What You Tell Your Patients Matters

Your patient just ruined a perfectly good windshield with his face.

He was a driver in a near-head-on collision with another vehicle, driven by a drunk driver. As blood dries on his face, your patient (who is sober) quietly asks, “Am I OK?”

What do you say? Do you tell him he could have cervical injuries that could paralyze him for the rest of his life, or do you tell him all is fine and not to worry?

Will your response to their questions and response to their comments have an effect on your management of their treatment and transport? Here is an example that illustrates the importance to the patient and to me, the responder.

It’s 8 a.m., and we had just completed the morning routine on our rig when a local on-duty motorcycle officer walked into the day room. He is a gregarious giant of a man, outweighing almost any two of us and standing head and shoulders above all of us. After a warm greeting he showed us his new motorcycle boots. Tall, shiny black leather reaching almost to his knees. They cost him a fortune, and he was very proud of them.

In jest, I pulled out my rescue knife and joked that it was capable of gliding through that shiny black leather. Several hours later, a hit and run driver knocked him off his motorcycle on the freeway. My partner and I were dispatched to the call.

On approach to the scene, it was clear that he needed to be on a backboard due to possible neck and back injuries. In those first few seconds, we were focused on scene safety and planning the safest and most expedient way to stabilize and transport him. We noted that he was conscious and breathing, so our assessment process moved onto other issues. We considered the ramifications of blunt-force trauma, assuming hitting the ground at 65 MPH qualifies the concrete as a blunt object.

Upon exiting the rig, we did an approach visual assessment with the added stress of knowing the patient was a friend and colleague.

He recognized me and said, “Please don’t cut my boots!” I reassured him that we would not. He smiled and calmed down.

Once bundled, we transported him to the hospital. I was able to convince the emergency room doctor to x-ray through the boots first, in order to rule out major bone damage, and then helped slip the boots off to find no injuries to his lower extremities.

Afterwards I reflected on this and other past incidents. Recalling the conversation we had with the officer, I realized that patients often become somewhat fixated on a thought. Some ask about the welfare of a person who was not in the accident, and some experience something similar to retrograde amnesia. Some ask the same question over and over, not remembering my answer. My experiences with patient responses in these situations remind me of a mental timeout. How you approach and deal with that issue will set the stage for how much trust the patient will put into the rescue team.

When a patient does not trust you, they are more likely to be anxious, stiffen up in anticipation of pain, move unexpectedly and not cooperate, physically or verbally.

Here is an analogy we can all relate to: You slam your finger in a door and are struck by the suddenness and magnitude of the agony. Your husband/wife/friend nearby, laughs and says, “Are you OK? Does it hurt?.”

What is your first thought?

“Let me slam your fingers in the door and you tell me if it hurts.”

Do you trust this person? Is what they said helpful or supportive? Or does it make you even more upset?

What you most likely want are supportive statements, not critical or self-serving comments. Something like, “Elevate it above your heart which will help reduce the pain, and I will get you some Ice.”

That is a helpful statement, one that engenders trust.

What we say to the patient is often taken as a promise. If you tell a patient that they will be fine, you had better have a way of making good on that promise, or your credibility will tank.

Imagine promising a patient that they will be fine and not realizing that the family overheard you. Suddenly the patient arrests and resuscitation is unsuccessful or the injury requires an amputation. Who will the family initially question?

Have I lied to a patient in the past? Yes. Have I stretched the truth sometimes? Again, yes. Have I dodged questions I could not or did not want to answer? Yes. Was I comfortable doing it? No.

Early on, it was because I did not know any better. Later on, it was intentional, because at the time it was decided that it was in the patient’s best interest to do so. It was your basic risk versus gain assessment.

My policy is to never promise anything I cannot personally deliver. If a patient asks me, and they have hundreds of time, if they’re going to be ok, I tell them what I see that is positive and I try to be supportive where I can. It has to be the truth and it has to be tempered with the understanding that too much truth can be frightening and counter- productive.

My goal is to gain their trust and keep them calm. This is a critical investment in their immediate future, particularly in the event we have to do something we know will cause the patient pain like lifting them to the gurney, splinting a fractured femur or starting an IV.

I want them to know what I tell them is very close to what they will experience. The trusting patient will know that you did your best to lessen the pain, as opposed to the patient who is distrusting and blames you for the pain and may become frightened of what will come next.

Remember, to a patient your words are your promises. Never promise anything you cannot personally deliver. Always deliver what you promise.

Mark Lodge, BS, Emergency Management Coordinator, Instructor II with the California Emergency Management Agency, Hazardous Materials Section (Retired). He began as a Hospital Corpsman (USN) in 1971 and spent 10 years as a paramedic, a couple of years as a police officer, some time in fire service and as the lead instructor in the State’s Hazmat Technician training program. He is now retired and loving life.