The link above is a post by Mark Glencourse an English Paramedic who who has taken the patient refusal question to a whole new level. He is and he isn't advocating so much a change policy as he is advocating a change in mindset. Nobody wants to lose a patient and none of us wants a patient to die on us, (For the most part) but we all know that we are going to make mistakes and a patient may die as a result. We in EMS seem to have this mindset that we can never say no to a patient and it doesn't mater if the patient ends up being discharged before we get the paperwork done.
I am quoting Mark: "Now think what our job what look like if it was accepted that some patients may slip through the net. Not through negligence, but through a natural disease process that was not present at the time of the assessment by the paramedic."
In my opinion that kind of a change would be nothing more than an acknowledgement that sometimes we don't get it right. We can evaluate a patient and they may seem fine, but we may overlook something or there may have been no signs or symtoms of another issue that would happen a short time later. I am reminded of a patient that I transported that showed absolutely no signs or symtoms of a cardiac problem and was transported for a minor injury, they began having nausea and had a major MI while at the hospital. I could have let them sign a refusal and it would have been perfectly fine for me to have done so. That MI would have occurred in their own car or at home and who knows what the result could have been.
I guess what this really boild down to is, are we really willing to admit that we don't always get it right and we may mistakes if we say no to a patient and tell them that right now you don't need to go to the hospital by ambulance and you can be appropriately treated another way, such a an appointment with your regular doctor or transport some other way than a 911 (999) ambulance. This would be a major change for the EMS industry in the US and I am not sure it would or could be accomplished without quite a bit of grandstanding by outraged politicians who would claim racism or some other false charge to make the transition difficult. I honestly think we need to make that attitude change but it will be very difficult and there will be a few missteps along the way. By missteps I mean people getting fried by the media because some politician felt it was more important for them to get reelected than for them to tell the truth and admit that sometimes mistakes happen, and we need to realize that sometimes STUFF HAPPENS!
Isn't that why we are here? Because sometimes stuff happens and it really is nobodies fault?
Qoute from The EMT Spot
"There is a patient out there who is on a collision course with your skills. They don't know you yet. You've never met them either. They have no idea that they are going to meet you in the future, but the day they do, they will test you." From The EMT Spot
Wednesday, September 8, 2010
I read this post and have to comment! I can't speak for anybody else but I don't think it is possible to have too little education if you work in the EMS field, and it doesn't make any sense to me for someone to say it is too much information. I will admit that I have been to training opportunities that I wasted because I didn't know enough to take full advantage of them but that was not the fault of the instructor. There are two things that I need to start doing and the first is to stop finding out what the bare minium is that I have to do to make sure I pass the course. I have gone back to class after breaking my rib and right out of the gate found myself ill prepared because I didn't allow myself enough time to prepare. I guess I am trying to say that it's not too much information, it's just that I'm not always willing to put forth the effort to learn the information I have available to me and it might force me to work on improving myself. I don't think that makes me any different than the individual that is mentioned in the post above. (I really hope you bothered to read the other post by this point!) This probably makes both of us just like alot of other people in the world, but doesn't help make us better human beings or paramedics. You have to struggle every day against the urge to be just good enough or just trained enough. You have to struggle against the idea that you aren't quite smart enough or the job is too difficult for you and you are good enough now and don't need to be any better or maybe can't be any better. I hope I can always push myself to be better; I may not always succeed, but I hope I always care enough about my patients and myself to keep trying.