A stressed, panicky patient can be very difficult to help. Persuading someone to focus on questions so that we can gain a full history may seem impossible. They might not be receptive to any intervention at all, particularly if there’s a chance of pain being involved. Convincing patients to remain still for their own sake, as well as ours, during processes involving sharps, wound management or extrication may feel futile.
So how can we reduce their stress and panic in order to increase safety, maximize the quality of care we provide, cut down on time spent negotiating and ultimately make the job a whole lot less stressful while we’re at it?
It stands to reason that patients and bystanders often hang on to every word in order to interpret what’s happening, so they can regain a sense of control, and form an understanding of the situation they find themselves in.
That initial meeting is crucial to patient care. It’s all we have available to work with from the moment we arrive [1-2]. Our safety overview, assessment, information gathering, rapport building and any necessity for immediate interventions have to begin right away.
The words we choose can give us a great starting point to work from. As humans, if we hear clear, recognizable words during stressful events, this can give us a little insight. Along with that insight comes the natural desire to slow down, quiet down, settle down, listen in and work towards a shared goal.
So how do we apply this to prehospital care?
1. Avoid blinding with science
Medical terminology certainly has its place, but for most patients, layperson terms will usually hit the mark a whole lot quicker and help them to reach the understanding they crave.
To improve a patient’s situation, one of our aims must be to allay their fears. In doing so, we stand a much better chance of having them work with us, rather than against.
Adapting to the patient’s style of knowledge helps us to make ourselves understood much quicker and can encourage them to help with the task at hand, as if we’re all speaking the same language, reducing the potential for confusion before it has a chance to arise 3-4].
2. Ditch the scary words
Some terms become part of our everyday language, particularly around other health professionals, but what meaning do they hold for patients and bystanders?
Exercise great care in using words that risk instilling fear in all patients, particularly around specialized groups such as children, the elderly and patients with learning difficulties or complex needs.
A seemingly innocuous request for our crewmate to “bring in the defib” may be our standard way to ask for the cardiac monitor. For the awaiting patient or relatives, this may leave them worrying that the defibrillator is going to be needed.
“I’ll just cut here,” when preparing tape and dressings, could completely traumatize a small child with an injured finger without an explanation of what’s going to happen first.
“Once we have IV access, we’ll be able to give you some medication,” may cause the needle-phobic patient to panic without the necessary preparation.
3. Keep our cliches
The repetition that we experience from repeating the same maneuvers and interventions time and time again may get boring, but we have to remember that it’s all new for the majority of patients. No matter how tempting it is to mix it up and replace what we’re taught with what begins to feel more natural, it’s our job to keep patients comfortable.
Answering a patient’s concerned question with “No, the cardiac monitor can’t shock you accidentally, these electrodes are different from the pads for this reason,” may turn into a comical, “it’ll only shock you if I hit the button.” These well-intentioned gentle jokes have their place, but only once we know that the question has been answered and the patient feels safe. [Read more: Laughter may be the best medicine, but only if we titrate it to effect]
“Do you mind if I pop this thermometer in your ear to check your temperature,” could become, “just sticking this in your ear!” Innocent and chatty may distract, but clear, defined information and consent must remain at the fore so that they can enjoy the chat without worry.
“You’ll feel a couple of bumps as we load the stretcher into the ambulance, but you’re perfectly safe,” may eventually become silence as the unprepared patient is rocked and shocked by the unexpected motion.
It may be monotonous to repeat, but the things that patients needed to hear for the first year or two of our careers, they still need to hear now. We may have changed and become comfortable; they haven’t.
4. Deliver differentials with care
Throwing out a list of potential diagnoses to colleagues on-scene may feel harmless, it may even be helpful and proactive, but what does the patient make of it?
We cannot know if an illness or pathophysiological event has significant meaning in their past emotionally, culturally, economically or otherwise and, if so, its positive or negative connotations [5].
Although we have to come up with differentials in order to form a treatment plan, we can usually explain them in a rounded, non-confirmational manner, amongst other conditions, or perhaps generalize to a degree while still remaining truthful.
Of course, it may be necessary to state clearly when we suspect something like a CVA or STEMI, so that the patient is fully aware of this before they hear us discussing it on a mobile or radio call to the receiving facility.
If we can stay focused on how each patient may receive information, rather than thinking aloud without realizing, we give ourselves the chance to proactively formulate words and deliver them with care, rather than having to backtrack and soften the reactive blow.
5. Lose the labels
With the growing trend for medical memoir books, reality TV and online discussion available for public consumption, wider familiarity with the use of labels for certain patient groups can be damaging.
Such commonplace language is easy to adopt, particularly in newer paramedics who may never have been taught about its potential to offend patients, families and bystanders within seconds.
It is well known that the words we choose may convey our attitudes, so negatively geared labels may automatically indicate – rightly or wrongly – stereotyping, judgement or blame towards a patient’s health issues, lifestyle and situation [2,6].
If a patient is bariatric, elderly, a frequent caller, has an addiction or falls into any other category at risk of stereotyping, our use – be it accidental or intentional – of any label will undoubtedly be the word that is heard the loudest, no matter how professional and attentive we are in every other aspect.
Instead, if we can promote understanding of each situation, rather than the ongoing cause, without stigma, we may find that our patients find the interaction more satisfying and helpful than many medical experiences from their past [6].
The evidence in favor of selecting words carefully is stacked heavily. With better communication, relationship building, information flow and patient education comes a more successful response to interventions, analgesia, respiratory measures and overall interaction, and we all know where that leads – increased patient satisfaction, increased positive outcomes and a corresponding decrease in complaints, job-related stress and burnout [1,4,6-7].
Read next: 4 things to explain to patients to increase their comfort and compliance
References
- Barrier, P. A., Li, J. T-C. & Norman, M. (2003). Two words to improve physician-patient communication: what else? Mayo Clinic Proceedings, 78(2), 211-214. Retrieved from ProQuest
- Crawford, T. & Candlin, S. New perspectives on understanding cultural diversity in nurse-patient communication. Collegian, 24(1). DOI: 10.1016/j.colegn.2015.09.001
- Jucks, R. & Bromme, R. (2007). Choice of words in doctor-patient communication: an analysis of health-related internet sites. Journal of Health Communication, 21(3), 267-277. DOI 10.1080/10410230701307865
- Wittenberg-Lyles, E., Goldsmith, J., Parker Oliver, D., Demiris, G, Kruse, R. L. & Van Stee, S. (2013). Using medical words with family caregivers. Journal of Palliative Medicine, 16(9), 1135-1139. DOI: 10.1089/jpm.2013.0041
- Wood, M. L. (1991). Naming the illness: the power of words. Family Medicine, 23(7), 534-538. Retrived from https://europepmc.org/article/med/1936736
- Sogg, S., Grupski, A. & Dixon, J. B. (2018). Bad words: why language counts in our work with bariatric patients. Surgery for Obesity and Related Diseases, 2018(00-00). DOI: 10.1016/j.soard.2018.01.013
- Gilligan, T., Salmi, L. & Enzinger, A. (2018). Patient-clinician communication is a joint creation: working together toward well-being. American Society of Clinical Oncology Education Book, (38)532-539. DOI: 10.1200/EDBK_201099\
