yeah, so, you're having a heart attack

[paramatt_]

Good links WH, I vaugely remember learning SPIKES. Here's another link that explains it out a bit more

http://theoncologist.alphamedpress.org/content/5/4/302.full

People have a very incomplete understanding of what a heart attack or stroke, or any other acute condition is, even if they recognize the name. They will recognize it's serious, but beyond that, they might have no idea what that means. Avoid false assurances, but let them know that there is a plan for their care and it's happening right now.

Word.

It's really strange what people will remember, which is why I thought discussing how we communicate with patients can really change things not only in the short term (reducing fear and anxiety), but also to the long term. The few thank you cards I've recieved in my short career weren't thanks for driving fast to hospital, or for any technical skill, but rather for being thoughtful and professional.

Not trying to get off track here, but an example from personal experiance from when my granpa died (I was 4 or 5). One of the few things I can remember 20-something years later is how the nurse held my hand and gave me a 7up. I'll be my bottom dollar, it's the little things like that patients and thier families are going to remeber. I would really hate that if the only lasting memory of the patient or family in the case I originally presented left them feeling lost, confused, or scared if we didn't bothered to take into account their feelings/emotions at the said time. Not sure, maybe that makes some sence

[mobey]

I am with all the others, there has to be the right tone.

I am not much of a hand holder, but I can fake it pretty good. I usually offer a "I am sorry you are going through this, we will make it as comfortable as possible", or "I am sorry for your loss"

I have also thrown out: "I know you're thirsty, but I am working on saving your foot right now", and "Your heart is in a lethal rhythm, and we are going to give you some medication to try straighten it out".

I really do make myself the clinical one on a scene, I am not running around giving hugs, I am not raising my voice, or using terms heard on Grey's Anatomy, but if you want clinical information, or someone to remain professional in an emotionally charges situation, I'm your guy.

I don't see much wrong with the student's performance, other than missing the followup info about treatment, given it was presented professionally.

I think it is important to point out that alot of the coping mechanisms seen on scenes (crying, panic, anger, etc) have to do with the unknown. Just giving a diagnosis, and verbalizing a treatment plan relieves alot of anxiety for everyone..... including the practitioners!

[Happiness]

_{So lets go back to before this newbie even attended the call. Did you as a preceptor go through explaining to him/her that when we communicate a pts condition we try to make it so they can understand what is going on and that we try to communicate the condition with out adding extra stress.}

_{So for example Joe Doe if we come across a Heart Attack when we are talking to the pt we dont say "Sir your having the big Jammer" but might say "Sir I believe you are having a Heart Attack and we need to get you to a hospital asap, as we are going I will start an IV and......................"}

_{New medics are so focused on trying to diagnois what is going on that they forget how to communicate. I have had to train the new one just out of school and they are not really told how to talk to pts, and what they are taught really isnt always real clear.}

_{When I had to ride with my Preceptor I was very lucky to have one that would say to me "So we are going to blah blah what are the things that you might want to think about on our way there" I would give my answer, she would never say I was right or wrong as that defeats the purpose of precepting. Then she would say so if you come across blah blah blah how are you going to talk to the patient, how are you going to get the information that you need from the patient or the family members. Communication is learned and learning by example to me is the best way.}

_{just my two cents}

[paramagican]

I have told patients the exact same thing albeit with a little more fluff around the edges. There is nothing wrong with what he did.

[mobey]

_{So lets go back to before this newbie even attended the call. Did you as a preceptor go through explaining to him/her that when we communicate a pts condition we try to make it so they can understand what is going on and that we try to communicate the condition with out adding extra stress.}

_{New medics are so focused on trying to diagnois what is going on that they forget how to communicate. I have had to train the new one just out of school and they are not really told how to talk to pts, and what they are taught really isnt always real clear.}

I do think we expect this to be established when precepting a Paramedic student (This is U.S.... so NOT Primary Care Paramedic *EMT) This is a basic communication skill. Right or wrong, we do not expect to teach basics to Paramedic students.

[WolfmanHarris]

I do think we expect this to be established when precepting a Paramedic student (This is U.S.... so NOT Primary Care Paramedic *EMT) This is a basic communication skill. Right or wrong, we do not expect to teach basics to Paramedic students.

There's a few different ways to view the role of the preceptor and Walter Tavares, an ACP, PhD candidate and the coordinator of the Centennial College/University of Toronto Paramedic program has done some interesting papers on Paramedic education including different models for precepting. I'm afraid I don't have a citation for that paper as I saw a presentation on his theories in person and my notes are long gone. From that and my own thinking and experience I'd break precepting into two main models.

One if that of final arbiter of fitness to practice; that is, taking the student at the end of their diadactic and clinical time, who should have all requisite knowledge and training and to place them in a supervised work environment for evaluation. This seems to be the more traditional model of precepting and how precepting was done where I was a student. The preceptor in this model makes the sole reccommendation on fitness, though there may be an appeal process.

Another model, and one that I've become convinced is a better move for education is to view the role of the preceptor as a mentor and tutor. They are there predominantly to guide and develop the candidate and while they do evaluate them, their evaluations are meant to direct their education and track progress, but not to determine fitness to practice. In this model as the candidate nears the end of their precepting they would be rotated through a wide range of evaluating medics over the course of various shifts. Those medics would then each evaluate a set number of calls on a set score sheet and the scores tabulated. The model used by Centennial College (if I recall correctly) is six final shifts, six different evaluators, first emerg call of the shift is evaluated regardless of type.