Sirens blare as the ambulance races down the street, rushing to care for a man having chest pain. With screeching tires, the ambulance shudders to a halt, and two EMTs hop out of the rig, hustling out of the “rig” and into the house.
We watch as with fervor and urgency the medics check a pulse and blood pressure, glancing grimly at each other.
Quickly they put the patient on high flow oxygen, ask him to chew some baby aspirin, help him with his nitro, and start an IV.
The scene then cuts to this poor man being wheeled towards the ambulance on a stretcher, lightly covered with a sheet. Once the ambulance is loaded up, the driver runs around the ambulance and jumps into his seat. With a wailing siren and screaming tires, they then whisk the unfortunate soul away to the nearest hospital.
While television and the movies portray this exciting and glamorous picture of Emergency Medical Services, that is far from how it really works in most circumstances, and there is so much more to that story.
I am an EMT and Emergency Medical Services Instructor in the State of Connecticut, so I teach EMT’s how do do what we do…It’s not all about getting in the left lane, driving fast, and taking chances…
We may race to a scene because the reported issue is significant, but we are trained in assessing patients and finding out what’s going on with them. We investigate the patient’s complaint and then take action that is indicated based on their signs, symptoms, and history.
But, I thought this was about financial coaching!?
Here’s the deal… as a coach, I don’t just pick up the phone, hop on Zoom, or rush over to the client and start telling them what to do or how to fix their money problems.
I couldn’t do that to my client anymore than I could assist my patient with nitroglycerine before digging into his problem… the nitro, even if it’s his, if taken under the wrong conditions, could kill him. So too, with my coaching clients, jumping in and recommending financial interventions before I have an idea of what’s going on, can do them greater harm than help.
So, how does it work?
It always starts with some kind of reaching out. Sometimes clients reach out to me through lead management resources that act like a 911 dispatcher. At other times, I may already be talking to someone, and they share with me that they’re having a money issue.
In EMS, we call that the chief complaint. This may, or may not be the real issue – and usually isn’t. It is their pain point. Most times, when people reach out for medical help it’s because they’re running a fever, or having a hard time breathing, or they’ve injured themselves and it hurts… their body is telling them there is something wrong.
That is the very same for me as a financial coach, they, too, reach out with a chief complaint – a symptom of a problem that they have financially… it could be:
- Mounting Debt
- Incessant phone calls
What ever it is… they’re not responding to the problem, they’re reacting to pain.
Before I get started with my patient, before I even walk in the door, I need to be sure that the scene is safe and secure. Are there any hazards or traps that I may encounter? Is there something I’m seeing or hearing that indicates a hostile environment? Do I need additional assistance, or perhaps are there other resources that need to be deployed before I can intervene safely? As a financial coach, I too must consider these issues… is there a marriage involved, is the partner on board? Are there signs (things I can see myself) that there is a more immediate need, like marriage counseling? These types of issues may be detected early on – but sometimes they only show themselves later – withdrawing for the safety of myself, my patient, or my client is not abandonment. It is wise and may result in a greater net improvement over time. What’s best for them – and for me?
Investigating the Chief Complaint
Once I am confident that the scene is safe and that it is appropriate for me to be there I can get started, I make more direct contact. I start with forming a general impression that gives me a larger picture of how much distress this person is in. That can usually be gleaned from the first phone call/direct contact – their tone of voice, the speed with which they talk (or perhaps how much they avoid saying something). I look at their face – are they sad, worried, looking down (worried or ashamed). And as I begin my approach, I begin with my very first intervention, reassurance.
My initial approach to the patient or client is essential. It is not my emergency. It is theirs, and they’ve asked for my help. I must present myself as calm, knowledgeable, confident and competent. If I do that, I’m injecting hope into the situation, and they’re already starting to feel better. As I engage them in conversation, I start to ask questions and offer to help… In EMS it is essential that I obtain their expressed consent to render any assistance, even to dig into what they’re complaining about and in order to treat them properly – the same holds true for me as a coach. I cannot simply force a client to accept my help. They have to want it and accept it.
It’s then that I really get to work and begin my assessment, digging into the person’s complaint using an approach we call the “O-P-Q-R-S-T-I Interview.” In this “interview” I do very little talking aside from asking direct and clarifying questions. My job is to watch and listen. That’s it, for now, to get a lay of the land – and to think… carefully and critically about what the person (or couple) is telling me. And so I begin…
The O-P-Q-R-S-T-I Interview….
This interview is designed to do two things simultaneously. It allows me insight into what is REALLY bothering the patient, and to establish rapport with and express empathy for the person I’m serving. And as in the medical field, I’m looking for both signs and symptoms. It is important that we look for both but that means we need to understand what both are:
Sign: This is an objective reality that we can see, experience, measure or quantify… in a patient vital signs are: pulse, blood pressure, breathing rate, etc. We can see and record those things. In financial coaching there are also signs… observable, measurable things that may be happening in the life of the client… To make it easier to understand, sign has the letter “I” in it… and I can see it…
Financial Vital Signs might be things like: Income, debt level, savings, bills that are coming in, phone calls or letters, avoidance of discussions, number of credit cards, disagreements, and arguments fall into this category too… measurable and quantifiable realities and experiences that we can have record of. These might also things they have in place that are correct – Budget, Emergency fund, will, insurances, etc.
Symptoms: These are subjective statements that the patient or client is FEELING. We have no way to really measure them, although we can often tell by looking at them that there is some discomfort. A good way to remember what a symptom is, is that it starts with the letter “Y” as in “You” because You have to tell me about it for me to know it’s there….
Financial Illness Symptoms are are many… fear, anxiety, restlessness, stress, guilt, shame fear, hopelessness, desperation, anger, blame, depression…
And now to the interview itself – The interview is a systematic way for me to investigate what the person is talking about…
I generally ask a person what’s going on and let them just talk… I’m looking for specific information that is in the list below, but I let them tell their story… They are the experts on themselves. If they don’t know where to begin, then I will work down the list below… Newer EMTs are trained to work down the list until they get really good at listening and understanding.
O – Onset: When did this start? How long has this been happening? Was there something that happened to bring this on?
P – Provocation/Palliation: What makes this feel worse or better? This will often give me a hint of what they may have tried (if anything) to address the issue. They may say that things got better when they got a raise, bonus or gift. Or they may talk about how a layoff, or sudden illness brought added to their debt load…
Q- Quality: What does it feel like? What are you losing sleep over? What is your stress point? How do you feel when..., Describe for me… Tell me about… It’s generally here that we get the feelings and sense that my patients and clients really open up… In the coaching scenario, we can also add some “predictive” questions like – what would it feel like if….
R – Region/Radiation: Where is this issue located? For example is it really the client’s issue – or is it located outside the client (spouse)… Is it an income problem or an expense problem…. Does the problem have an impact on more than just the client or does it radiate or spill over into other relationships, marriage, children, friends, family, work?
S- Severity: How bad is it? Often I will ask on a scale of 1 to 10, 1 being not so bad, 10 being the worst. I find in coaching, that people start calling around a 4 or 5 but won’t commit to coaching until they hit 9 to 10. When it really hits the fan, they may say (as some of my patients do), “12!” Those are the ones who are really ready for some intervention. I have also found that further investigation allows for them to realize that their pain is actually worse than they initially believed… why? Because severity can be a relative concept…and what is needed sometimes if for us to unearth more… and that more is found in their History, which I’ll talk about in a minute.
T – Time: This is not the same as time of onset. Sometimes, when people call for the ambulance, it’s because something has just happened and they need help right away…That’s onset… However, there are times when a person has been sick for a few days, and they finally call for help. As an EMT (and as a coach) I sometimes want to ask (but don’t) What took you so long to call? What’s wrong with you??? – Rather the question that needs asking is, “What has changed that prompted you to call for help now?” This precipitating event is usually just the straw that broke the camel’s back. They just couldn’t keep on going as they were… In addiction and recovery terms, they seem to have received “the gift of desperation.”
I – Interventions: This isn’t what I’m going to recommend that they do or that I want to do. This is where I ask them, “So, what have you done to help improve your own situation.” Most people who are in pain or who are sick will try something – not everyone will, some are too scared, too worried, too overwhelmed to act, and so they either wait til things have progressed and then call (or they call right away). And as I stated earlier, some people have already mentioned some of this in the “what makes this worse or better” questions or the “P” questions.
As an EMT I’ve come to realize that there are often underlying conditions that bring about medical situations. And so we continue our interview by obtaining relevant history from the patient – and as a coach I’ve found that the same history taking is vital to my serving my clients well. These underlying conditions and situations will better inform me what has happened in the past that is influencing what is happening now. This is called the SAMPLE history.
The conversation continues as I try to dig deeper into issues that may be related to my patient’s/my client’s condition. And it starts in an usual place with a moment of silence.
S – Signs and Symptoms: As I finish the first part of my conversation with them, I have found it helpful to take a moment of silence so that I can reflect on what I’ve heard. I do not want to make the mistake of developing tunnel vision. Often, if there is something unclear about what has been shared, this is the moment when I ask if I’ve gotten those facts right… We might call it reflective questioning in which I ask, “So if I understood your right… here’s what you’ve reported thus far. Is that right?”
A – Allergies: As an EMT, I would ask, “Sir, Ms. – Do you have any allergies that I need to be aware of or that the hospital should know about?” Now it you might be wondering, “What kind of allergy is there in finances?” Well, if we understand that an allergy is the body’s overreaction to a stimulus, that is that a person is oversensitive to a particular thing, they get into difficulty. So, in coaching, the question isn’t, “What are you allergic to?” Rather we want to know, “What kinds of things tend to make you act oddly with money, or what money issues send you over the edge?”
M – Medications: As an EMT, I ask about any prescriptions, OTC’s, supplements, or other substances that the patient is using, is supposed to be using on a regular basis or that they used today/recently. This will give me some insight into what might be wrong with them as in, telling me which illness they have or if I’m seeing the side-effect of a medication – or even a drug interaction – As a coach, I ask, “What recommendations have people made to you thus far? Have you tried it? If not, why not? If yes, how did it work for you? (NOTE- this could be an allergy zone for the client… they couldn’t tolerate something for some reason… a new place to dig). And by asking about recommendations, I get a hint as to an underlying issue- recommendations to write a budget would tell me they don’t control their money… Recommendations to increase withholding indicates a tax problem, etc.
P – Past Pertinent History: Here I ask directly of my patients, are you under a doctor’s care currently? This might translate to have you consulted financial or legal professionals before? If so, for what? Has this kind of thing ever happened before? Did you seek help for it? How was it resolved?… This can unearth a pattern of behavior not yet determined in our discussion… history of collections referrals, lawsuits, bankruptcies, has there been a history of unstable employment, or irregular income because of business ownership or commission based pay?
L – Last ins and outs: While in the medical world that refers to eating, drinking and elimination processes, this can be seen in the financial world as a study of the client’s cashflow…. are they bringing in at least as much as they are sending out? Is the income/outgo consistent, regular? Have they tried to increase intake or reduce output?
E – Events Leading Up – This comes back to the most immediate thing… and connects in some way to the question about Time “what has changed since this all started… but this may also be where we learn how they specifically came into contact with me… I was really worried so I started looking on the Ramsey Website, or I Googled coaching and found your site… I was talking to a friend who suggested I call you….
This helps me help them! In some cases, in many, there is something I can do immediately to help them improve. In other cases, I have quickly identified that they need someone with more training or a higher level/more specialized help… There are times when I will need to take the patient to one hospital over another despite what they want because of the kind of care they need. And in coaching, it may well be that my client also needs the care of a tax pro, a real estate agent, an investment advisor, or an insurance agent, and so the interview also helps me to arrange for the client to connect with those services, just as my ambulance patient will end up seeing the right doctor when we get where we’re going.
It is also essential to keep in mind that very often, my patients and my clients merely need supportive and affirming care. There’s nothing really wrong, but they’re not sure of what to do next. Not every ambulance call is a real emergency. Not every coaching situation is a crisis. I’ve been part of a team that has delivered a baby, and a coach who has helped a family realize their dream of adopting. It took careful assessment to figure out the right course of action. And the tools were all there for me to do so.
In EMS the assessment process occurs very quickly – somewhere between 10 and 15 minutes. In coaching this may be your initial consultation and perhaps part of your first paid meeting with your client.
If you ask questions, establish rapport and say little else at first, then watch and listen, you will learn more about your client that you would imagine. They will reveal what it is that they need.
You see, by doing this I pay my patients, and I pay my clients before they pay me.
What do I mean?
I pay them with time.
I pay attention.
When you treat people like you care, when you treat people like they matter, often, they will respond positively.
I teach my EMS students that “treatment” is not what most people need. What most people need is excellent care, and the same is true for my clients. They need me to care enough to attend to them, to listen to them and only after having listened to chart a course with them for their future success. When they realize that I want what’s best for them, they usually let me help them!
Need help? Let me respond!