Missing your Manners

 

“Hi, my name is Brandon. I’m an EMT with Save-a-life Ambulance. Can I help you?”

Anybody remember that? I think it was on page 6 of the EMT textbook.

I suppose it’s about communicating your name, which is nice. And it’s about obtaining consent, which is important, although in reality, consent in EMS is usually handled the same way as consent in sexual activity — you just go until someone says stop.

But mainly it’s about courtesy and professionalism. It’s gauche to swoop into a room and just start playing with somebody’s lesions without so much as a how-do-you-do.

The trouble is that the formal intro is so hokey nobody actually uses it. Or uses anything remotely similar. And I think that’s a shame, because although it’s silly, it’s getting at something important.

We understand that people call us mainly to bring some order to their crisis. Obviously, that involves Doing Medicine. But the medicine is just a means to an end.

Why do we call plumbers? When your sink starts flooding water into the kitchen, you don’t know what to do. This situation is alien; it’s outside of your expertise. You may be very good at many things in life, such as fueling your car, tying your shoes, and making cherries jubilee, but you don’t know what to do about this.

You know that there are people who have the answers, though; they’re called plumbers. So you call a plumber, and say, make it right.

We’re the same way. People don’t know what to do when they get chest pain or crash their car. But they know that if they call 911, professionals will come who know what to do. So they call us. That’s why people sometimes ask 911 to fetch cats out of trees or ask when the circus is coming to town. It’s why the first reaction of so many motorists after a crash is to call their spouse or their dad.

The thing is, when we walk in and our first reaction is to Do Medicine, it’s not helping the problem. All that medicine is just more strangeness, unless your patient is a fellow clinician. So now their distress is going to continue until you can finally tell them what’s wrong. Except you won’t, because you don’t think you’re qualified for that. So now they’ll stay confused and scared until they get to the hospital. And on and on.

Throw them a rope!

The fastest way to restore normality to a situation is to reintroduce a familiar activity. And social courtesies are very familiar to everyone.

When you introduce yourself and shake someone’s hand, they’re transported from the confusing world of a medical crisis to something much more comfortable. They know how to do this. Smile, shake, say your name. It’s easy. They’re good at it.

Sometimes patients are visibly shocked when you do this, and seem to reset; you can literally watch them change channels. Now they’re a little calmer, a little happier, and you can work with that. With enough balls, you can pull this off in the most outrageous circumstances. Sing praise for the EMT who can walk in on the triple traumatic amputation and say “Hi! I’m Jim. What’s going on?”

Now, of course, you don’t want to minimize the patient’s distress. In an emergent situation, it can be galling and obnoxious for their freak-out to be met by your apparent apathy or boredom. That’s why you have to find a middle ground between projecting calm confidence and acknowledging the seriousness (perceived or real) of the patient’s situation. Don’t let them drag you along into panic, but don’t try to abruptly pull them to a halt either; strike a balance, pace them, and then gradually slow them back down. The point is that introducing yourself like a regular person is a powerful tool for restoring normality to a crazy situation: use that tool liberally, but intelligently.

I’ve had patients tell me I was the only Medical Person they could remember introducing themselves. That’s a damned shame. People greet each other and make a introduction when they meet. And aren’t patients people?

Comments

  1. Lately I have been working with new EMT’s and in the midst of quizing them on protocols and medications, I’ve noticed that most of them simply arrive to the call and “start doing things” without asking any questions. Their’ response is usually “well I need a blood pressure or a set of vitals”. Yes but not before you even ask what the problem is or even what the patient’s name is. Thanks and great read!

    • I think people are more comfortable with “doing” because it’s simpler… and this tends to be exacerbated during scenario work, where the extra barrier between you and the imaginary “patient” can make it tempting to minimize the back-and-forth. Not sure how to manage this.

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  1. [...] Otto has written a fine post, Missing your manners, about the importance of introducing yourself to your patient with a simple, “Hi my name is [...]

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