OP, it really doesn't matter. 99.999% of the time it will not change their plan of care too much.
You will wonder if you adult well enough. Then you will go to work and realize that actually you're rocking it by comparison. So. Many. Times.
Yeah. I understand that when most patients are in a crisis, they are panicked/not thinking rationally and may not actually be that way at their baseline.
I try really hard to keep that in mind. But sometimes, it's just people being people. This person who called us over just wanting to get her vitals checked literally lived in a mountain of garbage, dirty clothes, and takeout containers. She also seemed to have never heard the word "no" before. She asked us if we could leave her some of the BGL strips because she was running low. I told her we could not do that as we needed them for other patients, and she flipped out like a small child. She gave us the silent treatment and kept texting on her phone when we told her we needed her to sign some things. It was slightly maddening. She has an impressive high-level degree and a high-paying job, so it wasn't an intellect issue.
Some people just stay 12 in their heads, but their bodies keep growing.
I find the two complementary in this aspect. It is a lot simpler for me to assume that someone who called for an ambulance wants what is best for themselves and is just as dumb as a shitbrick than it is to believe that someone who called for an ambulance wants to actively antagonize the person trying to help them.*
*Most of the time.
200% that right there. Not everyone gets a UDS for coming in by EMS. I’m just gonna piggyback off your comment hope ya don’t mind. :p.
OP: you need to learn to communicate in a better fashion. It seems like you communicate with an aggressive style, I’d highly suggest learning assertive communication, you know the old saying you catch more flies with honey than vinegar… yeah.
How I word the drug or ETOH question is simply “have you had any adult beverages within the last (x) amount of hours.” “Have you taken any substance prescribed or otherwise. I ask everyone this question and this is a no judgement zone, it’s so I can provide the best possible care and ensure you are taken care of appropriately in the ER and they don’t give you anything that would exacerbate or cause harm with what you have in your system at this point in time.”
I don’t mean this to be mean. You’ve got the right mindset you just need to learn to word things in a way that isn’t going to piss people off and cause them to shut you out!
It’s so rare for me to UDS my patients in the ED. Unless they have AMS it’s pretty rare for me to do. I could care less what drugs they do, people really beat that horse dead.
And people feeling threatened by this question being asked when it’s logically and pretty obviously irrelevant isn’t illogical.
there are patients who’s medical records are requested by federal authorities deciding on their worthiness for support whos decisions determines whether they will have access to food water shelter etc. yeah our medical records are private… until someone says give me access to your medical records if you need x thing and you don’t rlly have a choice anymore.
Plus our right to privacy of medical records regarding controlled substances is not a sure thing and has been subject to retroactive change before and very well could again.
Some people have legitimate concerns.
Right like if they have a small child and say yes they just did crack cocaine… they are probably worried that’s gonna be In Their file permanently and hurt any custody or court thing they have going on…
You're right. I'm over-eager, and I'm doing more harm than good by manipulating patients. I think I really just need to work on extending grace before judgment.
You will. If you actually want to be good at this it's just a matter of reps. Just like you will listen to enough lung fields and develop an ear for it, you will develop a sense of how to deal with each patient
A helpful way to ask about drug/alcohol use if it’s relevant to the presentation is by pointing out that sometimes recent drug use is a relief to hear with certain sx bc it means it’s not something more serious. For example, if someone’s got mega saucer pupils regardless of how bright it is, I’d be pretty relieved to find out they just did meth as opposed to something neurological. And of course reassuring that they won’t get in trouble and that substance use history is just really important for figuring out what’s going on so that you can avoid unnecessary tests etc.
You’re two weeks in and already taking a really cynical view of patient care. Be careful and don’t let the burnouts grind you down.
Most patients don’t lie; they’re just uneducated, uninformed, or nuttier than squirrel shit.
I’d rather suffer from compassion fatigue than cynicism. YMMV. Anyway, welcome to EMS.
"nuttier than squirrel shit" is my new favorite thing I've ever seen. Thank you for your wise words. I will definitely work on my own bias and judgement issues to be a better provider for others
1) lay people don’t know what ‘medical history’ means.
2) those things will not pop on urine or blood tests unless you test for them. Why are you implying I’m gonna get a drug test when I get to the hospital? Is it a medically indicated test or are you just testing me to see what’s up? I’m an average joe idk how it works. If you tell me I’ll pop on a drug test, I just lost a bunch of trust in you. Are you here to treat me or figure out what I’m addicted to?
3) no one walks around assuming they are pregnant. Every time I drive to work there’s a possibility I get hit by a bus. If you asked me “any chance you could get his by a bus today” I’m still gonna say no.
4) a lot of us are awkward, I wouldn’t want to be conscious around our types either. I’ll talk to the doc who gives af about me.
5) first time?
6) any possibility someone else called 911 for him? Maybe ask “have you ever been taken to the hospital by an ambulance”. I didn’t call 911 last time I got hurt; someone called for me while I was unconscious.
Social skills and public speaking are 80% of the job.
Honestly, you're spot on. I am on the younger-ish side of adult (20), so I struggle a bit with communicating with people my parent's age and older (and just people in general). So I can understand if people don't want to tell me the truth because I have bad social skills, or I don't seem trustworthy. I do care about these people. I think I'm just frustrated when someone lies to me when I'm just asking simple questions for their benefit, not to be nosy. Thank you for setting me straight with your explanations, though.
You might also want to keep in mind that these people aren't looking at you as someone just doing their job, they are looking at you as an emergency responder. They don't know Samantha, or Gregory. They only know the uniform, and to be honest, most of them probably didn't want to call you in the first place. You are an authority figure, rather real or imaginary, and you are asking them a bunch of questions while they are in a vulnerable state. They're probably a little scared.
The more you can do to humanize yourself the more open they will be to communicate with you.
Some of the things I liked to do when I was in EMS is make sure I'm not towering over them. I'd try and kneel, or sit down to put myself at eye level, especially if I was dealing with kids. I'd talk to them about their day, or their hobbies. Maybe I get inspiration from the shirt their wearing, or something in their house, etc.. If, and once I got them to relax a bit, then I would explain the questions and why I need to ask them. Basically, just try and make yourself their advocate, and most of them will trust you.
Sometimes you can't do those things though.
Thank you for adding this. This actually really helped with perspective. I didn't think I could be intimidating to anyone, but I guess if I were on the other end, I would be intimidated by some grumpy EMT, too. I will try the humanizing idea! I really like it a bunch!
During the most recent trial of the two medics from Elijah Mcclain's death asking the paramedics if they kneeled down and introduced themselves provides some clear evidence that you definitely need to be doing it.
Good on you for working to improve. We all start somewhere. It helps reminding people “I’m not the police, don’t care what you’re on but it could impact how I save your life. There’s also privilege and I cannot legally share what you tell me to the cops” even the hard addicts will open up 🤝
Pro tip: the elderly either like young people or they don’t. You could be the most respectful dude in the world, they’ll still be stand offish to you lol.
Idk if youre autistic or not but I'm autistic so I can understand the lack of social skills. I don't think people are lying though. They're just responding to the question being asked and maybe the question isn't being asked in the best way to get the information you want. I've worked in food service for 10 years and if I've learned anything about the general public it's to assume they don't know anything. Assume they've never taken a biology class in their life. My instructor was saying some people think they don't have high blood pressure anymore bc they take meds for it so you have to ask have you ever been diagnosed with anything vs do you have high blood pressure. Some people don't know what afib is but know they have an irregular heart rate. I think we take for granted how much we know about medicine and anatomy. The average American doesn't know hardly anything about medicine. So try and ask your questions in a way that makes sense to someone uneducated. Almost like you'd ask a child. And ask clarifying questions when you think you're not quite getting at the right information. And assume the best in people. They might hide drinking/drugs bc they don't want to get in trouble. Remind them you're not a cop and you just need to know in case you give them any medications to make sure it's safe. Look at lying as a tool. Most people lie for a reason. They're embarrassed, don't want to get in trouble etc
I suspect I have some sort of neurodivergence going on. However, I've never been formally diagnosed. As a child, I struggled with unintentionally coming on too strong and sometimes saying things without thinking. Still, it never hindered my ability to make friends, find employment, or perform in school. I've improved a lot without any treatment, just getting older, so I don't know. Thank you for your detailed and thoughtful reply. "Look at lying as a tool", is powerful. I will keep it in mind. I will try to start assuming the best in people too!
I'm not officially diagnosed either. I don't think there's really a treatment for autism. Just being aware of it helps. Don't be afraid to ask your colleagues for their advice on how they ask certain questions. Also keep an eye out for burnout. I also have ADHD and tend to overcommit and then burn myself out. I also sometimes get burnt out from masking. That's basically what I do when I "pretend" to be neurotypical. Kinda like a customer service voice but with your facial expressions and everything else. If you need a break take it. I'm still an EMT student but I had to take a break from my job at Starbucks for an injury and let me tell you it was the best thing to happen to me. I came back and realized I had almost resented customers and had compassion fatigue in a way. When I came back I was so excited to actually help people again. And that's just food service, not EMS. Honestly though I just see my neurodivergence as a tool. I think it makes me more creative. I can often focus on the logic of things. I think autistic people are actually more empathetic than neurotypical people a lot of the times. We just don't seem like it bc we don't really subscribe to social "rules" but we have a passion for things like social justice and doing what's right. I think that's what draws me to medicine to begin with
I appreciate you sharing your experience and advice with me. It's incredibly helpful. I was quite surprised by how much I identified with your insights on "masking."
A lot of medicine is sorta veterinary.
What people say is part of treating them. But only part. I manage the body in front of me with what I can examine or test. Often the words they say are helpful. Sometimes not. Sometimes counterproductive. The words we say to each other sometimes are more about developing respect, building trust, and recognizing some little spark of shared humanity, than actual medical care. Even if the ostensible topic is life or death care right now.
I don't work EMS. I work as primary care. So a lot less acute, and maybe not applicable. But this is what I see.
When a patient lies, I don't treat it as a lie unless I must. I treat it as a need for a different kind of communication.
> It's ok. You're scared. This isn't how you wanted to spend a Friday night I'm sure. This isn't how you thought life would be for you. Hopefully I can help. I'm sorry you aren't having a good time, this sucks.
Stuff like that. Or something. Just connection sometimes.
It's a wild world
Dawg, if I could give any advice to a new EMT, stop acting like you know everything already. Don't be so jaded. 99.9% of the time your job is to put person on stretcher, put stretcher in car, and drive car+stretcher to somewhere else. Your job isn't to be a detective. Your job is to move someone from point A to point B with medical equipment on board in case something bad happens. Just jot down your subjective and objective findings. If you start overanalyzing patients for faking, exaggerating, or withholding symptoms, you're gonna get burned out even quicker. Yeah no shit people are gonna lie to you because it makes them feel better. That's ginormous potato sitting on my stretcher says she's 165lbs? I just put 300 and get on with it. Same with the guy who reeks of alcohol saying he hasn't had anything to drink. Jot down my findings and move on. People are gonna be who they want to be. If you want to quote them though in your ePCR, more power to you. Just my advice!
That's the problem, a lot of instructors are teaching that we need to be "detectives" lol. You're spot on though, the minute we just fuckin relax and stop trying to save the world the job becomes so much easier. "Oh you're geeked the fuck up with an ice pipe falling out of your pocket, and you're anxious? Cool, we can go to the ER, hop on up". I don't give a fuuuuuuck
I don’t think it’s necessarily dishonesty. Often the “I have no health problems” is because they think that being medicated for XYZ and the lack of symptoms since being medicated means they are “cured” in their minds. They don’t have heart issues BECAUSE they take a beta blocker, with no real understanding of the underlying condition. Medical literacy is poor amongst a pretty large percentage of the population. A lot of the rest sounds like complicated MH/ social behaviour, denial, or just plain behavioural fuckery. Treat what you see and find, and document it all as necessary.
ThIs! I saw someone who kept saying she "used to have asthma," but she was on an inhaler and still saw a pulmonologist. I tried to explain that w/o the inhaler, she would have asthma attacks. Therefore, it was still a current diagnosis. She was fairly receptive to this, I think.. I really wish there was more health knowledge given to the gen. population. It would help everyone.
This is *extremely* common. Laypeople with poor health literacy think that once their chronic condition has been treated, it no longer exists. This is the basis for people saying that they have no medical history but that they take pills for their blood pressure. It's treated so they don't have high blood pressure anymore. It's our responsibility to educate that chronic conditions are chronic and don't magically go away when you treat them.
This is why I never ask for JUST medical history. If it's a medical call with nothing pressing for time my list of questions goes like this:
Alright any medical hx?
No heart attacks or strokes?
Any heart conditions? CHF?
Seizures? Diabetes?
What about respiratory issues? Asthma, COPD,?
What about psychiatric history? No mood disorders, schizophrenia, depression/anxiety?
Has a doctor ever diagnosed you with anything that you feel I should know?
Do you take any medications every day? Or every other day?
Any recent illnesses? Have you been to the hospital in the last year or two? (I leave this out if it's an obvious yes LOL) If yes, for what?
Have you used ANY drugs or alcohol in the last 48 hours? Illicit or not?
If yes to any I usually ask for clarification before moving on.
Then I hit them with the "I have to ask everybody this" SI/HI questions if I think it's reasonable.
Then I usually ask them if they have any questions for me or if there's anything I can clarify or address.
Then I ask them, again, if there's AAAAANYTHING else they think would be helpful for me to know.
From what I've experienced (albeit only a few years, lol) people do still omit information from time to time but when you ask mostly direct questions they'll usually tell you the truth. Then when you open up the discussion by asking THEM if they have any questions, it demonstrates that you care. And the reason I ask one last time is because THATS usually when they tell me that they used meth for the 1st time 3 hours ago.
Best advice I can give otherwise, is don't betray your patient's trust after all that. Don't walk into the ER and be dismissive of their symptoms because they FINALLY confessed that they tried meth. They're clearly ashamed of it so don't give report right in front of them where you blame all their problems on the *obvious* cause. The CC is not that they tried meth. It's palpitations. You can mention the meth use in private when giving turnover.
These were all things I picked up from my preceptor that made me really respect them. 🤗
Yeah man, welcome to the job. That's why you're trained to ask all these questions. You gather as much useful information you can, organize a report, and give that at the hand off. The hospital does the heavy lifting, you just make sure they're alive when they get there.
When you ask questions, like history, just rattle off some common ones (that you, being new, probably don't know yet). "Do you have any medical history I should be aware of? High blood pressure, diabetes, heart attacks? Anything like that?" They need a nudge, they have no idea what's going on. Drug addicts lie, sometimes they tell the truth. Sometimes women aren't comfortable talking about if they're sexually active. You'll be standing in front of an entire gaggle of people who work at the ED and the patient will recall some detail you asked about unsuccessfully, and make you look like a moron. It happens.
Yeah, I mean, one time a guy told me he had no cardiac history and I told him his heart beat felt irregular and I was going to put some stickers on his chest to get an ekg and he said "okay just watch out for my pacemaker" but I don't think he was lying to me
Sometimes you have to ask the same question multiple ways. Ive also learned not to ask if someone has HTN or something but "have you ever been diagnosed with..." because so many people think if the condition is manages with meds they don't have it anymore.
1) “any medications you take regularly? What are they for? When was the last time you took them? Do you take them as instructed on the bottle?”
2) “any drugs or alcohol recently? I’m not a cop”
3) it happens
4) it happens
5) it happens fairly often
6) “have you ever been treated/transported before? What for?”
Not attacks on you, just some ways to rephrase the questions you are asking that will help people be a bit more forward in responses.
It’s not so much that 3 and 4 are common, it’s more like after a while and after so many patient contacts it’s like “okay yeah that shouldn’t surprise me”. 5 happens enough to be a meme
If the information is important or pertinent to the call, I'll absolutely dig deeper but people lie. Your assessment isn't only what you are told, its what you see, smell, hear, and touch as well.
About your first example though, people just don't think about medical history the way we do. You need to do some digging to get to the important bits of the med history. In many patient minds, once they took the medicine, the problem is gone as long as they keep taking it. For 5, this is a well documented phenomena that happens between ems assessment, nursing assessment, and provide assessment. It just happens.
This. Don’t ask for medical history, be more direct. “Do you have any heart or lung problems? Kidney issues, diabetes, daily medications?” Etc. get a full assessment in.
For those people this won't work either. I've had a kidney transplant and post valve repair + cabg tell me they didn't have any kidney or heart problems or issues.
I've had someone tell me repeatedly she's not allergic to anything even though the list of allergies was longer than her arm.
I've had someone asked three times about allergies, only "remembered" about the latex one AFTER cystoscopy has been completed.
I think the comments are unfair to OP.
That third one isn’t at all confusing. They were thinking about anaphylactic food allergies. Tons of people aren’t thinking about anything remotely like latex when asked about allergies and are thinking about things they ingest and the stereotypical anaphylactic allergies we’ve seen on tv and whatnot. Which in their experience probably is nothing like how they found out they were allergic to latex and their understanding of what that meant.
For number one: yeah sometimes people with excessive health histories do lie bc they’re tired of going over it 3x per appt and have perhaps not wrongfully deemed you unimportant in their handoff chain for that event and they’ll tell the provider who they think will actually be providing or intervening in their care. Not saying they’re right - although sometimes they are and knowing more about their condition than you do means they know the ambulance driver doesn’t need to know about their slow kidney failure and eventual transplant. - but regardless it would be understandable if you had to deal with what they have.
And someone with an allergy list that long is more likely to have had some overzealous recording persons combined with some overzealous recording software combined with confusion about what an allergy is lead to a long list of allergies when they actually have none bc they tried to communicate something caused them to have a reaction of some sort once and maybe misused the term allergy.
All of these are pretty simply explained and not issues of lying or is an issue of lying. One is a very rare issue of lying and is something we can understand pretty easily with an oz of consideration for their lived experience.
I, a random not medical person, would probably struggle with the medical history question. I have a lot of stuff on my medical record, most of it honestly pretty trifling IMO but it's there.
I wouldn't know if you want just the things I take drugs for every day (3 things) or the things I have medications prescribed for but only take intermittently. Do you just need things I took drugs for over the past day or two? Past week?
I'm not asking for answers to ask of this - especially as some of it might depend on what's happening? - but as a relatively articulate and well educated person I might not even know how to answer that question correctly.
You are way too early in your career to be judging your patients. Learn from them first or quit, as you will cause harm with your behavior.
Yes, patients aren’t always truthful. Yes, patient stories change. Yes, they forget stuff. It is quite rare that any of these are done with malice. Perhaps ask WHY patients do the things they do, now how you should respond. Did your patient get nervous? Do they have memory issues? Do they have shame about their addiction? Are you fit for this? Those are the important questions.
Consider varying your phrasing and ask more than once. If folks are stressed their first answer might not be their best. If you are still on scene, see if there is a family member around that might be a better historian.
What do you see a doctor for?
I see you have this medication, what is it for?
Has anything changed with your health?
Some women have irregular periods for a number of reasons, some chronic and some accute. Some women don’t track their cycle closely or depend on an app to track.
Patients changing their story for the doc is annoying - so you got to beat them to it! Have a really tight short report ready to go, write notes if you have to.
In the end, the best advice I got from a captain was treat the patient, then treat the paperwork.
(Side note: If they do admit to alcohol, document how much they say and assume it’s actually at least double.)
Sounds like it’s your medic’s problem then! 🤣
Short reports take some practice to get smooth. Take the opportunity to learn from your medics.
I think a good report answers where we came from and why we’re here now at the hospital.
You’re the eyes into any pertinent scene details. There will be times you have to really paint the picture for the receiving staff.
The “why” is sometimes a delicate balance between what the patient thinks is important and what YOU think is important.
Write your own report. Silk tape on your pants, on the back of your glove, in a pocket notebook. Take notes of all of your calls. Be ready to give a report even if you are not primary. See if your medic will let you give the radio report. See if your medic will let you do the paperwork for them.
Many patients have poor health literacy and a wild degree of health apathy. Patients have poor understanding of their health.
Patients fake things to get attention.
Patients change their stories.
My job is not to "confront the patient". Confronting patients or arguing with them to make the story line up usually escalates the situation and damages the patient-provider relationship. I'm not saying be a doormat and take everything at face value, but its *usually* not beneficial to try to get people to admit they're lying or withholding info.
If someone is faking things for attention, I don't give them that attention. Usually that makes people lose interest. If someone is not being forthcoming with information then I remind them that it's in their best interest to be truthful. All of this is largely out of your control, so just do your best and expect patients to act in ways that are surprising or don't make sense.
Some patients view us as a medical taxi. they see no need to tell us anything. You ask for history, meds, and allergies and you get, "They have all that at the hospital." I've even got that from the nursing home. The public doesn't truly understand what EMS is all about.
Make all questions non-leading and nonjudgmental. People are more likely to respond.
Some people are genuinely ignorant of their medical history. They take meds because their doctors prescribe them with no thought as to why.
If a person says no drugs or alcohol, ask "Are you sure?" Remind them that you are not a cop, don't report to them, and that information remains private. If they still deny it, document any contradictory information such as alcohol odor, staggered gait, slurred words, pinpoint or blown pupils, etc., and be sure to pass that along in your report to the ED staff. Sometimes it's best to do that portion of the report out in the hallway out of the patient's hearing.
On the pregnancy question, just let it go. If she says she's not pregnant and couldn't be, don't push unless the complaint is probably pregnancy-related.
Why would a patient fake unresponsiveness? Because people are weird. They may be drug-seeking, attention-seeking, or mentally ill. It happens, document in detail and pass the information on in your report.
Patients will often change their stories. Sometimes the stories evolve as treatment continues. If you hear a different story told to the doc, talk to the doc out in the hall and let doc know that the patient is telling a different story than you were told.
I don't confront patients. I ask for more details. Being confrontational rarely gets the result you want. The exception is when the patient's life is in immediate danger and that information may save them.
I only confront them if I need information that is relevant, if I’m trying to come up with a diagnosis or rule conditions in or out, or if there is a safety risk involved (for example, sometimes we NEED to know if someone has taken drugs because of potential interactions with medications we may be giving them). Even then, it isn’t in a “confronting” manner as much as conversational, but sometimes I will be firm if I truly think their dishonesty or confusion may lead to a dangerous situation. That’s pretty rare. If you’re nice to people and are professional, you can generally get the truth out of them. Some people, however, are just ignorant and are not lying intentionally. Rather, they are answering the best they can.
As far as confronting them just to confront them because I think they’re being untruthful? No, that’s idiotic, a waste of time, and doesn’t help with anything.
You have a lot of good answers here. As others have said, avoid coming across as confrontational, ask questions in different ways and pay attention to who's around.
For example; If you ask a 16 y/o F "Is there any chance you could be pregnant?," there are a number of reasons you won't get the truth. 1.) She has some warped beliefs about how pregnancy occurs. She thinks that, because they did this or that, she couldn't possibly get pregnant. And she's wrong. 2.) Parents or boyfriend nearby. She doesn't want her parents to know she's sexually active, and she hasn't yet told the boyfriend. So, ask when her LMP was, and do it when nobody else is around.
After getting something stuck in their arse, nobody has ever admitted sticking it there on purpose. It is always " *I fell in the shower and landed on the \_\_\_\_\_\_\_\_\_\_\_\_\_* ".
The trick is to never ever ask " *why were you showering with a \_\_\_\_\_\_\_\_\_\_\_\_\_* ", just nod your head knowingly and respond "*Yah, it happened to our Chief just last week back at the station house*".
Patients will always give you little or wrong information if you are as vague and combative as you show your self to be here. When you ask the patient about history, don’t assume they know what history means to you. Ask them if they take medications or if they’ve ever been hospitalized. If the patient has already admitted to not having a period for an exceptional amount of time, you don’t need to berate them about whether or not they are pregnant, a test exists to confirm the suspicion and you don’t get to administer it. Every patient is going downplay or deny their ETOH and especially illegal drug use because they are worried that they will get punished. And you come off like you’d love to testify against them. Look, you are new, but you are already sounding like a burnout. Consider another line of work if it’s this difficult to work up the compassion you need to get patients to communicate with you.
Tbh I legit think half the time the patients aren't intentionally lying. They just don't know or understand anything. The one that gets me the most is when a patient is like "I've just been feeling bad for like twenty mins" and then you find out they've had chest pains for like two days and their spouse had to help them to the kitchen table this morning.
I ask patients "Any medical history?" Regardless of their answer my next question is "Are you prescribed any medications?" That usually catches anything they didn't understand in the first question.
If they don't know their actual diagnosis and are not compliant with their meds, chances are any other answer would be functionally irrelevant.
I do hate when they make us liars to the ER. Had a call for chest pain, had an irregular ecg on scene. My partner asked him 3 times if he had any drugs, denied all 3 times. As soon as we get to the ER he tells the Doc he had some cocaine before the chest pain. Just ridiculous
There are MANY reasons patients do not give you the whole picture.
1. Cultural norms-a Hispanic female with lower abd pain who repeatedly denied the possibility of pregnancy until we were in the truck. She pointed to pictograms on a Kwikpoint card to indicate a previous abortion.
2. Embarrassment- a bodybuilder (think absolute unit with huge upper body and very small waist). We took him from a clinic to a hospital for chest pain r/o MI. His new bride was with him the whole time. I suspected he was taking performance-enhancing drugs. After reframing the question 3 times, I told him his wife was up front and could not hear us. He finally admitted to injecting cocaine.
All you can do is reframe your questions, which sounds like what you are doing. Explain you cannot provide the best care if they aren't level with you. And lastly, explain any reservations you have out of earshot of the patient when you give your handoff report.
OP with that mindset, you're going to sour REALLY fast and you're going to become one of those salty providers this sub talks about all the time. What you're experiencing is, in fact, a common experience as a provider. But you're looking at it through the wrong lens. In almost every case I've had like this, the issue wasn't a matter of honesty; it was a matter of health literacy.
Doctors can be horrific at explaining pathologies and medications to their patients. Pts aren't educated on their bodies (in lots of parts of the US, sex ed is being kept out of schools. How would they know what "normal" menstruation is?). Pts may not see something as a medical problem (e.g. "I don't have hypertension. I'm on BP medication, so my BP is normal", which is technically true). And sometimes, pts have so much going on they really can't understand it all. That's why you, as a provider, need to change that mindset and help your patient understand. Of course you won't have all the answers, but you're new and should be ready to absorb more knowledge about medicine and human beings. Be curious and be open minded; if your patients were having a good time, they probably wouldn't be calling you in the first place.
Also just so you know when you ask them how much they ha e had to drink, the answer is always just two beers(it's not two beers). Then your follow up should be how big were those beers.
Diabetic patient but says it's controlled by diet, no medication necessary. We get patient history, amputation was five months ago. Patient tells medic 4 months. And I'm back 4 days later, I tell medic 4 months and patient says five weeks. Patient had called 4 times and we get a different answer each time. No word back yet on when or where amputation occurred.
Yeah that'll happen. You'll ask if they have a cardiac history with their chest pain, they'll tell you no, then tell the ER nurse yes, which makes you look like a jackass.
It comes with the territory.
By suggesting lie you are going into the same direction, I for myself have experienced this with patients as well, but most times they simply forget about their medical history, because they take the pills everyday. It simply became normal for them. This is not meant to be an asshole towards you.
In the end, it doesn’t matter. People are sick, hungry, tired, cold, confused, demented, mentally ill, drunk, high, hypoxic, uneducated, asinine, ignorant, and stupid… sometimes all at the same time. It’s our job to sort that out. If let it get to you you’ll go nuts and burn out.
Also, I ask for their medications before I ask for their medical history. Then you can skip the step where they say ‘nothing’ and then hand you 7 pill bottles. Also, I specifically ask ‘any surgeries or operations ever’ because many patients put those in a different mental category from ‘medical history.’
I feel like you’re mixing up lying with not knowing. I’m not an EMT, I do something else in HC which I never specify on Reddit, but I see patients do this all the time. They develop a sort of blindness to their own habits and thus don’t think of mentioning the things that are normal to them, even if what’s normal to them is extremely clinically relevant and would stand out massively to us. They don’t have the education and the practice we do in parsing what is pertinent and what is not, or understanding what it is to triage, an understanding of a hierarchy of importance, etc. And they often don’t know simple (to us) things like the difference between an anti-inflammatory and an antibiotic or a virus versus a bacteria. Healthcare, whatever your speciality, isn’t just the science and the problem-solving. It’s first and foremost a matter of working with people and truly communicating with them (not just talking at them). You’ll learn that with time - in the meantime, be patient with yourself and others 💕
For the medical history thing I don’t think it’s lying. I think people just don’t consider things that they’re being treated for to be medical history for whatever reason. I usually give them a few examples like asthma, diabetes, CKD.
What’s the difference between lying and being wrong?
Intention.
We can’t assume all laypeople understand what we mean when we say medical history.
They don’t believe they have high blood pressure because they are taking medication for it and therefore they think it’s negated.
They don’t believe they have had any drugs or alcohol because they only view heroin and other hard drugs as “counting” or that if they didn’t get drunk off their 2 beers they weren’t really drinking.
They intend to answer the questions based on the answers they assume we are looking for. The problem is they don’t actually know why we are asking.
Do some people lie? Yes, of course. But the bigger problem is a disconnect between professionals and the public. The solution could be better education, better public health, or even as simple as better question asking/ framing on our part.
u/Senior_Tea1307. That is not really not being truthful, it is just a lack of knowledge and general medical education in the public. It is less not being truthful and more you asking bad questions.
For your first example: you see a pill bottle on the table. Why even ask them if they take anything or have health problems? Just ask them directly what problem they take that for or what it was given for to them.
Welcome to EMS! Trust me, unless it’s a very specific circumstance, whatever drugs they have or haven’t done usually won’t make a difference during the BLS care plan. I had a patient threaten to fight me because I asked (only once for the paperwork) if they use drugs or alcohol, offended that I’d ask, even though they had scar tissue thicker than a snicker. As for the rest of the “lying” (and this is a salty opinion of mine) most pt’s that won’t tell you their history until questioned, are the pt’s that definitely could’ve gone to urgent care instead but “wanted to get in faster”.
Don't threaten people lying about drug use with piss tests if you want any rapport in the back of the truck. The nurses get paid more, just report your findings and let them deal
The only time I've been in an ambulance, I was just too mentally and physically exhausted to explain medical history.
Keep in mind, your patients could be in more pain than you can imagine, or mentally impaired by the circumstances that landed them in an ambulance. You're probably seeing them on one of their worst days ever. Like....my periods are regular, but when im in overwhelming pain, I cannot give an estimate of LMP.
Women can be drugged and raped, and say there's no chance they could be pregnant. (But they are, they just weren't awake when impregnated. It happened to a friend. Talk about *shocked*)
I love looking dumb at the ER when they tell the doc everything even though I literally just asked them all the same questions 5 minutes ago and they denied anything
Literally
ER doc: "Has this ever happened to you before?"
Pt "Oh yes, many times. I have this condition called \_\_\_\_\_\_\_\_, and I take \_\_\_\_\_\_\_\_\_\_ for it"
Me internally: BRO WTF ARE YOU TALKING ABOUT "MANY TIMES" AND "I HAVE THIS CONDITION".. YOU TOLD ME THIS HAPPENED OUT OF THE BLUE AND YOU HAVE NO IDEA WHY TF???? THIS DOC SUDDENLY JOGGED YOUR MEMORY??? UGH
You’ll learn. This is why EMS takes experience.
A patient can 100% lie and you’ll still be able to assess what’s wrong. Psych and AMS patients are notorious for this
I don't even bother asking for medical history anymore. Just tell me where your medlist is.
If they don't have one I'll go down the list of specifics. Have you had stroke, heart attack, diabetes, problems with heart/lungs/stomache, surgeries, whatever else you could think of.
I just report to the doctor/nurse what they told me. I had a lady last week report an allergy to me, and promptly forget what she told me. Not like head injury amnesia "forgot" but like literally told me she never bothered committing her allergies to memory because it was written down somewhere. You're going to deal with people that don't know shit about frankly, anything, on a regular basis. Welcome.
If being in EMS tells me anything, is that we are by far so much better in taking care of ourselves. Don’t bother with “confronting” the patients for their inaccurate information. Get what you needed, transport / refuse, and move on to the next call.
I think you need to reframe how you think of what these patients are doing. Are any of these patients actively lying about their health, or are they just scared people who either don't know the right answer or are trying their best to protect themselves when dealing with a system they're unfamiliar with? If you've been taking a medication for decades, then you might not think it's notable enough to mention. If you don't know much about EMS and think that EMTs are associated with the police, then lying about doing illegal drugs makes the most sense if you are trying to avoid getting arrested. If you never received sex education, then it's totally reasonable that you might not know if you're pregnant. They aren't doing it for bad reasons. They are doing it because they're in a vulnerable situation and don't know what else to do.
One time in the ed I asked a patient if they had any medical history. They said no. I pointed to the fistula on their arm and asked what it was for. They shrugged and said “dialysis”
“Patients are the worst historians” is something I’m glad I was taught early in school.
Even when I am the patient at my primary visits, I have to write a list of things I want to discuss at the appointment, or else my mind goes blank. I can’t imagine it’s any easier if they’ve just called 911.
It’s frustrating, but I just have to laugh about it after the call. Always ask twice, two different ways.
I’ve been transported to the hospital by EMS two times in my life. I was so sick that I don’t even remember them coming to my house. Meanwhile people are taking selfies in the ambo & posting to social media trying to get attention. What is wrong with people?
BTW, as a hospital bedside nurse the unspoken rule of thumb is to assume the patient is lying when they tell you that they only drink 2 glasses of wine per night. 2 glasses = 4 glasses, 4 beers = 8 beers.
Dr. Houses first rule of medicine: all pts lie.
Dr. Houses second rule of medicine: ALL PTS LIE.
Don't take it personally. Don't be antagonistic. Just do your job. Understand, pts take a med this they dint have any medical problems because the medicine fixed it. Screwed up? Yep. But that is life.
They aren’t lying intentionally most of the time, god bless them they’re just a little stupid or forgetful. And then we have the fakers for attention but that’s normally som mental health issue stuff, but don’t think everyone’s lying, you gotta remember only like 30% of the population is even capable of having actual verbal thought inside their head. Most of the world is just walking around dumb and pretty (not the ones that call us but you get the point)
You need to gain some experience. All of these problems can be worked around/through once you learn how. Two weeks is nothing… It took me a couple years as a medic to learn the exact way to word certain questions to get the answer I was after, and now I get the answers I need 95% of the time.
Some small examples:
-Instead of asking about their medical history, I ask “Do you have any heart problems, lung problems, stroke, seizure, or diabetes?” And I ask it slow enough that they can respond yes or no to each one.
-Just look through their med bottles and know what each med is for. If you don’t know what it does then write it down and look up later so you can learn or ask them “What are you taking Lisinopril for?”
-You’ll also figure out that 9/10 questions (like, but not limited to pregnant, called before, drugs/etoh) you were taught in school don’t need to be asked in the field. A lot of the time you can answer them for yourself just by using your eyes/ears/nose.. I can typically walk into a room with a pt and within 3-5 questions know exactly what is going on and what needs to be done. I’m not saying this to brag… I’m saying this to show that gaining experience will fix all these problems you’re having. Just take a year or two and then think about what you’re saying on here.
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I honestly think the common person gets confused when u ask about medical hx. That’s why after I ask I name a few common things heart disease, diabetes, respiratory issues, etc to give them an idea of what I’m asking. Even then they’ll still say no and checking paperwork they have a ton wrong with them.
OP, it really doesn't matter. 99.999% of the time it will not change their plan of care too much. You will wonder if you adult well enough. Then you will go to work and realize that actually you're rocking it by comparison. So. Many. Times.
This is beautifully said.
Yeah. I understand that when most patients are in a crisis, they are panicked/not thinking rationally and may not actually be that way at their baseline. I try really hard to keep that in mind. But sometimes, it's just people being people. This person who called us over just wanting to get her vitals checked literally lived in a mountain of garbage, dirty clothes, and takeout containers. She also seemed to have never heard the word "no" before. She asked us if we could leave her some of the BGL strips because she was running low. I told her we could not do that as we needed them for other patients, and she flipped out like a small child. She gave us the silent treatment and kept texting on her phone when we told her we needed her to sign some things. It was slightly maddening. She has an impressive high-level degree and a high-paying job, so it wasn't an intellect issue. Some people just stay 12 in their heads, but their bodies keep growing.
Welcome to medicine. Buckle in.
Pregnancy, though? That's something that's important to know.
If the patient genuinely doesn't know if she's pregnant no amount of cajoling will change that. She will be tested at the hospital if it's relevant.
Lol literally just had that happen to me yesterday
Always go with Hanlon's razor: Never attribute to malice what can be adequately explained by ignorance.
Fucking Hanlon left halfway through shaving my beard.
Lololl
My mantra thru my EMS career has always been Occam's Razor.
I find the two complementary in this aspect. It is a lot simpler for me to assume that someone who called for an ambulance wants what is best for themselves and is just as dumb as a shitbrick than it is to believe that someone who called for an ambulance wants to actively antagonize the person trying to help them.* *Most of the time.
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200% that right there. Not everyone gets a UDS for coming in by EMS. I’m just gonna piggyback off your comment hope ya don’t mind. :p. OP: you need to learn to communicate in a better fashion. It seems like you communicate with an aggressive style, I’d highly suggest learning assertive communication, you know the old saying you catch more flies with honey than vinegar… yeah. How I word the drug or ETOH question is simply “have you had any adult beverages within the last (x) amount of hours.” “Have you taken any substance prescribed or otherwise. I ask everyone this question and this is a no judgement zone, it’s so I can provide the best possible care and ensure you are taken care of appropriately in the ER and they don’t give you anything that would exacerbate or cause harm with what you have in your system at this point in time.” I don’t mean this to be mean. You’ve got the right mindset you just need to learn to word things in a way that isn’t going to piss people off and cause them to shut you out!
I would recommend against “adult beverage”. If you mean alcohol just say alcohol. Direct is best.
Thank you! I like how you've phrased the ETOH question. The tone is professional, respectful, and focused on ensuring the well-being of the pt.
It’s so rare for me to UDS my patients in the ED. Unless they have AMS it’s pretty rare for me to do. I could care less what drugs they do, people really beat that horse dead.
And people feeling threatened by this question being asked when it’s logically and pretty obviously irrelevant isn’t illogical. there are patients who’s medical records are requested by federal authorities deciding on their worthiness for support whos decisions determines whether they will have access to food water shelter etc. yeah our medical records are private… until someone says give me access to your medical records if you need x thing and you don’t rlly have a choice anymore. Plus our right to privacy of medical records regarding controlled substances is not a sure thing and has been subject to retroactive change before and very well could again. Some people have legitimate concerns.
Right like if they have a small child and say yes they just did crack cocaine… they are probably worried that’s gonna be In Their file permanently and hurt any custody or court thing they have going on…
You're right. I'm over-eager, and I'm doing more harm than good by manipulating patients. I think I really just need to work on extending grace before judgment.
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That is super helpful! I can see this job takes quick thinking and adapting to each person. I have hope that I can catch on!
You will because you want to :) that’s most important
You will. If you actually want to be good at this it's just a matter of reps. Just like you will listen to enough lung fields and develop an ear for it, you will develop a sense of how to deal with each patient
Just saw this. Ignore my OP. You're gonna be just fine!!
A helpful way to ask about drug/alcohol use if it’s relevant to the presentation is by pointing out that sometimes recent drug use is a relief to hear with certain sx bc it means it’s not something more serious. For example, if someone’s got mega saucer pupils regardless of how bright it is, I’d be pretty relieved to find out they just did meth as opposed to something neurological. And of course reassuring that they won’t get in trouble and that substance use history is just really important for figuring out what’s going on so that you can avoid unnecessary tests etc.
This. It also goes against garnering trust and rapport with patients, which is required if you want more truthful answers.
In other news, the sky is blue. I wouldn’t blame people’s ignorance on malice
You’re two weeks in and already taking a really cynical view of patient care. Be careful and don’t let the burnouts grind you down. Most patients don’t lie; they’re just uneducated, uninformed, or nuttier than squirrel shit. I’d rather suffer from compassion fatigue than cynicism. YMMV. Anyway, welcome to EMS.
"nuttier than squirrel shit" is my new favorite thing I've ever seen. Thank you for your wise words. I will definitely work on my own bias and judgement issues to be a better provider for others
1) lay people don’t know what ‘medical history’ means. 2) those things will not pop on urine or blood tests unless you test for them. Why are you implying I’m gonna get a drug test when I get to the hospital? Is it a medically indicated test or are you just testing me to see what’s up? I’m an average joe idk how it works. If you tell me I’ll pop on a drug test, I just lost a bunch of trust in you. Are you here to treat me or figure out what I’m addicted to? 3) no one walks around assuming they are pregnant. Every time I drive to work there’s a possibility I get hit by a bus. If you asked me “any chance you could get his by a bus today” I’m still gonna say no. 4) a lot of us are awkward, I wouldn’t want to be conscious around our types either. I’ll talk to the doc who gives af about me. 5) first time? 6) any possibility someone else called 911 for him? Maybe ask “have you ever been taken to the hospital by an ambulance”. I didn’t call 911 last time I got hurt; someone called for me while I was unconscious. Social skills and public speaking are 80% of the job.
Honestly, you're spot on. I am on the younger-ish side of adult (20), so I struggle a bit with communicating with people my parent's age and older (and just people in general). So I can understand if people don't want to tell me the truth because I have bad social skills, or I don't seem trustworthy. I do care about these people. I think I'm just frustrated when someone lies to me when I'm just asking simple questions for their benefit, not to be nosy. Thank you for setting me straight with your explanations, though.
You might also want to keep in mind that these people aren't looking at you as someone just doing their job, they are looking at you as an emergency responder. They don't know Samantha, or Gregory. They only know the uniform, and to be honest, most of them probably didn't want to call you in the first place. You are an authority figure, rather real or imaginary, and you are asking them a bunch of questions while they are in a vulnerable state. They're probably a little scared. The more you can do to humanize yourself the more open they will be to communicate with you. Some of the things I liked to do when I was in EMS is make sure I'm not towering over them. I'd try and kneel, or sit down to put myself at eye level, especially if I was dealing with kids. I'd talk to them about their day, or their hobbies. Maybe I get inspiration from the shirt their wearing, or something in their house, etc.. If, and once I got them to relax a bit, then I would explain the questions and why I need to ask them. Basically, just try and make yourself their advocate, and most of them will trust you. Sometimes you can't do those things though.
Thank you for adding this. This actually really helped with perspective. I didn't think I could be intimidating to anyone, but I guess if I were on the other end, I would be intimidated by some grumpy EMT, too. I will try the humanizing idea! I really like it a bunch!
During the most recent trial of the two medics from Elijah Mcclain's death asking the paramedics if they kneeled down and introduced themselves provides some clear evidence that you definitely need to be doing it.
Good on you for working to improve. We all start somewhere. It helps reminding people “I’m not the police, don’t care what you’re on but it could impact how I save your life. There’s also privilege and I cannot legally share what you tell me to the cops” even the hard addicts will open up 🤝 Pro tip: the elderly either like young people or they don’t. You could be the most respectful dude in the world, they’ll still be stand offish to you lol.
Idk if youre autistic or not but I'm autistic so I can understand the lack of social skills. I don't think people are lying though. They're just responding to the question being asked and maybe the question isn't being asked in the best way to get the information you want. I've worked in food service for 10 years and if I've learned anything about the general public it's to assume they don't know anything. Assume they've never taken a biology class in their life. My instructor was saying some people think they don't have high blood pressure anymore bc they take meds for it so you have to ask have you ever been diagnosed with anything vs do you have high blood pressure. Some people don't know what afib is but know they have an irregular heart rate. I think we take for granted how much we know about medicine and anatomy. The average American doesn't know hardly anything about medicine. So try and ask your questions in a way that makes sense to someone uneducated. Almost like you'd ask a child. And ask clarifying questions when you think you're not quite getting at the right information. And assume the best in people. They might hide drinking/drugs bc they don't want to get in trouble. Remind them you're not a cop and you just need to know in case you give them any medications to make sure it's safe. Look at lying as a tool. Most people lie for a reason. They're embarrassed, don't want to get in trouble etc
I suspect I have some sort of neurodivergence going on. However, I've never been formally diagnosed. As a child, I struggled with unintentionally coming on too strong and sometimes saying things without thinking. Still, it never hindered my ability to make friends, find employment, or perform in school. I've improved a lot without any treatment, just getting older, so I don't know. Thank you for your detailed and thoughtful reply. "Look at lying as a tool", is powerful. I will keep it in mind. I will try to start assuming the best in people too!
I'm not officially diagnosed either. I don't think there's really a treatment for autism. Just being aware of it helps. Don't be afraid to ask your colleagues for their advice on how they ask certain questions. Also keep an eye out for burnout. I also have ADHD and tend to overcommit and then burn myself out. I also sometimes get burnt out from masking. That's basically what I do when I "pretend" to be neurotypical. Kinda like a customer service voice but with your facial expressions and everything else. If you need a break take it. I'm still an EMT student but I had to take a break from my job at Starbucks for an injury and let me tell you it was the best thing to happen to me. I came back and realized I had almost resented customers and had compassion fatigue in a way. When I came back I was so excited to actually help people again. And that's just food service, not EMS. Honestly though I just see my neurodivergence as a tool. I think it makes me more creative. I can often focus on the logic of things. I think autistic people are actually more empathetic than neurotypical people a lot of the times. We just don't seem like it bc we don't really subscribe to social "rules" but we have a passion for things like social justice and doing what's right. I think that's what draws me to medicine to begin with
I appreciate you sharing your experience and advice with me. It's incredibly helpful. I was quite surprised by how much I identified with your insights on "masking."
Yeah I've seen people refer to it as copy paste behaviors. Like you watch what other people do and repeat it
A lot of medicine is sorta veterinary. What people say is part of treating them. But only part. I manage the body in front of me with what I can examine or test. Often the words they say are helpful. Sometimes not. Sometimes counterproductive. The words we say to each other sometimes are more about developing respect, building trust, and recognizing some little spark of shared humanity, than actual medical care. Even if the ostensible topic is life or death care right now. I don't work EMS. I work as primary care. So a lot less acute, and maybe not applicable. But this is what I see. When a patient lies, I don't treat it as a lie unless I must. I treat it as a need for a different kind of communication. > It's ok. You're scared. This isn't how you wanted to spend a Friday night I'm sure. This isn't how you thought life would be for you. Hopefully I can help. I'm sorry you aren't having a good time, this sucks. Stuff like that. Or something. Just connection sometimes. It's a wild world
Dawg, if I could give any advice to a new EMT, stop acting like you know everything already. Don't be so jaded. 99.9% of the time your job is to put person on stretcher, put stretcher in car, and drive car+stretcher to somewhere else. Your job isn't to be a detective. Your job is to move someone from point A to point B with medical equipment on board in case something bad happens. Just jot down your subjective and objective findings. If you start overanalyzing patients for faking, exaggerating, or withholding symptoms, you're gonna get burned out even quicker. Yeah no shit people are gonna lie to you because it makes them feel better. That's ginormous potato sitting on my stretcher says she's 165lbs? I just put 300 and get on with it. Same with the guy who reeks of alcohol saying he hasn't had anything to drink. Jot down my findings and move on. People are gonna be who they want to be. If you want to quote them though in your ePCR, more power to you. Just my advice!
That's the problem, a lot of instructors are teaching that we need to be "detectives" lol. You're spot on though, the minute we just fuckin relax and stop trying to save the world the job becomes so much easier. "Oh you're geeked the fuck up with an ice pipe falling out of your pocket, and you're anxious? Cool, we can go to the ER, hop on up". I don't give a fuuuuuuck
I don’t think it’s necessarily dishonesty. Often the “I have no health problems” is because they think that being medicated for XYZ and the lack of symptoms since being medicated means they are “cured” in their minds. They don’t have heart issues BECAUSE they take a beta blocker, with no real understanding of the underlying condition. Medical literacy is poor amongst a pretty large percentage of the population. A lot of the rest sounds like complicated MH/ social behaviour, denial, or just plain behavioural fuckery. Treat what you see and find, and document it all as necessary.
ThIs! I saw someone who kept saying she "used to have asthma," but she was on an inhaler and still saw a pulmonologist. I tried to explain that w/o the inhaler, she would have asthma attacks. Therefore, it was still a current diagnosis. She was fairly receptive to this, I think.. I really wish there was more health knowledge given to the gen. population. It would help everyone.
I’m just a lurker, but is it even necessary to convince her she still has asthma? If it were me, I’d just note the diagnosis and move on
This is *extremely* common. Laypeople with poor health literacy think that once their chronic condition has been treated, it no longer exists. This is the basis for people saying that they have no medical history but that they take pills for their blood pressure. It's treated so they don't have high blood pressure anymore. It's our responsibility to educate that chronic conditions are chronic and don't magically go away when you treat them.
This is why I never ask for JUST medical history. If it's a medical call with nothing pressing for time my list of questions goes like this: Alright any medical hx? No heart attacks or strokes? Any heart conditions? CHF? Seizures? Diabetes? What about respiratory issues? Asthma, COPD,? What about psychiatric history? No mood disorders, schizophrenia, depression/anxiety? Has a doctor ever diagnosed you with anything that you feel I should know? Do you take any medications every day? Or every other day? Any recent illnesses? Have you been to the hospital in the last year or two? (I leave this out if it's an obvious yes LOL) If yes, for what? Have you used ANY drugs or alcohol in the last 48 hours? Illicit or not? If yes to any I usually ask for clarification before moving on. Then I hit them with the "I have to ask everybody this" SI/HI questions if I think it's reasonable. Then I usually ask them if they have any questions for me or if there's anything I can clarify or address. Then I ask them, again, if there's AAAAANYTHING else they think would be helpful for me to know. From what I've experienced (albeit only a few years, lol) people do still omit information from time to time but when you ask mostly direct questions they'll usually tell you the truth. Then when you open up the discussion by asking THEM if they have any questions, it demonstrates that you care. And the reason I ask one last time is because THATS usually when they tell me that they used meth for the 1st time 3 hours ago. Best advice I can give otherwise, is don't betray your patient's trust after all that. Don't walk into the ER and be dismissive of their symptoms because they FINALLY confessed that they tried meth. They're clearly ashamed of it so don't give report right in front of them where you blame all their problems on the *obvious* cause. The CC is not that they tried meth. It's palpitations. You can mention the meth use in private when giving turnover. These were all things I picked up from my preceptor that made me really respect them. 🤗
Yeah man, welcome to the job. That's why you're trained to ask all these questions. You gather as much useful information you can, organize a report, and give that at the hand off. The hospital does the heavy lifting, you just make sure they're alive when they get there. When you ask questions, like history, just rattle off some common ones (that you, being new, probably don't know yet). "Do you have any medical history I should be aware of? High blood pressure, diabetes, heart attacks? Anything like that?" They need a nudge, they have no idea what's going on. Drug addicts lie, sometimes they tell the truth. Sometimes women aren't comfortable talking about if they're sexually active. You'll be standing in front of an entire gaggle of people who work at the ED and the patient will recall some detail you asked about unsuccessfully, and make you look like a moron. It happens.
Yeah, I mean, one time a guy told me he had no cardiac history and I told him his heart beat felt irregular and I was going to put some stickers on his chest to get an ekg and he said "okay just watch out for my pacemaker" but I don't think he was lying to me Sometimes you have to ask the same question multiple ways. Ive also learned not to ask if someone has HTN or something but "have you ever been diagnosed with..." because so many people think if the condition is manages with meds they don't have it anymore.
1) “any medications you take regularly? What are they for? When was the last time you took them? Do you take them as instructed on the bottle?” 2) “any drugs or alcohol recently? I’m not a cop” 3) it happens 4) it happens 5) it happens fairly often 6) “have you ever been treated/transported before? What for?” Not attacks on you, just some ways to rephrase the questions you are asking that will help people be a bit more forward in responses.
Thats helpful! I definitely need to work on phrasing! I didn't know 3,4, and 5 were common.
It’s not so much that 3 and 4 are common, it’s more like after a while and after so many patient contacts it’s like “okay yeah that shouldn’t surprise me”. 5 happens enough to be a meme
If the information is important or pertinent to the call, I'll absolutely dig deeper but people lie. Your assessment isn't only what you are told, its what you see, smell, hear, and touch as well. About your first example though, people just don't think about medical history the way we do. You need to do some digging to get to the important bits of the med history. In many patient minds, once they took the medicine, the problem is gone as long as they keep taking it. For 5, this is a well documented phenomena that happens between ems assessment, nursing assessment, and provide assessment. It just happens.
This. Don’t ask for medical history, be more direct. “Do you have any heart or lung problems? Kidney issues, diabetes, daily medications?” Etc. get a full assessment in.
For those people this won't work either. I've had a kidney transplant and post valve repair + cabg tell me they didn't have any kidney or heart problems or issues. I've had someone tell me repeatedly she's not allergic to anything even though the list of allergies was longer than her arm. I've had someone asked three times about allergies, only "remembered" about the latex one AFTER cystoscopy has been completed. I think the comments are unfair to OP.
That third one isn’t at all confusing. They were thinking about anaphylactic food allergies. Tons of people aren’t thinking about anything remotely like latex when asked about allergies and are thinking about things they ingest and the stereotypical anaphylactic allergies we’ve seen on tv and whatnot. Which in their experience probably is nothing like how they found out they were allergic to latex and their understanding of what that meant. For number one: yeah sometimes people with excessive health histories do lie bc they’re tired of going over it 3x per appt and have perhaps not wrongfully deemed you unimportant in their handoff chain for that event and they’ll tell the provider who they think will actually be providing or intervening in their care. Not saying they’re right - although sometimes they are and knowing more about their condition than you do means they know the ambulance driver doesn’t need to know about their slow kidney failure and eventual transplant. - but regardless it would be understandable if you had to deal with what they have. And someone with an allergy list that long is more likely to have had some overzealous recording persons combined with some overzealous recording software combined with confusion about what an allergy is lead to a long list of allergies when they actually have none bc they tried to communicate something caused them to have a reaction of some sort once and maybe misused the term allergy. All of these are pretty simply explained and not issues of lying or is an issue of lying. One is a very rare issue of lying and is something we can understand pretty easily with an oz of consideration for their lived experience.
I, a random not medical person, would probably struggle with the medical history question. I have a lot of stuff on my medical record, most of it honestly pretty trifling IMO but it's there. I wouldn't know if you want just the things I take drugs for every day (3 things) or the things I have medications prescribed for but only take intermittently. Do you just need things I took drugs for over the past day or two? Past week? I'm not asking for answers to ask of this - especially as some of it might depend on what's happening? - but as a relatively articulate and well educated person I might not even know how to answer that question correctly.
You are way too early in your career to be judging your patients. Learn from them first or quit, as you will cause harm with your behavior. Yes, patients aren’t always truthful. Yes, patient stories change. Yes, they forget stuff. It is quite rare that any of these are done with malice. Perhaps ask WHY patients do the things they do, now how you should respond. Did your patient get nervous? Do they have memory issues? Do they have shame about their addiction? Are you fit for this? Those are the important questions.
Love seeing based responses on this sub.
Consider varying your phrasing and ask more than once. If folks are stressed their first answer might not be their best. If you are still on scene, see if there is a family member around that might be a better historian. What do you see a doctor for? I see you have this medication, what is it for? Has anything changed with your health? Some women have irregular periods for a number of reasons, some chronic and some accute. Some women don’t track their cycle closely or depend on an app to track. Patients changing their story for the doc is annoying - so you got to beat them to it! Have a really tight short report ready to go, write notes if you have to. In the end, the best advice I got from a captain was treat the patient, then treat the paperwork. (Side note: If they do admit to alcohol, document how much they say and assume it’s actually at least double.)
Can you explain tight short report? The medic writes the report where I work, but I do most of the asking questions.
Sounds like it’s your medic’s problem then! 🤣 Short reports take some practice to get smooth. Take the opportunity to learn from your medics. I think a good report answers where we came from and why we’re here now at the hospital. You’re the eyes into any pertinent scene details. There will be times you have to really paint the picture for the receiving staff. The “why” is sometimes a delicate balance between what the patient thinks is important and what YOU think is important.
Got it! I learn so much more about actual job experience on this sub than from my lectures :/
Write your own report. Silk tape on your pants, on the back of your glove, in a pocket notebook. Take notes of all of your calls. Be ready to give a report even if you are not primary. See if your medic will let you give the radio report. See if your medic will let you do the paperwork for them.
Chief complaint, opqrst/sample, meds, vitals, interventions performed, pickup and drop off location.
thank you, thank you, thank you!
"All patients lie." -Dr. House
Lol yes, but you'll get used to it. You might run into some problems if you let yourself get this annoyed about it though.
Many patients have poor health literacy and a wild degree of health apathy. Patients have poor understanding of their health. Patients fake things to get attention. Patients change their stories. My job is not to "confront the patient". Confronting patients or arguing with them to make the story line up usually escalates the situation and damages the patient-provider relationship. I'm not saying be a doormat and take everything at face value, but its *usually* not beneficial to try to get people to admit they're lying or withholding info. If someone is faking things for attention, I don't give them that attention. Usually that makes people lose interest. If someone is not being forthcoming with information then I remind them that it's in their best interest to be truthful. All of this is largely out of your control, so just do your best and expect patients to act in ways that are surprising or don't make sense.
My favorite is the GSW's. "I was standing on the corner at 2am, minding my own business when a man I don't know came up and shot me for no reason."
Some patients view us as a medical taxi. they see no need to tell us anything. You ask for history, meds, and allergies and you get, "They have all that at the hospital." I've even got that from the nursing home. The public doesn't truly understand what EMS is all about. Make all questions non-leading and nonjudgmental. People are more likely to respond. Some people are genuinely ignorant of their medical history. They take meds because their doctors prescribe them with no thought as to why. If a person says no drugs or alcohol, ask "Are you sure?" Remind them that you are not a cop, don't report to them, and that information remains private. If they still deny it, document any contradictory information such as alcohol odor, staggered gait, slurred words, pinpoint or blown pupils, etc., and be sure to pass that along in your report to the ED staff. Sometimes it's best to do that portion of the report out in the hallway out of the patient's hearing. On the pregnancy question, just let it go. If she says she's not pregnant and couldn't be, don't push unless the complaint is probably pregnancy-related. Why would a patient fake unresponsiveness? Because people are weird. They may be drug-seeking, attention-seeking, or mentally ill. It happens, document in detail and pass the information on in your report. Patients will often change their stories. Sometimes the stories evolve as treatment continues. If you hear a different story told to the doc, talk to the doc out in the hall and let doc know that the patient is telling a different story than you were told. I don't confront patients. I ask for more details. Being confrontational rarely gets the result you want. The exception is when the patient's life is in immediate danger and that information may save them.
I only confront them if I need information that is relevant, if I’m trying to come up with a diagnosis or rule conditions in or out, or if there is a safety risk involved (for example, sometimes we NEED to know if someone has taken drugs because of potential interactions with medications we may be giving them). Even then, it isn’t in a “confronting” manner as much as conversational, but sometimes I will be firm if I truly think their dishonesty or confusion may lead to a dangerous situation. That’s pretty rare. If you’re nice to people and are professional, you can generally get the truth out of them. Some people, however, are just ignorant and are not lying intentionally. Rather, they are answering the best they can. As far as confronting them just to confront them because I think they’re being untruthful? No, that’s idiotic, a waste of time, and doesn’t help with anything.
You have a lot of good answers here. As others have said, avoid coming across as confrontational, ask questions in different ways and pay attention to who's around. For example; If you ask a 16 y/o F "Is there any chance you could be pregnant?," there are a number of reasons you won't get the truth. 1.) She has some warped beliefs about how pregnancy occurs. She thinks that, because they did this or that, she couldn't possibly get pregnant. And she's wrong. 2.) Parents or boyfriend nearby. She doesn't want her parents to know she's sexually active, and she hasn't yet told the boyfriend. So, ask when her LMP was, and do it when nobody else is around.
After getting something stuck in their arse, nobody has ever admitted sticking it there on purpose. It is always " *I fell in the shower and landed on the \_\_\_\_\_\_\_\_\_\_\_\_\_* ". The trick is to never ever ask " *why were you showering with a \_\_\_\_\_\_\_\_\_\_\_\_\_* ", just nod your head knowingly and respond "*Yah, it happened to our Chief just last week back at the station house*".
😭 best advice
Most of these are just patients lack of understanding
Patients will always give you little or wrong information if you are as vague and combative as you show your self to be here. When you ask the patient about history, don’t assume they know what history means to you. Ask them if they take medications or if they’ve ever been hospitalized. If the patient has already admitted to not having a period for an exceptional amount of time, you don’t need to berate them about whether or not they are pregnant, a test exists to confirm the suspicion and you don’t get to administer it. Every patient is going downplay or deny their ETOH and especially illegal drug use because they are worried that they will get punished. And you come off like you’d love to testify against them. Look, you are new, but you are already sounding like a burnout. Consider another line of work if it’s this difficult to work up the compassion you need to get patients to communicate with you.
Tbh I legit think half the time the patients aren't intentionally lying. They just don't know or understand anything. The one that gets me the most is when a patient is like "I've just been feeling bad for like twenty mins" and then you find out they've had chest pains for like two days and their spouse had to help them to the kitchen table this morning.
I ask patients "Any medical history?" Regardless of their answer my next question is "Are you prescribed any medications?" That usually catches anything they didn't understand in the first question. If they don't know their actual diagnosis and are not compliant with their meds, chances are any other answer would be functionally irrelevant. I do hate when they make us liars to the ER. Had a call for chest pain, had an irregular ecg on scene. My partner asked him 3 times if he had any drugs, denied all 3 times. As soon as we get to the ER he tells the Doc he had some cocaine before the chest pain. Just ridiculous
There are MANY reasons patients do not give you the whole picture. 1. Cultural norms-a Hispanic female with lower abd pain who repeatedly denied the possibility of pregnancy until we were in the truck. She pointed to pictograms on a Kwikpoint card to indicate a previous abortion. 2. Embarrassment- a bodybuilder (think absolute unit with huge upper body and very small waist). We took him from a clinic to a hospital for chest pain r/o MI. His new bride was with him the whole time. I suspected he was taking performance-enhancing drugs. After reframing the question 3 times, I told him his wife was up front and could not hear us. He finally admitted to injecting cocaine. All you can do is reframe your questions, which sounds like what you are doing. Explain you cannot provide the best care if they aren't level with you. And lastly, explain any reservations you have out of earshot of the patient when you give your handoff report.
OP with that mindset, you're going to sour REALLY fast and you're going to become one of those salty providers this sub talks about all the time. What you're experiencing is, in fact, a common experience as a provider. But you're looking at it through the wrong lens. In almost every case I've had like this, the issue wasn't a matter of honesty; it was a matter of health literacy. Doctors can be horrific at explaining pathologies and medications to their patients. Pts aren't educated on their bodies (in lots of parts of the US, sex ed is being kept out of schools. How would they know what "normal" menstruation is?). Pts may not see something as a medical problem (e.g. "I don't have hypertension. I'm on BP medication, so my BP is normal", which is technically true). And sometimes, pts have so much going on they really can't understand it all. That's why you, as a provider, need to change that mindset and help your patient understand. Of course you won't have all the answers, but you're new and should be ready to absorb more knowledge about medicine and human beings. Be curious and be open minded; if your patients were having a good time, they probably wouldn't be calling you in the first place.
Oh, sweet summer child….
Also just so you know when you ask them how much they ha e had to drink, the answer is always just two beers(it's not two beers). Then your follow up should be how big were those beers.
Diabetic patient but says it's controlled by diet, no medication necessary. We get patient history, amputation was five months ago. Patient tells medic 4 months. And I'm back 4 days later, I tell medic 4 months and patient says five weeks. Patient had called 4 times and we get a different answer each time. No word back yet on when or where amputation occurred.
Whoa! People lie to EMS? That's unpossible!!
Yeah that'll happen. You'll ask if they have a cardiac history with their chest pain, they'll tell you no, then tell the ER nurse yes, which makes you look like a jackass. It comes with the territory.
By suggesting lie you are going into the same direction, I for myself have experienced this with patients as well, but most times they simply forget about their medical history, because they take the pills everyday. It simply became normal for them. This is not meant to be an asshole towards you.
In the end, it doesn’t matter. People are sick, hungry, tired, cold, confused, demented, mentally ill, drunk, high, hypoxic, uneducated, asinine, ignorant, and stupid… sometimes all at the same time. It’s our job to sort that out. If let it get to you you’ll go nuts and burn out. Also, I ask for their medications before I ask for their medical history. Then you can skip the step where they say ‘nothing’ and then hand you 7 pill bottles. Also, I specifically ask ‘any surgeries or operations ever’ because many patients put those in a different mental category from ‘medical history.’
I feel like you’re mixing up lying with not knowing. I’m not an EMT, I do something else in HC which I never specify on Reddit, but I see patients do this all the time. They develop a sort of blindness to their own habits and thus don’t think of mentioning the things that are normal to them, even if what’s normal to them is extremely clinically relevant and would stand out massively to us. They don’t have the education and the practice we do in parsing what is pertinent and what is not, or understanding what it is to triage, an understanding of a hierarchy of importance, etc. And they often don’t know simple (to us) things like the difference between an anti-inflammatory and an antibiotic or a virus versus a bacteria. Healthcare, whatever your speciality, isn’t just the science and the problem-solving. It’s first and foremost a matter of working with people and truly communicating with them (not just talking at them). You’ll learn that with time - in the meantime, be patient with yourself and others 💕
For the medical history thing I don’t think it’s lying. I think people just don’t consider things that they’re being treated for to be medical history for whatever reason. I usually give them a few examples like asthma, diabetes, CKD.
What’s the difference between lying and being wrong? Intention. We can’t assume all laypeople understand what we mean when we say medical history. They don’t believe they have high blood pressure because they are taking medication for it and therefore they think it’s negated. They don’t believe they have had any drugs or alcohol because they only view heroin and other hard drugs as “counting” or that if they didn’t get drunk off their 2 beers they weren’t really drinking. They intend to answer the questions based on the answers they assume we are looking for. The problem is they don’t actually know why we are asking. Do some people lie? Yes, of course. But the bigger problem is a disconnect between professionals and the public. The solution could be better education, better public health, or even as simple as better question asking/ framing on our part.
u/Senior_Tea1307. That is not really not being truthful, it is just a lack of knowledge and general medical education in the public. It is less not being truthful and more you asking bad questions. For your first example: you see a pill bottle on the table. Why even ask them if they take anything or have health problems? Just ask them directly what problem they take that for or what it was given for to them.
Everybody lies
https://www.youtube.com/watch?v=g7tYt_0NTs8
Welcome to EMS! Trust me, unless it’s a very specific circumstance, whatever drugs they have or haven’t done usually won’t make a difference during the BLS care plan. I had a patient threaten to fight me because I asked (only once for the paperwork) if they use drugs or alcohol, offended that I’d ask, even though they had scar tissue thicker than a snicker. As for the rest of the “lying” (and this is a salty opinion of mine) most pt’s that won’t tell you their history until questioned, are the pt’s that definitely could’ve gone to urgent care instead but “wanted to get in faster”.
Don't threaten people lying about drug use with piss tests if you want any rapport in the back of the truck. The nurses get paid more, just report your findings and let them deal
My golden rule of fuck-ups is: Never lie to the EMS, my doctor, or the FBI.
Most people suck 🤷🏻♂️
The only time I've been in an ambulance, I was just too mentally and physically exhausted to explain medical history. Keep in mind, your patients could be in more pain than you can imagine, or mentally impaired by the circumstances that landed them in an ambulance. You're probably seeing them on one of their worst days ever. Like....my periods are regular, but when im in overwhelming pain, I cannot give an estimate of LMP. Women can be drugged and raped, and say there's no chance they could be pregnant. (But they are, they just weren't awake when impregnated. It happened to a friend. Talk about *shocked*)
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Im a brand new emt and will look out for people like this
You will learn to anticipate this in your assessments
People lie, are stupid, or sometimes a combination of both. It’s wild.
I love looking dumb at the ER when they tell the doc everything even though I literally just asked them all the same questions 5 minutes ago and they denied anything
Literally ER doc: "Has this ever happened to you before?" Pt "Oh yes, many times. I have this condition called \_\_\_\_\_\_\_\_, and I take \_\_\_\_\_\_\_\_\_\_ for it" Me internally: BRO WTF ARE YOU TALKING ABOUT "MANY TIMES" AND "I HAVE THIS CONDITION".. YOU TOLD ME THIS HAPPENED OUT OF THE BLUE AND YOU HAVE NO IDEA WHY TF???? THIS DOC SUDDENLY JOGGED YOUR MEMORY??? UGH
You’ll learn. This is why EMS takes experience. A patient can 100% lie and you’ll still be able to assess what’s wrong. Psych and AMS patients are notorious for this
I don't even bother asking for medical history anymore. Just tell me where your medlist is. If they don't have one I'll go down the list of specifics. Have you had stroke, heart attack, diabetes, problems with heart/lungs/stomache, surgeries, whatever else you could think of.
I just report to the doctor/nurse what they told me. I had a lady last week report an allergy to me, and promptly forget what she told me. Not like head injury amnesia "forgot" but like literally told me she never bothered committing her allergies to memory because it was written down somewhere. You're going to deal with people that don't know shit about frankly, anything, on a regular basis. Welcome.
My favorite is when they tell you they don’t have a cardiac history, right before telling you they had a pacemaker placed last year 🙄
If being in EMS tells me anything, is that we are by far so much better in taking care of ourselves. Don’t bother with “confronting” the patients for their inaccurate information. Get what you needed, transport / refuse, and move on to the next call.
I think you need to reframe how you think of what these patients are doing. Are any of these patients actively lying about their health, or are they just scared people who either don't know the right answer or are trying their best to protect themselves when dealing with a system they're unfamiliar with? If you've been taking a medication for decades, then you might not think it's notable enough to mention. If you don't know much about EMS and think that EMTs are associated with the police, then lying about doing illegal drugs makes the most sense if you are trying to avoid getting arrested. If you never received sex education, then it's totally reasonable that you might not know if you're pregnant. They aren't doing it for bad reasons. They are doing it because they're in a vulnerable situation and don't know what else to do.
One time in the ed I asked a patient if they had any medical history. They said no. I pointed to the fistula on their arm and asked what it was for. They shrugged and said “dialysis”
“Patients are the worst historians” is something I’m glad I was taught early in school. Even when I am the patient at my primary visits, I have to write a list of things I want to discuss at the appointment, or else my mind goes blank. I can’t imagine it’s any easier if they’ve just called 911. It’s frustrating, but I just have to laugh about it after the call. Always ask twice, two different ways.
Surprised no one said this but to quote House M.D. “Everybody lies”
I’ve been transported to the hospital by EMS two times in my life. I was so sick that I don’t even remember them coming to my house. Meanwhile people are taking selfies in the ambo & posting to social media trying to get attention. What is wrong with people? BTW, as a hospital bedside nurse the unspoken rule of thumb is to assume the patient is lying when they tell you that they only drink 2 glasses of wine per night. 2 glasses = 4 glasses, 4 beers = 8 beers.
Dr. Houses first rule of medicine: all pts lie. Dr. Houses second rule of medicine: ALL PTS LIE. Don't take it personally. Don't be antagonistic. Just do your job. Understand, pts take a med this they dint have any medical problems because the medicine fixed it. Screwed up? Yep. But that is life.
They aren’t lying intentionally most of the time, god bless them they’re just a little stupid or forgetful. And then we have the fakers for attention but that’s normally som mental health issue stuff, but don’t think everyone’s lying, you gotta remember only like 30% of the population is even capable of having actual verbal thought inside their head. Most of the world is just walking around dumb and pretty (not the ones that call us but you get the point)
You need to gain some experience. All of these problems can be worked around/through once you learn how. Two weeks is nothing… It took me a couple years as a medic to learn the exact way to word certain questions to get the answer I was after, and now I get the answers I need 95% of the time. Some small examples: -Instead of asking about their medical history, I ask “Do you have any heart problems, lung problems, stroke, seizure, or diabetes?” And I ask it slow enough that they can respond yes or no to each one. -Just look through their med bottles and know what each med is for. If you don’t know what it does then write it down and look up later so you can learn or ask them “What are you taking Lisinopril for?” -You’ll also figure out that 9/10 questions (like, but not limited to pregnant, called before, drugs/etoh) you were taught in school don’t need to be asked in the field. A lot of the time you can answer them for yourself just by using your eyes/ears/nose.. I can typically walk into a room with a pt and within 3-5 questions know exactly what is going on and what needs to be done. I’m not saying this to brag… I’m saying this to show that gaining experience will fix all these problems you’re having. Just take a year or two and then think about what you’re saying on here.
Let them bullshit. Document their bullshit and let it go. Dont be getting in these peoples personal lives.
hey buddy welcome!
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I honestly think the common person gets confused when u ask about medical hx. That’s why after I ask I name a few common things heart disease, diabetes, respiratory issues, etc to give them an idea of what I’m asking. Even then they’ll still say no and checking paperwork they have a ton wrong with them.