talking about scene presence, I think it’s important to bring this one up. I’ve hesitated to talk about the illusion of control on the blog even though it’s a learning point that I invariably discuss with new students on the rig in the first one or two shifts. The illusion of control is deeply applicable to learning scene presence, but, quite frankly, it contradicts something I’ve preached here on The Spot for some time.

It contradicts my advice to always be authentic. When it comes to authenticity, the illusion of control is the exception to the rule. I suspect that some of my regular readers may have take issue with that. It’s OK, I’m a big boy. I can handle it.

In the world of scene management and scene control, the illusion of control is a metaphor for how we should respond when things don’t go the way we planned.

There is an awkward and embarrassing moment that we all have to deal with while running calls. It helps to think it over before it happens. If you’ve been in EMS for any length of time, it’s already happened to you. So let’s talk about it now. How do you react when you make a mistake during a call? What do you do when things don’t go as planned? How do you respond when you make an outright flub, guffaw or blatant error right there for everyone to see?

My answer, “The illusion of control.” Allow me to explain.

Continue Reading…

Credibility and Redundancy

I’m going to make an important point and I need you to pay attention. That sentence, the one I just wrote. The one about saying something important. That was a redundant statement. And it undermined your sense of my credibility as a blogger and an EMS educator. No really, it did.

Not in a huge way. Not like if I had said something that you knew to be completely false, or got all wishy-washy, namby-pamby about some critical issue regarding your patient care. But it made you doubt my sincerity just a little. Somewhere in your subconscious you thought, “If it’s important, why not just say it?” You questioned why I felt the need to preface my important thought with a statement declaring my own thought important.

It’s as if I doubted my own credibility.

So why shouldn’t you doubt it too.

Right?

Continue Reading…

Don’t Be A Jerk

I didn’t draw the graph at right. It was made by a woman named Jessica Hagy over at www.thisisindexed.com. Jessica is not in the medical profession. She draws her observations about the world on index cards and posts them online.

She also has a long and growing list of blogging awards from around the world. Mostly due to her brilliantly irreverent style and her ability to make social observations that resonate with people.

Like this one.

It’s a sad but true observation. For some reason, it seems like many medical personnel have an interesting combination of helpfulness and jerkiness. Why do you suppose that is? I’ve thought a lot about that over the years.

I think a friend of mine, Steve Brien put it best when he said, “Some of us still have a lot of us still in us.”

Our profession is about the patient. It’s not about us. Remembering that simple fact, and keeping it at the forefront of our thoughts, isn’t as easy as it might seem.

Don’t Forget To Ask The Patient

Let the young know they will never find a more interesting, more instructive book than the patient himself. ~Giorgio Baglivi

It was nearly two decades ago that I knelt on the floor before Sammy in the Santa Clara County Sheriffs booking facility. I remember him so vividly that it’s hard to believe so much time has passed. There was nothing exceptional about him. Handcuffed to the waiting area bench, he looked very much like you might expect a man high on drugs, being booked for petty larceny, might look.

Sammy felt like his heart was racing and, given his drug history, the officer thought that he needed a once-over before heading off to the county lock-up. I, the young, scared, mostly clueless paramedic intern was doing my best to evaluate him. Growing up in a quaint California suburb I hadn’t crossed paths with to many folks like Sammy. He, quite frankly, terrified me. My preceptors stood back and observed.

“Sammy did you do any drugs tonight?” I asked.

“Yeah, I did a speedball about an hour ago.” He casually offered.

I looked over at my preceptor Mark hoping for clarification. I got nothing. I looked back at Sammy and then again at Mark who smiled demurely. “What’s a speedball I asked?” Mark knew the answer but he had other ideas. He gestured toward Sammy. “Ask him. He’s the one who took it.”

Continue Reading…

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.

Continue Reading…

You Can’t Give Away What You Don’t Have

Imagine we were walking down the beach together on a sunny day and I suddenly looked at you and said, “Would you like an apple?”

If you were hungry, your initial reaction might be, “Yes, I’d love one.” But you might also be a bit perplexed. I mean, what if I clearly didn’t have an apple? Somewhere in your mind you’d wonder where the apple was. Did I have one stashed in a pocket? Do I know a good fruit stand near-by? Your next offering might be an awkward sounding question. “Uh … do you have an apple, Steve?” or perhaps, “Where is it?”

When it comes to physical objects the implication is clear. I can’t give you something that I don’t have. It’s not physically possible. Nothing could be more obvious. And that brings us to an interesting point about some of our more non-tangible assets like compassion, patience, kindness and good patient care.

You see, when writing about things like kindness, compassion and patient rapport I’m as guilty as the next guy of falling into “tips and tricks” mode. In the past I’ve written articles about how to speak and behave in ways that help build patient rapport. I’ve listed tips for making the patient feel welcome and comfortable and I’ve extolled the virtues of good listening, kind interactions and compassionate care. But I, like many other EMS authors, have overlooked one simple truth.

None of it  really works if you don’t feel it.

Continue Reading…

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:

Continue Reading…