Quality Corner: The Art of Being Nice—Part 1

Several years ago I was dispatched to a call for abdominal pain. We arrived to find a 54-year-old female who complained of diffuse lower abdominal pain. As always, I formed a general impression of the patient as I entered the room, recognizing she was in some discomfort but not excruciating pain. As I walked toward her, I asked what was bothering her. As she rubbed her hands over both lower quadrants of her abdomen, she said she’d had pain in her belly all day long.

I introduced myself as “Joe the Paramedic,” explaining “Joe the Plumber” was already taken. I took her hand in mine and palpated her radial pulse with the fingers of my other hand. It was strong, about a 100 a minute. Her skin was warm and dry; her color and capillary refill were good as well. So within about 10 seconds I’d confirmed the patient was hemodynamically stable. My EMT partner acquired vital signs while I took the history and performed a focused exam. The patient’s abdomen was soft and nontender, with no rebound tenderness. There were no other associated symptoms such as nausea, vomiting or diarrhea.

The vital signs the EMT reported were unremarkable, as I expected based on my rapid assessment. But that’s where all the efficiency and smoothness of the call ended. Despite the patient seemingly having good veins, I failed to gain vascular access. As an experienced EMS provider, I should have been smart enough to recognize that it simply wasn’t my day for IVs and stopped, especially since the patient was stable, with no immediate need for fluids or meds.

But the patient’s veins seemed to mock me as I looked at them. An experienced paramedic of my caliber, and I’m going to quit? There’s no reason I should not be able to cannulate one of those veins, I thought. So I tried again…and blew it again. I apologized to the patient, explaining, “I’m usually pretty good at this. I’m going to try one more time, and we’ll go with or without it.” The patient was more than patient. I took another stab at it, so to speak, and blew it again. “I’m so sorry,” I said as I taped another 2x2 over the third of her medic-induced stab wounds.

What medic hasn’t been where I was that day? No matter how long you’ve done this job, there’s probably nothing more frustrating than not being able to get an IV on a seemingly good vein for no logical reason. So, we all begrudgingly have to admit the obvious: It’s all in our heads, even as you look at the patient’s arm in continued disbelief.

It was cold outside, and I made sure the patient was covered up before moving out into the Pennsylvania winter. I figured it was the least I could do. We loaded her into the ambulance, and I noticed an expression of concern on her face. I put my hand on hers and reassured her she was going to be OK. I told her we hadn’t been able to identify the cause of her pain, which was both the good news and the bad news—if it had been obvious, it probably would have been serious. But, I told her, the docs at the hospital where we were going were great, and they’d figure this out and have her up and dancing in no time. She smiled at the same one-liner that makes my partners who have heard it so many times roll their eyes. During the transport I asked about her medications and medical allergies. She told me she had hypertension and took Norvasc. “Me too,” I replied.

We finally arrived at the hospital, where I transferred the patient’s care to the nurse. “Good luck,” I said as I turned to leave. She took my hand. “Thank you for taking such good care of me,” she said. “You’re welcome,” I replied with what had to be a look of total confusion.

My partner deconned and made the litter back up while I restocked the quarter-dozen IV catheters I used on my victim…I mean patient. As I repacked my IV kit, my mind wondered how in the world she could have been so appreciative for a call I felt was a disaster of total medical incompetence. As we pulled out of the hospital parking lot, it finally struck me. “Oh—I was nice to her,” I blurted out.

“That’s great,” my partner replied. “Maybe next time you could spare her the bloodletting.”

His reply revealed he’d evaluated the call the same way I had. But patients will frequently have a completely different way of evaluating their EMS experience.

Of course no one wants to be stuck even once with a needle, much less endure multiple sticks. But most patients recognize that you’re trying to help them and no one is perfect. Unfortunately we do not always have it within our power to perform every intervention perfectly the first time, every time. But what we do have total control of every time is how we treat our patients on a human level. There’s no reason we cannot always be nice, because as proclaimed in the Ten Commandments of Quality EMS: In most cases patients will be more appreciative for how you treat them than the treatments you give them. That is the art of being nice.

Joe Hayes, NREMT-P, is deputy chief of the Bucks County Rescue Squad in Bristol, PA, and a staff medic at Central Bucks Ambulance in Doylestown. He serves as the quality coordinator for both of these midsize third-service agencies in Southeastern Pennsylvania. Contact Joe at jhayestpc@gmail.com.