I was talking to a friend in the business, thinking of an idea for an episode of the new GenMed Show podcast, and racking my brain for what is a crucially important thing to talk about regarding young people in medicine. I was thinking about all the things we talked about, and about some of the younger partners I've had working in EMS, and thought about when I was brand new myself. Speaking to patients inappropriately is definitely one of my pet peeves.
In EMS, or any kind of medicine for that matter, the majority of our patients are senior citizens (unless you’re in peds, OB, or some other overly lovey, estrogen-laden specialty). It’s important to understand with all patients that you’re treating a person and not a disease. With the huge generation gap between patients and young new caregivers, that idea seems to be getting lost somewhere along the way.
With the modern social media culture, people don’t even know how to talk to each other anymore. It keeps getting easier to get by with emails and text messages, and “OMG LOL” your way through life and society. Learning how to speak to people properly is becoming a lost skill, and that’s apparent in our youth.
With the initial impression many seniors will have of a young caregiver, establishing a respectful patient-caregiver relationship is important not only in the short term of treating your current patient, but in pushing forward the acceptance of our very different generation by our elders. If a patient finds a caregiver to be respectful, intelligent, and caring, despite their body modification, unique hairstyle, and other attempts at individuality, they will ultimately feel more comfortable with that caregiver, and other similarly appearing caregivers in the future.
So, the first step in establishing this relationship is in the address. Call a patient what they want to be called, and what is most respectful. DO NOT EVER call a senior woman "hun", "sweetie", or "dear"! They are not your girlfriend, they’re not in kindergarten, they have been alive three to four times as long as you, been through more than you can possibly understand, and they know it. You need to know it too. You would never dare speak to your own grandmother that way unless you were really trying to be off their Christmas list and out of their will. Men equally are deserving of the respect they’ve earned throughout their lives. Many seniors are military veterans and very accustomed to and expecting of formal address. Upsetting that expectation will not do anything good for your relationship with your patient. Remember Clint Eastwood in Gran Torino? Would you ever call him "dude"?
Beginning an address using the proper title of ma’am or sir in your introduction is appropriate, followed by using Mr. or Mrs. (last name). At that point you have begun a very respectful and appropriate dialogue with your patient, and earned a good deal of their respect by showing yourself to be mature, caring, and respectful. For instance:
“Hello ma’am. My name is Jake. I am a paramedic with the ambulance service.”
“Hello Jake, my name is Mary.”
“Mary may I ask your last name?”
“It’s White. Mary White.”
“Mrs. White how may I help you?”
“Oh, Mary is fine. Just call me Mary.”
Now you’ve established your relationship and an appropriate dialogue. Notice that beginning a question with asking their permission “…may I ask…” is very respectful of their wishes and their privacy. It shows that you’re mindful of the way you’re addressing them.
As you perform an assessment of your patient, explain yourself and ask permission. Ask if you may perform an assessment, i.e. “Mary may I check your pulse while we’re talking? I’d like to have my partner check your blood pressure also if that’s alright.” Speak to them sincerely, and show them that you care who they are and that you have their best interests in mind. Speak to your patient like a person, and like an adult. It’s far too common for a caregiver to address a senior like a child, and treat them like they’re stupid.
Bear in mind that your patient has probably had a history and physical done more times than you’ve done one. They’ve probably been on a cardiac monitor and a pulse-oximeter more times than you’ve used one. “We’re gonna’ put these stickers on you” is condescending, and entirely inappropriate for any patient beyond grammar school. “Mary, may I put you on the heart monitor?” is more appropriate. They know what you’re doing, and may even understand it more than you do. Don’t forget; retired nurses and doctors call 911 too, and generally if a senior patient doesn’t understand something, they’ll ask. They want to be involved in their care, and to understand what is being done to them and why, so explain your actions and make yourself available to answer all of their questions honestly.
While assessing your patient, treat their anxiety too. This doesn’t mean chemically sedate everyone over 55. It means that you need to understand that people call 911 because they’re scared and feel helpless. It’s very common also for seniors to suffer from generalized anxiety and often be prescribed anxiolytic medication. Rushing, yelling, and demanding things will only exacerbate their anxiety. Don’t make your patient be afraid to be in your care. Be calm, collected, quiet, and calculated. Control your scene. Look them in the eyes, hold their hand, listen carefully and attentively, be sincere, make humble suggestions and ask them what they want to do. Your calm presence will set the tone for all the caregivers involved. There is no need to rush anything for a patient that isn’t almost dead, in which case they wouldn’t notice what a spaz you’re being anyhow.
Be mindful of your patient’s social situation. Keep in mind that older senior citizens were depression-era children. They are accustomed to being very frugal and wasting nothing, sometimes even to the point of a psychological hoarding disorder. They may also be very limited in their income, living solely off social security or other very finite income, and they simply can’t afford any loss. The bed sheet you use to carry them may be their only bed sheet. The nightgown you cut open with your trauma shears may be their only nightgown. They will probably feel incredibly uncomfortable and insecure leaving valuables at home or not knowing where they are. Their purse or wallet, their glasses, their medication, their house keys, their list of phone numbers, a couple pieces of precious jewelry may all be crucially important to their comfort. Take the time to attend to these concerns. They may also be incredibly concerned about their pets who have become their closest companions. Offer to speak with a neighbor who has a house key for them before leaving their home. Take the time to call one of their relatives for them from the hospital when you arrive, because you never know when the hospital staff may have the time to do it.
Be respectful of your patient’s dignity. Put a blanket over them when wheeling them out on the gurney in their pajamas. Turn off the lights on your apparatus parked out front if you can, especially if you’ll be there for a while. Avoid talking about private or embarrassing things in front of too many people. Most touchy topics can wait until a more discreet moment.
Be sympathetic to your patient’s medical situation. Their aging may make simple tasks very arduous, and not tending to even their minor difficulties and discomforts makes you a poor caregiver. Some things may also be very embarrassing, like incontinence, constipation, gas, hemorrhoids, etc. and they may not allude to symptoms like this in front of other people. They may be afraid of upsetting their family members with complaints or explanations. Medical information is a very private thing, and you need to treat it as such. It’s completely alright to gather a little extra history from family members alone, but don’t talk about a patient in front of them like they aren’t in the room.
Talk to your patient. Ask them questions. Humble yourself to their knowledge and experience. They very likely understand their medical history better than you do, especially related to obscure diseases. If you don’t know what something is, be honest about it and ask them to inform you. They’ll respect your humility, and you’ll learn something new and interesting.
Mostly, be humble in that you don’t understand exactly what they’re going through. There’s no way for you to have true empathy for what you don’t understand, but you can be caring and sincere, and that’s good medicine.
Homework:
Watch Patch Adams and Gran Torino
