Commentary, Exclusives, Patient Care

The Art of Dealing with Challenging Patients and Family

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Often times in EMS, we focus solely on the clinical aspect of our jobs. Not to say this isn’t a great thing, but what about the “human factor?” What about the different types of personalities and emotions that we encounter from patients and family members? This is a thought which often goes by the wayside. As we know, in EMS, we encounter people from all backgrounds with different personalities. Everyone expresses emotions differently in times of crisis. Some cry. Some scream. Some become violent. Some remain calm. This presents a unique challenge for us as EMS providers.1

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How we, as providers, react to and deal with challenging patients and family members is a highly important aspect of our job. Dealing with these situations in a professional and objective manner projects a positive image to the public, protects the integrity of our organizations, and may determine whether or not you go home in one piece at the end of your shift. In this article, I’d like to outline and elaborate on three rules for effectively dealing with challenging patients and family members. In my 20 years as a provider, I find that following these rules and doing your best to be objective with patients and family members you encounter will aide in a successful outcome.

1. Be objective; Don’t take it personally.

We’ve all encountered situations where we walked into a residence and a patient or family member began screaming at us. How do we deal with this? Our first instinct as human beings is to become defensive and yell right back. “How dare this person scream at me? I’m not putting up with this!” I can guarantee you that doing this will make matters worse and possibly put you in a position of danger.

I know this because there was a time in my career where I didn’t always follow my own rules. As a provider, you must put yourself in a mental position to realize that it’s not personal and you should never take it that way. How could a patient or family member be mad at you? They just met you three seconds ago! They couldn’t possibly be mad at you. It’s because they’re not. They are upset about whatever outside factor is upsetting them that has nothing to do with you as a provider. You just happened to walk in and they’re projecting their frustration onto you.

This is important for us as providers to understand as it aids us in keeping our cool when faced with these challenging situations. As a seasoned EMS provider, I’ve been called every foul name in the book by patients and family members who were angry before I arrived on scene. The only way I deal with this is to not take it personally! I fully understand that we, as EMS providers, are humans also and we have our own stressors in life that tend to thin our patience with challenging people.

It’s important to effectively manage these stressors outside of work and leave them at the door of the station when you report for duty.2 This is a huge factor in maintaining your patience and objectivity when dealing with challenging situations.3

2. Identify and empathize with the outside factors that are upsetting a patient or family member.

I once walked into a house for an elderly woman not feeling well. Her son, who was about 6-foot-6, towered over me and began to scream. I knew how I reacted to this could mean the difference between whether or not I was going to need an ambulance. I quickly realized that he was upset because his mother wasn’t feeling well. It had nothing to do with me personally.

I said to him: “Sir, I realize you’re upset because your mother is ill. I personally guarantee you that she will receive the best care possible and I will make sure I speak with the nurses and doctors in the hospital to make sure she is given priority care.” This huge man broke down and began to cry. Which was a huge sigh of relief! The successful outcome in dealing with this particular situation was identifying and empathizing with the outside factor which was upsetting him.4

It kept me in one piece, projected a good public image and protected the integrity of my organization. Most importantly, it offered this man reassurance that his beloved mother was going to be well taken care of. Had I gotten defensive and began to yell back, the situation would’ve gone bad quickly. It’s important to identify why someone is emotional in order to address it and deal with it in an objective and professional manner.

3. Spend as much time as it takes with a patient and/or family in order to facilitate care and transport.

As providers, there are times where we are in a rush. We’re tired, were hungry and we need to get to the three other calls that are holding in the dispatch queue. It’s OK to admit it. We’ve all done it. This often results in allowing someone to refuse that we could’ve spent more time convincing to go to the hospital. This also results in ineffective care and angry family members. Keep in mind that system resources are not your problem as providers. You must effectively care for the person in front of you before you move on to the next call.

My clinical manager, who I consider to be one of the best EMS educators on the planet, once said to me: “If you can’t be with the one you love, love the one you’re with.” Meaning: take it one call at a time and take as much time as reasonably necessary to provide effective care and facilitate transport for someone who needs it. I once encountered this elderly lady with dementia who was failing to thrive. Her son wanted her transported to a hospital. She did not want to leave her bedroom. She did not have the capacity to refuse treatment due to her mental state and her son insisted that she be transported.

In this situation, what are my options as a provider? I’m absolutely not physically forcing an elderly woman with her dementia out of her room. I can’t allow her to refuse. The only option I had is to convince this woman to be transported to a hospital willingly. I spent about a half hour talking with her, joking with her and laughing with her. In the end, she agreed to be transported to a hospital and as a bonus, asked me to marry her on the way. This was my first proposal during the course of my duties!

We have a wide array of challenges that we face every day. Our jobs as EMS providers are difficult, stressful and challenging. However, the most important things to consider are: keeping yourself safe and providing excellent customer service and patient care to those who call upon us. There’s no amount of stress or impatience that is worth putting yourself, your patients or your respective organizations at risk.

References

  1. King M. The Importance of Cultural Diversity in Health Care [Internet]. Burlington (VT): University of Vermont; 2014 Sept 25 [cited 2020 Sept 16]. Available from: https://learn.uvm.edu/blog/blog-health/cultural-diversity-in-healthcare.
  2. Lamplugh Jr MW. The Stress in EMS: Effects of Stress on the Unsung Heroes of the EMS Profession [Internet]. Fair Lawn (NJ): Journal of Emergency Medical Services; 2018 May 8 [cited 2020 Sept 16]. Available from: https://www.jems.com/2017/05/08/the-stress-in-ems-effects-of-stress-on-the-unsung-heroes-of-the-ems-profession/.
  3. Shepard S. Challenges of Cultural Diversity in Healthcare: Protect Your Patients and Yourself [Internet]. The Doctors Company. [cited 2020 Sept 16]. Available from: https://www.thedoctors.com/articles/challenges-of-cultural-diversity-in-healthcare-protect-your-patients-and-yourself/.
  4. Birks YF, Watt IS. Emotional intelligence and patient-centered care; J R Soc Med. 2007 Aug; 100(8): 368–374.