Verbal First Aid

Benjamin Franklin’s wise words are quoted at the beginning of this important book on verbal first aid: ‘Remember not only to say the right thing in the right place, but far more difficult still, to leave unsaid the wrong thing at the tempting moment’. We all know what he means, and he is no doubt writing from experience! More sombrely, the other lead quotation refers to the danger that words uttered in jest when people are under great stress can lodge in the patient’s mind and cause untold harm. These two quotations define the scope of the book, which extends from responses to everyday medical emergencies to principles of clinical care. This makes it a book for lay people and specialists alike, since, as the authors point out, you never know when you might be confronted with the kind of medical emergency where verbal first aid is your only resource.

The book is divided into four parts with fifteen chapters in all: Verbal First Aid, Heart to Heart Communication, Putting it all into Practice, and You the Caregiver. It opens with some telling examples of how verbal first aid works in practice, an intervention where the title of the book ‘The Worst is Over’ is a key therapeutic phrase that can begin the process of healing. Then the authors give an overview of the evidence for a close mind-body connection, which forms the theoretical underpinning of verbal first aid, followed by a discussion of the ‘healing zone’, the altered (and very suggestible) state in which people find themselves in the immediate aftermath of an accident.

Part Two describes communication techniques that work in medical emergencies. The first step is to establish a rapport (empathy in practice), then a ‘contract’ that enables a process of therapeutic exchange where you can convey a sense of authority. The authors then put forward detailed proposals for therapeutic suggestions where ‘our words are the tools, but their power derives from awareness and love’. Awareness means being centred, a vital first stage, followed by what they call the four Cs – compassion, concern, confidence and credibility. The suggestions are ‘blueprints for action’ and their guidelines are both helpful and practical. Aspects that struck me were the moving of attention to another uninjured part of the body and the use of ‘I know a guy who’ parallel stories with positive outcomes.

Part Three is more specific in applying the approach to different types of medical emergency, pain relief, chronic conditions, emotional conditions, suicide and death and dying (‘last aid’). Here the instructions are specific and are illustrated with real stories and sample dialogues. A conundrum addressed in this part is the way in which a physician presents a negative diagnosis without it being a hex or curse which sets the person off on a negative spiral. Larry Dossey discussed this very question in Beyond Illness in the 1980s, and it is surely (and literally) a vital issue. Doctors certainly have no desire to prescribe an outcome! It is also important to find out what kind of metaphor is likely to work for people if using visualisation techniques.

The final part considers the needs of the caregiver, who may need help in coming to terms with the emergency encountered. Survivor guilt or post-traumatic stress may need some self-healing, self-talk or self-aid. Finally, humour can help – one or two examples are given. The book succeeds admirably in its purpose of providing a primer for everyday life with specialist advice for the clinic – as such it should form part of every family health library.