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Long Transports Afford Teachable Moments


I keep going back and forth on this thing. I flip-flop like a fish on the deck. My swings of opinion probably have more to do with how much EMS burnout I’m suffering from at any given moment than any objective criteria of effectiveness.

Late afternoon of my third shift in a row? Trying to teach anything to a patient in the back of an ambulance is as useful and trying to explain consequences to a teenager.

Sunny morning post-coffee on the first day of a duty tour? It’s my job to recognize and take advantage of any opportunity to educate the public with which I’m presented.

As usual, sitting in front of the computer in my office—wearing civilian clothes and sipping a caffeinated beverage, far from the smell of diesel fumes and the unwashed masses—my opinion falls somewhere in between. But, like any successful intimate encounter, teachable moments require both parties to be open to the experience. And like any such encounter, the mood and timing has to be just right for it to be successful.

Last weekend I was working with a paramedic about as barnacle-encrusted as I am. I enjoy patient bonding, a good on-the-way-to-the-hospital chit-chat and a few chuckles as much as the next prehospital care provider, but Don really surprised me. He surprised me because not only is he nearly as long-in-the-tooth as I, but he has a reputation of, let’s say, being direct and a bit opinionated. This, along with his stories about the survivalist compound he calls home, led me to believe he would be a business-only paramedic. I was wrong.

Don's medic unit is about as far away from the downtown hospitals as you can get within the city limits. Transport time can easily take 30 minutes. How surprised was I, then, to hear Don chatting with every patient for almost the entire trip every time he was in the back. And not only was he talking, but he was also discussing the patient’s medical conditions in earnest and emphasizing the importance of such things as regular checkups, medication compliance, diet, glucose checks or whatever. And these conversations occurred with not only the better educated and chatty patients one might assume would be receptive to such a conversation, but also the less-savory, frequent-flyer knuckleheads who make up the majority of our clientele.

After listening to a few of these encounters, I asked Don, “Hey! What’s up with the lengthy consults in the back of the rig?”

He looked nonplussed. “Why, is there a problem?”

“No, just kinda surprised that an old dog like you makes such an effort.”

“We’ve got long transport times, and sometimes, I can get through to them. You never know.”

And I think that’s right. You never know. You never know when something will sink in. As much as we all resisted our parents’ words of wisdom, we can each quote some important nugget from mom or dad that eventually sank in and serves us well today.

So we can never tell when something will have an effect—maybe the patient finds something in Don to trust (he’s got a cool beard); maybe this trip to the hospital was a last straw; maybe Don is able to phrase something in just the right way. Who knows? But as long as Don has the energy and the talent to discover and take advantages of the teachable moments, why not?

And I think sensitivity and tact are the keys here. There are teachable moments, and there are shut-up moments. There are teaching techniques, and there are piss-your-patient-off techniques. Of course some medics piss patients off on purpose. Let’s talk about those losers another time.

But lots of medics, especially newbies, are so puffed-up with themselves and the idea of their own knowledge and authority that they don’t know when to shut up, and they don’t realize when they condescend.

For example, we were precepting a medic student on a call to a toddler who was severely injured in a crash. The student, while we were still unsure whether the kid would survive, decided this was a golden moment to educate the child’s mother regarding the proper use of car seats. I had to stop my treatment to physically grab him by the back of his collar and propel him to the floor by the back door of the ambulance with an admonition to neither move nor speak for the rest of the call.

Don is not condescending or inappropriate. He takes his role as educator seriously, and when there’s an opening or opportunity, he explains things in a matter-of-fact, straightforward manner.

Is it effective? Who knows? But what I do know is that it requires talent to identify—and energy to take advantage of—teachable moments. Don has provided me with a little inspiration, a little nudge to be more diligent in seeking those opportunities out and doing my job better. So, at least for the first few calls of the next tour, I’ll be on the lookout for teachable moments.

But by the last half of the third day of the tour, I’m sorry; school will probably be closed.


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