When your patient asks if he is having a heart attack, do you tell him, no matter how bad the 12 lead looks? Have you ever avoided these quesions, told white lies or just plain lied in what you thought was the best interest to the patient? What do you think? When does a patients stress level or anticipated reacition influence what or how you tell them?
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Interesting conversation.
I’ve always had a general rule to be truthful and blunt with patients. It has served me well over the years.
That is not to say I’ll go beyond what I think I know to be true.
For instance: If a patient is rolling around, clutching their chest, sweating up a storm and has obvious ST elevation in the inferior leads, I’ll say, “Hey, listen… this is important. You ARE having a heart attack. Now this is what’s going to happen…..”
Its my opinion that the patient needs to hear the truth for the simple reason that nearly all of them have no idea what is happening to them and are oblivious to how the situation is going to be handled. It gives them comfort to know that somebody has figured it out and is going to take charge. Taking charge is part of a medic’s job.
All of us know, however, that it is only a handful of times a year that you actually see an obvious STEMI. Most of the time you are dealing with chest pain whose cause can only be sorted out at the hospital. In these situations, again, you tell them the truth. “I’m not the doctor, I don’t know. But its important that we go and have this checked out.”
The discussion about psych patients was pertinent and I agreed with Tim. “I don’t know what you are feeling. But here is what I do know; You are going to the hospital with me because you are on a hold. When we get there, you will see those who will understand your situation and want to help. How all of this is going to shake out is going to be up to you. It is going to be important that you cooperate with all of us who are trying to sort this out. I want my report to say that you were completely compliant during transport.”
Now while telling the truth is my general rule, at times I’ll lie shamelessly.
Two nights ago I was working a MLB ballgame. A home run was hit into the stands and about 15 minutes later a guy walked in the First Aid room with a mangled left middle finger. His attempt to catch the home run ended poorly.
He had an open fracture and dislocation(s). In fact, it was hard to see how it could be any more screwed up. He wanted it bandaged but was refusing any further care. Going to the hospital was out of the question because he had to catch the train to go home, 70 miles away. Oh, BTW, alcohol was involved.
My response? “You are going to the hospital. If you don’t go now, you will be going later. You see the end of your finger and how blue it is? That means that the circulation has been cut and the end of the finger is dying. If you let this go, you may lose that whole finger.”
“But what about the train?” he asked.
“Don’t worry about it,” I replied. “They’ll have you in and out in an hour.”
He went to the hospital and I did not lose a minute of sleep.
Thanks for the great feedback and comments Jack. Loved your MLB story.
Hello. This is an interesting subject. I’m a volunteer EMT and during my training we’re taught to be honest with patients and family members, especially if things (e.g. an arrest at home) isn’t looking like a favourable outcome. In my full time job I work in sales, which bascially involves talking bullshit and handling objections. My route with the ‘am I having a heart attack’ question, is simply to say something like ‘The ECG is showing ischemic changes that aren’t normal and are better assesed at hospital. A heart attack can only be properly diagnosed by a blood test at hospital’. Thinking left field a sales or objection handling course for EMTs and paramedics would be a useful tool when talking to patients. Just a thought.