Building rapport: the art of small talk

If you’ve ever spent anytime in an ambulance, you’ll know that there’s only so much clinical work that can be done before you actually have to talk to your patient.

For some people, this comes naturally; they seem to get along with everyone, regardless of age or personality. For the rest of us, it’s a skill to work on which can be just as important as the ‘hard’ points of medicine.

Because whilst preventing that two hour patient transfer from being done in awkward silence is great, what’s really helpful is getting that panicking patient to calm down by asking them about their fishing trip; Or having the distressed relative relax enough to remember they have a full list of history and medications sitting in the cupboard.

The list of applications is endless. So here are some points on how (and how not)to do small talk with your patients.

First off, understand that the line between bad humor and insult can be very thin. Jeff Kenneally from PREHEMT (one of the best paramedic blogs on the net) explains this really well.  What may be funny to you, could be hugely distasteful to others in the room. This means no jokes about dead people, peoples partners, getting out of work or similar….. at least until you know what type of person your patient is.

As hard as it can be to switch off that aspect of the brain, remember that in ambulance we spend a lot of our normal work life in other peoples abnormal situations.

Also, most 80 year olds don’t take the F bomb too well either.

Secondly, once you do know what your patient’s personality is, wear it. Use the same language as them. Complain with them. Rejoice with them. You don’t need to sell out, but play your cards right and all of a sudden you’re the ambo they got along really well with. Not the jerk who didn’t talk to them.

Thirdly, get your Sherlock Holmes hat on and have a look at things as you go in. See a few guitars lying around? That’s a talking point. Caravan parked in the driveway? Winner. If there are photos on the wall, have a squiz and ask about them. “Where was that trip to?” ” How many grand-kids do you have?”

Then follow that rabbit down the hole. “5 kids ey? What do they do with themselves?” It doesn’t matter if you never plan on traveling to Asia. If that person’s been there you ask them about it. You ask where to eat. What travel agent they recommend. Anything.

People love talking about themselves, and most love giving advice. So ask them for it.

Next, ask open ended questions: these will save you from a mountain of awkward situations. The art of manliness has a wealth of information on communication and even if you’re not a man, you should check it out here.

This means instead of asking “were you a builder before you retired” you ask: “what did you do before you retired?” Instead of asking “is that Yamaha your girlfriend’s bike?” “You ask; who was the lovely lady inside?”  “Does she ride as well?” “What type of bike?” It prevents you from embarrassing people when you get it wrong, and gives you a more diverse base to get a reply from.

Finally, have a list of questions for yourself.  Mine usually consists of something like:

  • What do you do for work?
  • How long have you lived out here for?
  • What do you do when you’re not riding in ambulances?

To be honest, it’s pretty rare that by the time we have a conversation around each of those 3 points we haven’t already got to hospital. Find what works for you.

Sometimes at 3am, it’s a good idea to let your patient sleep the length of that transfer. But if you look for the person in your patient you never know what you might find, and what that distraction might help you dig up clinically.

I’ve met pilots, ship’s captains, missionaries, authors and all sorts of really amazing people.I’ve learned new fishing spots and been given opportunities to acquire gear or access to places I’d never dreamed of.

I’m sure you will to once you ask your patient’s about it.





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