Dealing With the Dichotomy

     Mixed in with all the nice and mostly nice patients you encounter on a daily basis out in EMS land are those who are not nice at all to you and your partner. There you are, trying to be pleasant, polite and professional while some guy is actively jerking you around. For the record, I'd guesstimate this slice of society represents less than 1% of our patients. But when we do encounter them, they extract far more emotional energy than you may imagine. And that's in addition to complicating your ability to effectively run the call when you are being challenged at every turn.

     This month in BTB, we'll take a brief look at this phenomena and what you can do to mitigate the situation, while still focusing on delivering quality prehospital care.

     Given the way biology works, I guess it just makes sense that life has to have a few jerks in the mix, along with the average Joes and superstars. However, while that may explain their existence, it does little or nothing to soften the impact these individuals can have on nice people.

     In some cases, there are real, logical reasons why someone is angry and behaving like a jerk. Take, for example, a young mom sitting for two hours in a walk-in emergi-clinic with a sick 4-year-old. A single mom with no extra money for a babysitter, she had no choice but to bring her 2-month-old along. The baby gets cranky and won't calm down, so mom finally gives up and goes home. Her 4-year-old is still sick, and mom is now totally pissed off. Two days later, her child is really sick, and, not wanting to repeat the endless wait at the emergi-clinic, she calls 9-1-1. Now, YOU are in the game, trying to deal with a person who is taking out her anger and frustration with the ineffective healthcare system on you and your partner.

     When this occurs, you certainly want to do whatever you can to calm the patient, but it is essential to stay focused on meeting their medical needs. Sure, these folks are incredibly trying, but don't let them make a large withdrawal from your emotional bank account. Never take these events personally, even if the taunts, slurs or comments are intended to be personal; take them professionally.

     From a professional perspective, an uncooperative patient is simply someone you encounter every now and then. If you were handling a combative and uncooperative head-injured patient with a traumatic brain injury, you'd take it in stride and deal with it. If you're trying to care for a diabetic who is exhibiting bizarre behavior because he forgot that he took his insulin, took a second dose and bottomed out his sugar, you would just consider his behavior part of business as usual. So, what's the difference if someone is just being an uncooperative creep? The answer is, nothing. Just take it in stride and deal with it. Deliver your medicine, but disconnect as much as possible from the abusive behavior. Keeping things in the professional domain serves to keep them out of your personal realm.

     Let's look at some strategies to help bring a successful conclusion to these challenging calls:

1.      Stay in control

        Irrespective of your patient's behavior, drive your medicine and stick to essentials (e.g., you ALWAYS get a sugar on a patient with altered LOC, but maybe not this time). Rationale: If a patient can continuously and intentionally jerk you around at every turn in patient care, the fact that he called 9-1-1 tells you he's perfusing just fine.

2.      Never, EVER think retribution

        I was involved in a case where a local medic had started two 16-gauge IVs in the back of a patient's hand, even though she was not very sick and her condition didn't require vascular access. When asked why he had placed two large- bore IVs in the dorsal hand, he answered: "This lady is a system abuser. She calls too much when she doesn't even need an ambulance. I was trying to teach her a lesson." That is clearly unacceptable.

3.      Kill 'em with kindness

        One of the most effective tools when dealing with a jerk is to turn up the kindness factor a notch or two. Continue to respond with "Yes sir" or "No sir," and refuse to let him get under your skin. Never forget that no one can make you angry…you have to allow that to happen. If you discount the abusive behavior to nothing, then nothing they can do will make you angry because you choose not to let that happen. Oftentimes, when the patient doesn't get the response he is looking for, he will give up. In other cases, social pressure from family or friends can rein in a jerk when he sees you and your partner never changed your focus on providing quality prehospital care in a professional manner.

4.      Focus on delivering medicine

        Shut off or ignore the rants and stay on task. Whatever the priorities are for your patient, systematically work through them and execute your care plan. We've already talked about how you can take the sting out of abusive commentary by discounting its value to zero. It's actually quite easy to ignore something you believe has no value, which, in turn, allows you to maintain your focus on patient care.

     My hope is that this dialog and these suggestions turn out to be useful. Until next month…