Do we question enough?

[MMiz]

Have you ever had a moment where you had to stop and think... I mean really think?

I hate to say it, but I rarely thought deeply when I worked as an EMT. I'd see something and treat it. See it, treat it.

Then there was that time when I left the medical history of a patient in the patient's room, and I only realized it as we were driving to the hospital. In back was me and the service's lead Paramedic/FTO. He made me take out the patient's medications, read them, and then tell him what they were for. Not too bad, especially with the help of my quick-flip. Then he asked me why the patient was experiencing their condition.

I honestly don't remember the condition, or why, but I remember the feeling of "oh crap I should have known this."

I just had a flashback to that moment of embarrassment, and wonder how many other folks out there may have been in the same boat. It seems as though during EMT school I couldn't stop questioning, and then all of a sudden I stopped thinking.

 

[Ridryder911]

Matt, you are becoming very wise..

I believe we are attempting to teach "treat and street" medicine. Unfortunately, I even see physicians do this more and more. Then when the patient reappears back to the ER in a worse condition or more ill, we are puzzled. Majority of misdiagnosis of all medical complaints is lack of a good history, and poor assessment skills.

I was taught in medic school there were 4 components of obtaining a medical diagnosis...
-History
-History
-Detailed assessment
-History

There is a fine art to questioning patients and even peers. One does not need to elaborate, but rather fine tune and point/direct the questions to obtain an accurate history. I suggest watching interview techniques from different specialties. Not all questions will and should be the same, in regards to the chief complaint. i.e. .. o.b. versus headache.

Utilize your field training officers and peers. I still ask questions from those I respect. Especially some of the new ones... I will ask to teach me new things, so I can understand their methodology and as well learn something new. Everyone can learn something off each other...

Be safe,
R/r 911

 

[firetender]

This may be a bit on the esoteric side but having lived through it in the back of an ambulance, it's worth mentioning, if, for nothing else but to reassure those who've experienced it that they're not crazy.

There's a place for not thinking.

Usually it comes as the result of really, really doing your homework, so much, and so well that after a while, you begin to bypass the linear, thinking mode and start, as I've called it, "acting off your spine."

Of course, that's just a natural by-product of experience, you think less and less -- if you allow yourself to. The problem is, a lot of us hold on to the linear process longer than may be necessary and the dependence can literally slow us down and limit our effectiveness.

We are capable of taking in all the data of our immediate experience, instantly running it through the blender of our past experience and then assimilating it into an immediate action.

In terms of Quantum Mechanics, it's something like this: everything has a frequency. With enough exposure, you begin to tune into a particular frequency. When you encounter that same frequency under different circumstances, you recognize it, immediately without having to think through its elements.

Most of us with EMS time under our belts have run into situations where things are so completely out of control and unmanageable that, instinctively knowing there's no way to figure it our point-by-point, we, in a sense give up, or surrender to our intuition and just follow one moment at a time.

All of a sudden, we've gotten through it and we don't know how.

My point is there are a lot of things that we are exposed to that defy logic, yet, they still happen and we don't talk about it much, if at all, because it does not fit the "thinking" form that we've been trained in.
I'm saying we should not be discouraged from allowing this to be part of our arsenals, too.

And I don't care how you cut it, working/living on the edge of life and death exposes you to some very weird stuff. Let's not neglect discussing any of it because through it we can gain new tools to work with.

 

[BossyCow]

I have been blessed (thought it always doesn't seem that way) with a 20+ year marriage to a Paramedic in a busy civil department. We go over most of my calls with him explaining to me the reasons why things are done and how it could have been done better, generally what particular system failure caused those particular symptoms, symptoms that also may show up with a patient in that condition, what might have been a better way to treat the patient, other information that the ED might have used, what I missed in my PE, how I should have written it on the report, several examples of cases that he's seen of the same thing where the patient was much, much worse, how that pt. responded to which meds, how those meds work, why they work that way........ (pause for breath)......

I've found that generally, when a doc asks me.. why didn't you........ the following brain activity relating to that call and my treatment of that patient is a major educational experience for the next similar call. Too many see it as a challenge, or accusation and shut down or become defensive... if you can delay that response and use the moment, the information you gain truly sticks with you for the next time!