Advice(Trust)

 Tell the Truth

We should never lie to patients. We should never lie to their families.

And we should absolutely never say we see things the patient sees or hear things they hear when we don’t. That doesn’t help anyone. All it does is create problems down the road.

I’ll be honest—I will sometimes keep information to myself if I feel it will cause more harm than good. That’s different than lying. There’s a big gap between not saying everything and saying something that isn’t true. I’ve been in the position before where I told someone, “Everything is going to be okay,” and it wasn’t. When that happens, you don’t just look optimistic—you look like a fool and a liar. Patients and families don’t forget that. False reassurance feels good in the moment, but it destroys trust when reality catches up.

If I’m fairly certain someone is having a heart attack, I tell them. I explain what’s happening, what I’m doing for them, and why I’m doing it. I also explain what will happen when we get to the hospital. I don’t sugarcoat it, but I don’t panic them either. People can handle the truth when it’s delivered calmly and clearly. I handle trauma patients the same way. If someone is badly injured, I tell them what I can see, what I’m doing, and what’s coming next. Trauma patients go through a lot very fast—clothes getting cut, IVs started, monitors placed, oxygen applied, pain medications given, then being rushed into a room full of people at the hospital. I don’t want them surprised by any of it.

The worst-case scenario with honesty is that you prepare someone for something serious, only for it to turn out to be less severe. In that case, they feel relieved. The opposite—telling someone everything is fine when it isn’t—creates shock, anger, and mistrust.

And that mistrust doesn’t end when we clear from the call. When patients or families feel lied to, that doubt follows them. The next time they call 911, they remember it. They question what they’re being told. They hold back information. They’re guarded. The next crew now has to work harder to earn trust that should have already been there. Mistrust in EMS carries forward from call to call, crew to crew.

Surprises create fear. Information creates control.

Another line we should never cross is pretending to share a patient’s hallucinations or delusions. Saying “I see it too” or “I hear it too” might feel like you’re calming them, but you’re reinforcing something that isn’t real. That can cause serious problems later, especially when mental health professionals are trying to help the patient sort out what’s actually happening. You can acknowledge what the patient is experiencing without lying about reality.

“I don’t see that, but I understand that you do.”
“That must be scary.”
“I’m here with you.”

That’s honesty with compassion.

Patients and families don’t expect us to be perfect. They expect us to be truthful. They expect us to explain what we know, admit what we don’t, and guide them through what’s happening without making things worse.

EMS runs on trust. Once it’s broken, it doesn’t just affect one call—it affects every call that comes after.

Comfort built on a lie never lasts—truth delivered with compassion does.