Are You A Professional Writer?

Thom is the author of People Care: Perspectives & Practices for Professional Caregivers. The recently released 2nd edition of this classic text includes seven new features: Death notification skills; suicide intervention strategies; safe procedures for defusing and, when necessary, restraining violent people; cases intended to illustrate the lessons of People Care; and strategies for reconceptualizing burnout and managing it as a balance issue. Click here to order.

You’ve arrived at a SNF in the middle of your district, where you’ve been called for seizures. You’re led to the dining area, where 15 people of all ages, both standing and in wheelchairs, are huddled around a small form on the floor. They part like lemmings, and you encounter a 20-year-old female staff member lying there, awake and looking bewildered. A woman seated on the floor is holding her head and instructing her to lie still. The older woman, maybe 40, has a name tag that says she’s an RN. She’s acting large and in charge.

“She needs to go to the hospital,” she says, but only mouths the words. Her emphasis seems so exaggerated, you have to force yourself not to laugh. You’ve obviously been commanded. Your partner gathers some history from the lemmings while you communicate with her (and of course, the horizontal person.)

You concentrate on the latter first, to get a clue about her current mentation. She’s awake and seems oriented. The nurse, Mary, tells you the patient had a first-ever seizure lasting three minutes, followed by a period of unresponsiveness. She says the patient fell headlong on her face, and was unresponsive when you were called. The patient disagrees. She says she experienced an episode of dizziness with no sensation of spinning, and lost her balance. She says she remembers stopping her fall with an outstretched arm, which is now mobile and not painful.

The patient’s vitals are normal, and her physical is unremarkable except for a temp of 100.4. In particular, her teeth and tongue are intact, and she’s not incontinent. She has an occasional, mild-intensity cough. Your partner returns, and the history from coworkers corroborates what you got from the patient. You help her up and ask her to stand for a moment. Nothing hurts her and the vertigo does not return, so she sits on your cot and you transport her to the closest hospital. The following day, you get a call from your supervisor. Mary has complained because you blew her off. She says she’s a former trauma nurse, and she’s appalled because she prompted you to take c-spine precautions and you failed to comply.

Q. Everybody’s an expert. We didn’t blow her off; we considered her history, but it didn’t fit. We don’t automatically c-spine everybody. Do we have to comply with her instructions because she’s an RN?

A. Do treat her like a colleague. But in most systems, you would get your medical direction from an MD. That could happen generally through written protocols, and more specifically by communication with a designated ED.

Mary is also unhappy because, she says, you never assessed the patient.

Q. Really? I don’t know why she would say such a thing. We did a thorough assessment of this lady, both initially and during transport. So, now it’s Mary’s word against ours, I suppose. Right?

A. Actually not. Anybody with a brain who analyzes this complaint would presume you couldn’t know in advance that Mary would complain. Your chart is just waiting to testify on your behalf. If you wrote a thorough, detailed chart, it can answer everybody’s questions. Of course, if you don’t write good charts, your position is a little weaker.

Q. What does that mean, weaker? The fact is, I’m not the best chart-writer in the world. I am a thorough caregiver, but although I do my best to document everything, writing is just not one of my strengths.

A. That works. But if it’s inadequate, whoever investigates this complaint will need to rely more on the testimony of third parties like your partner, the patient and the first responders than would otherwise be necessary. It’s more work, it’s more trouble, it costs more money, and despite all that it may be less convincing than a well written chart. It would help you to make writing one of your strengths.

Q. That’s easy for you to say. I’m telling you, I am a good medic. Not everybody can be a writer.

A. Writing good medical charts is a skill. You don’t need to turn out O. Henry novels. But you do need to be able to craft written evidence of what you say and do on every call. I would suggest you pick up a copy of The Elements of Style, by Strunk & White. You can read it in an evening. It’s every professional writer’s little secret.

And believe it or not, every medic needs to become a professional writer.

Thom Dick has been a passionate advocate of sick people and the safety of their field caregivers since 1970. He has written hundreds of articles and three books on those subjects, including the People Care books (www.emsworld.com/peoplecare.) Thom is also a member of the EMS World editorial advisory board. You can reach Thom via Facebook, or at boxcar414@comcast.net.