# First Ride Along w/ Funny Story



## Double-E (Jul 22, 2009)

k, so, first ride along.  wewt.  was great.  dual medic team and they were very nice, very informative etc.

now for the funny story:

last run of the day, long story short, we finally get the kid to tell us he did WAY too much coke the night before and is having an "anxiety attack".  total bs.  he's fine just coming down and is uncomfortable.  all psycho-somatic.

so the medic working on him says "we're going to administer an experimental treatment.  we're going to mix nitrous oxide with your oxygen to help with your anxiety."  

plugs in nasal canula of pure 02.  3 minutes later:

"feel better?"

"yah  "

"ok, we're going to try another TOTALLY experimental treatment, you want to try?"

"yah yah, give me everything!" (WAY too eager to have drugs administered)

"it's called transcutaneous aspirin.  it absorbs through your skin!" 

*tapes an aspirin to his forehead*

2 minutes later...

"feel even better?"

"yah, totally!"

the look on the nurses faces at the ED was PRICELESS :lol::lol::lol:


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## CAOX3 (Jul 22, 2009)

They were actually researching transdermal ASA, not for this of course, I have to look up the results of that.

I have a feeling these little acts of negligence are not going to go over well here, so I am going to move on before the shiit storm begins.

Good luck


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## boingo (Jul 22, 2009)

Yeah, I'll pull up a chair and settle in for a bit....


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## Sasha (Jul 22, 2009)

You think its funny to mock patients? You know cocaine does cause many medical problems, right? And that anxiety is a real medical problem? How do you know its bs? You want props for you and your preceptors being butts? Sorry not here.


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## reaper (Jul 22, 2009)

San Fran EMS at it's finest! They wonder why they are treated like jokes!


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## JB42 (Jul 22, 2009)

> And that anxiety is a real medical problem? How do you know its bs?



Sasha is right. It is a real problem and based on everything you posted it wasn't BS. 

While this wasn't the most profesional way to treat your patient it certainly sounds like it lowered his anxiety level. I'd just suggest next time not being a jerk to your patient just because he chooses to do something stupid like cocaine.


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## akflightmedic (Jul 22, 2009)

At a real loss of words except for ones that get me warnings or banned.

And "we" wonder why we are not considered professionals, why we do not get more pay, more respect, why we do not get more 'mad skillz' to add to our bag of tricks...

Just dumbfounded right now...


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## Sail195 (Jul 22, 2009)

Not exactly the stuff you want to be learning on a ride along.... way to set the standard of care low before you even get your cert


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## MMiz (Jul 22, 2009)

You'll learn that often times we do things in EMS that we don't post brag about in public.  You'll find that this is probably should have been one of those times.


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## fast65 (Jul 22, 2009)

MMiz said:


> You'll learn that often times we do things in EMS that we don't post brag about in public.  You'll find that this is probably should have been one of those times.



+1, there are somethings that are better left unsaid, this is obviously one of those things.

In EMS we're supposed to treat everyone with the same level of courtesy and respect, everyone receives the same level of care NO MATTER WHAT. The medics you were with might need to be reminded of that.


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## Melclin (Jul 22, 2009)

I can't see a problem really. I don't really see a problem with using a placebo effect or psychosomatics to bring about a positive outcome for the pt. They were obviously aware that it might have been some more nasty physical problem - did take him to the ED after all - so it doesn't really seem like they were sacrificing pt care. Seems to me like a clever way of lowering his anxiety levels without having to use any drugs except a little O2.

As far as professionalism goes, everybody in the medical profession makes fun of pt.s a little, in some way (except maybe Vent<_<). I don't think it's unethical, everyone complains about the various aspects of their jobs at some stage, there's no harm done. The student doctor network forum has a 55 page thread on stupid stuff that pts do in ED and the funny ways they were contained or treated, complete with a range of hilariously derogatory acronyms and stereotypes. If you think this is the reason why American EMS is still stuck in the dark ages and is not respected then you are sorely mistaken.


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## akflightmedic (Jul 22, 2009)

Lying to your patient and providing placebo treatments which make him look like a fool is ethical and accepted?

Notice I said make him look like a fool or humiliate him...yes, placebos are used in science and medicine but where is the need in this situation?

Wouldn't professional behavior and a more thorough understanding of potential underlying conditions been warranted in this situation? How about lessening their anxiety by talking to them, educating them on their condition as opposed to silly gimmicks which do nothing but humiliate or patronize the patient and make the providers look like arses when they roll into the ER with a silly smirk on their face seeking approval for their silly antic.

It is a gross display of unprofessional behavior and yes it does continue to perpetuate the stereotype of us in general amongst our other medical colleagues/professionals that we are idiots.


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## Level1pedstech (Jul 22, 2009)

When I was working as an engine company member we had a saying, what happens on the engine stays on the engine, nuff said.


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## Epi-do (Jul 22, 2009)

Melclin said:


> They were obviously aware that it might have been some more nasty physical problem - did take him to the ED after all - so it doesn't really seem like they were sacrificing pt care.



And how did you arrive at this determination?  Just because the drove him to the ER doesn't mean that they thought something could be going on with the patient.  It seems pretty apparent by there actions that they believed the entire run was total BS.  Why else would they lie to their patient and trick him into allowing ridiculous "treatments" to be administered.  

As for the OP, not much more to add that hasn't been said.  I am just glad that these particular providers are hundreds of miles from me and my family.  If they are willing to treat their patients in this manner, whether they believe the run is BS or not, I don't want them to come anywhere close to me, my family, or friends.


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## Melclin (Jul 22, 2009)

*We're you there?*



akflightmedic said:


> Lying to your patient and providing placebo treatments which make him look like a fool is ethical and accepted?
> 
> Notice I said make him look like a fool or humiliate him...yes, placebos are used in science and medicine but where is the need in this situation?
> 
> ...



In certain situations..yeah. 

_If you had a psych pt who was having an anxiety induced asthma attack and wouldn't put a mask on because he was afraid of it stealing his thoughts, and you took out your pen and wrote "thought protector" on a mask and told him it was a special device to actually stop people stealing his thoughts...I'd do that. But its still technically lying, and using a partly psychosomatic approach to calm him down by "protecting his thoughts", and sure look like an idiot being wheeled into ED with a thought protector on his face. But it would work. 
_
Maybe a similar situation ethically. We really don't know how reasonable and rational the guy was, maybe he was going absolutely nuts and they thought it was the quickest and easiest way to calm him down so he wouldn't hurt himself, we weren't there. So I don't necessarily want to write of the medic's actions without knowing more. My comment was not specifically about them, but about the ethics of that sort of action in general. Maybe it was the wrong course of action in that situation (like I said we can't really know unless we were there), but not inherently wrong in and of itself.

Plenty of doctors are immature, make jokes at pts expense, probably even tape the occasional asprin to a forehead or two, everyone still think they are professionals. I guarantee you, if all medics were required to have masters degrees, you could act the goat as much as you liked and people would still think you were pros. You've got bigger fish to fry, mate.



Epi-do said:


> And how did you arrive at this determination?  Just because the drove him to the ER doesn't mean that they thought something could be going on with the patient.  It seems pretty apparent by there actions that they believed the entire run was total BS.  Why else would they lie to their patient and trick him into allowing ridiculous "treatments" to be administered.



Why would you take them to the ED otherwise? Unless they were adamant to go themselves. I spose you might have some stupid protocol over there that says all pts go to ED or something...sigh. Anyway, as I said above, we don't know anything else about what they did to treat the guy. Maybe they monitored him, took vitals assessed, took Hx, we don't really know. Or maybe he rings them every few days having anxiety attacks and he's a little slow, and they know him and this is the best way to calm him down. Just because part of the story was _told_ as a humorous anecdote (*the OP may have misunderstood their intentions and because he thought they were humiliating him, he told the story that way...who knows*) doesn't mean they didn't take it relatively seriously. I realise that it's quite probably that there was a malicious element to their behaviour, but you really can't hang, draw and quarter a medics level of professionalism based on an anecdote about their practice told by a student who observed them (and may have misunderstood intentions etc) for a day.


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## JonTullos (Jul 22, 2009)

When a patient calls 911 for an ambulance they believe they're experiencing an emergency whether you do or not.  "It's not your emergency" is a saying that I've heard a lot and I believe it to be true.  What you may consider to be BS may not be BS to someone else, especially the patient.  Our job is to provide care and that certainly includes respect and compassion.  Please, don't follow their example.  It's unfortunate that they were your preceptors.  The example they set for you is irresponsible and downright foul.


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## timmy84 (Jul 22, 2009)

Nobody considered talking the patient down?  I worked on a psych unit for a long time (as a student as well as a CNA).  When a pt is coming down from cocaine, the are often able to be helped with conversation.  You need to keep their mind focused on a topic, the topic can even be their drug use.  Take the opportunity to convince them to seek treatment as well.


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## medichopeful (Jul 22, 2009)

Melclin said:


> As far as professionalism goes, everybody in the medical profession makes fun of pt.s a little, in some way



(Not in the profession of EMS yet, so take this at face-value.)

Yes, making fun of patients happens.  And it may be necessary to relieve the stress.  But if you have to do it, do it AWAY from the patient.  I see no reason to berate a patient in person.  Having a little fun with somebody who is in no danger and sees the hilarity of the situation is one thing, as long as they are having a good time as well.  It may help relieve the stress of the situation for them, which is a good thing.

But telling someone you are going to give them a medication, and then not doing that, is pretty stupid and, let's be honest, immature.  Put yourself in their shoes.

As far as being professional goes, here are my thoughts: be a professional when you are "working", and if you must, be comical in private or away from the patient.  Be a professional when you are in the public eye, or you are working with a patient.  Let loose when you're not.


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## medichopeful (Jul 22, 2009)

JonTullos said:


> When a patient calls 911 for an ambulance they believe they're experiencing an emergency whether you do or not.



Mind if I put this in my signature?


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## reaper (Jul 22, 2009)

Do you think that these great medics wrote all this in their report? I doubt it highly. This was nothing but immature medics showing off for a student.

It is unprofessional and unethical treatment. It has no place in medicine. If you condone it or try to make excuses for it, then you have no place in medicine.

Making fun of a pt, after the call, between you and your partner, is fine and a way of stress relief. You never have the right to make fun of a pt to their face. You are there to treat them medically, not for your amusement.

I think these medics need a two week vacation(unpaid), to think about their future in EMS!


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## Epi-do (Jul 22, 2009)

Melclin said:


> Why would you take them to the ED otherwise? Unless they were adamant to go themselves. I spose you might have some stupid protocol over there that says all pts go to ED or something...sigh.



Yes, we have some "stupid protocol" that says everyone that requests transport by ambulance gets a ride to the ER.  I most certainly have taken pts to the ER that I believed would have been served just as well by getting in one of the 6 cars parked in the driveway and driving to the ER, immediate care center, or the family doctor's office on their own.  However, when transporting those patients, I don't do things to humiliate them.  I still do my job - monitor vital signs, get as thorough a history as possible, provide comfort measures, etc.  I don't provide (nor have I ever) fake treatments to my patients.


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## JonTullos (Jul 22, 2009)

medichopeful said:


> Mind if I put this in my signature?



Go for it.

Melcin - it's a "stupid protocol" to transport someone that requests it and may very well need it?  Wow.


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## Sasha (Jul 22, 2009)

For the student, who doesn't seem to realize how dangerous cocaine use is.

Source: http://www.webmd.com/mental-health/cocaine-use-and-its-effects


> Cocaine is responsible for more U.S. emergency room visits than any other illegal drug. Cocaine harms the brain, heart, blood vessels, and lungs -- and can even cause sudden death. Here's what happens in the body:
> 
> *Heart.* Cocaine is bad for the heart. Cocaine increases heart rate and blood pressure while constricting the arteries supplying blood to the heart. _*The result can be a heart attack, even in young people without heart disease. Cocaine can also trigger a deadly abnormal heart rhythm called arrhythmia, killing instantly.*_
> 
> ...



*How Does Cocaine Effect The Heart?*
Source:http://www.circ.ahajournals.org/cgi/content/abstract/85/2/407


> It is clear that cocaine has cardiotoxic effects. Acute doses of cocaine suppress myocardial contractility, reduce coronary caliber and coronary blood flow, induce electrical abnormalities in the heart, and in conscious preparations increase heart rate and blood pressure. These effects will decrease myocardial oxygen supply and may increase demand (if heart rate and blood pressure rise). Thus, myocardial ischemia and/or infarction may occur, the latter leading to large areas of confluent necrosis.





> Direct toxic effects on the myocardium have been suggested, including scattered foci of myocyte necrosis (and in some but not all studies, contraction band necrosis), myocarditis, and foci of myocyte fibrosis. These abnormalities may lead to cases of cardiomyopathy. Left ventricular hypertrophy associated with chronic cocaine recently has been described. Arrhythmias and sudden death may be observed in acute or chronic use of cocaine.



Something I recently learned.
Source: http://drugsproject.co.uk/cocaine/


> Cocaine may also greatly increase this risk of developing rare autoimmune or connective tissue diseases such as lupus, Goodpasture’s disease, vasculitis, glomerulonephritis, Stevens-Johnson syndrome and other diseases. It can also cause a wide array of kidney diseases and renal failure. While these conditions are normally found in chronic use they can also be caused by short term exposure in susceptible individuals.


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## marineman (Jul 22, 2009)

We all have this grand vision in our heads of what constitutes an emergency. Truth is the patient is the one that matters and if they call it's an emergency to them.

I don't condone making a mockery of patients however I have given a 5cc saline flush and told the patient it was morphine. I would never do that on a patient who is obviously in pain that falls within our morphine administration protocols but there are times the placebo affect works better than the drug itself. 

Saying there's nitrous in the oxygen could be excusable if you legitimately thought that the placebo effect would help with the patients anxiety but the aspirin on the forehead is inexcusable no matter how you try to look at it.


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## Sasha (Jul 22, 2009)

> I don't condone making a mockery of patients however I have given a 5cc saline flush and told the patient it was morphine.



Do you document that you lied to your patient? Do you tell the nurses? 

And you have no right to withhold pain meds if you can give them to a person who says they are in pain because YOU don't think they are in pain. You can't possibly tell me that you know for 100% that your patient is not in pain, and to withhold pain management on personal opinion is cruel and unethical.


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## triemal04 (Jul 22, 2009)

For the record, taping an aspirin to the pt's forehead was a bit ridiculous and out of line, and not fully assessing the pt would also have been a fully stupid move.  But I wasn't there, so who knows what they did/did not do besides what was originally posted.

But beyond that...say that you do have someone who is having an anxiety attack and your only option is to talk them down...can't give versed, ativan, nitrous oxide, valium, nothing.  And you can't talk them down, it's just not happening.  Do you just sit back and allow them to continue on as they are, or try something else?  The placebo effect is a well document thing and has it's place in medicine.  There is no reason not to use it when it's appropriate.

And generally speaking, when someone is refused pn meds, it's not based on a personal opinion, but on the assessment of the pt, their presentation and their complaint...kind of like how the doctors at the ER decide that.  And if you think that everyone who steps into an ER complaining of pn get's something for it...wow...


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## Sasha (Jul 22, 2009)

> And if you think that everyone who steps into an ER complaining of pn get's something for it...wow...



Not everyone gets narcotics, of course not, but everyone should be entitled to pain management. It doesn't matter if your opinion is that they are in pain or not in pain. 

Take the chick in the news section who is sueing 911 because she got shot, no one took her seriously, because she could talk calmly. Not your picture of a gunshot victim, is it? 

Not everyone will meet your picture of a person in pain. 

Is a drug addict/drug seeker above feeling pain?


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## triemal04 (Jul 22, 2009)

Sasha said:


> Not everyone gets narcotics, of course not, but everyone should be entitled to pain management. It doesn't matter if your opinion is that they are in pain or not in pain.
> 
> Take the chick in the news section who is sueing 911 because she got shot, no one took her seriously, because she could talk calmly. Not your picture of a gunshot victim, is it?
> 
> ...


Actually, I don't have any generic impression of what a gunshot victim looks like; it varies from pt to pt.  In fact I've had one that was very calm (calmer than me; first I'd ever seen) on scene...very nonchalant in saying, "yeah, I've been shot...here, see."  Same as I don't have any generic impression of what someone in pn looks like.  Making assumptions about people and their treatement based on personal feelings...rather stupid and immature don't you think?

Yeah, you could say that everyone get's pn management.  But that does not mean that everyone gets narcs (not what I meant) or any kind of analgesic at all (which is what I meant).  Depending on the pt (and the doc's assessment, the pt's complaint and their presentation remember) the management may be being told "no, we will not give you anything at all," though not always in those exact words.

Like it or not, it happens daily across the country...hell, probably across the globe.

Edit:  And you didn't answer the question I posted in the first reply...want to take a stab at it?


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## Sasha (Jul 22, 2009)

> Edit: And you didn't answer the question I posted in the first reply...want to take a stab at it?



Try something else, of course, but not something that involves lying to the patient or making an idiot out of them by taping an asprin to their forehead so you can get your jollys too.

We will have to agree to disagree, all throughout my clinicals I have never seen anyone denied pain meds, and brief on the 911 road experience or IFT experience. Narcotics? Sure, but not pain management all together, toradol or even PO tylenol. There are also signs around the hospital informing the patient of their right to have their pain effectively managed.


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## triemal04 (Jul 22, 2009)

Sasha said:


> Try something else, of course, but not something that involves lying to the patient or making an idiot out of them by taping an asprin to their forehead so you can get your jollys too.
> 
> We will have to agree to disagree, all throughout my clinicals I have never seen anyone denied pain meds, and brief on the 911 road experience or IFT experience. Narcotics? Sure, but not pain management all together, toradol or even PO tylenol. There are also signs around the hospital informing the patient of their right to have their pain effectively managed.


The aspirin I agree with...bit overboard.  The "nitrous in a cannula" though...no problem there.  But, again, back to the question, there is nothing else for you to try.  Every form of talking someone down you know has been tried to no effect and you have no options left...what do you do?  You're just going to let them continue to suffer?  Or try something that can be beneficial?  Isn't it a bit contradictory that you want everyone who is in pn (real or not) to be given some type of analgesic for it, and yet you'll refuse to use a documented tool to potentially help someone having an anxiety attack?

For the rest...it'll happen, trust me on that.  The amount and degree that it'll happen will depend on your area, but at some point...


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## Sasha (Jul 22, 2009)

> yet you'll refuse to use a documented tool to potentially help someone having an anxiety attack?



I refuse to lie to my patients. Perhaps you lie to yours, but that is on you. I have already answered your question, it's just not the answer you were looking for.


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## CAOX3 (Jul 22, 2009)

Ms Rodriquez is fired up....

I believe the medical field in general is a little twisted and I am sure these actions happen more then we care to admit.


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## triemal04 (Jul 22, 2009)

Sasha said:


> I refuse to lie to my patients. Perhaps you lie to yours, but that is on you. I have already answered your question, it's just not the answer you were looking for.


It's an answer, which is what I was looking for.  While I do agree that you shouldn't lie to pt's whenever possible (and that includes lies of ommision), which it usually is, there may be times (and the above situation would be one) in which you aren't going to have a choice if you want to effectively treat them.  Basically you have said that your personal feelings on this matter will cause you to allow a pt to continue to suffer without trying all available forms of treatement.  Comfortable with that?


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## Sasha (Jul 22, 2009)

triemal04 said:


> It's an answer, which is what I was looking for.  While I do agree that you shouldn't lie to pt's whenever possible (and that includes lies of ommision), which it usually is, there may be times (and the above situation would be one) in which you aren't going to have a choice if you want to effectively treat them.  Basically you have said that your personal feelings on this matter will cause you to allow a pt to continue to suffer without trying all available forms of treatement.  Comfortable with that?



That is not what I said. I said I will try something different that does not include lying to my patients.

Like I also said, we will have to agree to disagree, neither one of us are going to move on this topic and your attempts to try and make me into a hypocrite are tiresome.


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## triemal04 (Jul 22, 2009)

Sasha said:


> That is not what I said. I said I will try something different that does not include lying to my patients.
> 
> Like I also said, we will have to agree to disagree, neither one of us are going to move on this topic and your attempts to try and make me into a hypocrite are tiresome.


I'm not trying to make you into a hypocrite.  (the difference in treatment/attitudes is interesting, but that's all).  And it is in effect what you have said; you refuse to lie to a pt for any reason, which, means that you will not use all available treatements, which means that the problem will continue.

Again though, far as the question goes, let me make it even clearer:  you have NO other options, everything has been tried and failed.  You're only choice is 1-do nothing and allow the pt to continue to suffer from an anxiety attack, or, 2-tell them something along the lines of "nitrous in a cannula" and see if the placebo effect works for them.

I'm really not looking for hypocrisy, more to see if you can understand why a complete blanket statement of "I will never do that and never lie to a pt" doesn't work, and why giving someone a placebo may sometimes be needed.  This doesn't mean that I'm condoning lying to a pt or that it should be a regular thing, just that, in this situation, it may be necessary.  Same with a placebo; it shouldn't be a regular thing, or the first, second, or even third treatment that comes to mind, but there may be a time when it is your only option.  In certain circumstances to do the above isn't going to be wrong, but an appropriate, albeit not the best, treatment.


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## Sasha (Jul 22, 2009)

triemal04 said:


> I'm not trying to make you into a hypocrite.  (the difference in treatment/attitudes is interesting, but that's all).  And it is in effect what you have said; you refuse to lie to a pt for any reason, which, means that you will not use all available treatements, which means that the problem will continue.
> 
> Again though, far as the question goes, let me make it even clearer:  you have NO other options, everything has been tried and failed.  You're only choice is 1-do nothing and allow the pt to continue to suffer from an anxiety attack, or, 2-tell them something along the lines of "nitrous in a cannula" and see if the placebo effect works for them.
> 
> I'm really not looking for hypocrisy, more to see if you can understand why a complete blanket statement of "I will never do that and never lie to a pt" doesn't work, and why giving someone a placebo may sometimes be needed.  This doesn't mean that I'm condoning lying to a pt or that it should be a regular thing, just that, in this situation, it may be necessary.  Same with a placebo; it shouldn't be a regular thing, or the first, second, or even third treatment that comes to mind, but there may be a time when it is your only option.  In certain circumstances to do the above isn't going to be wrong, but an appropriate, albeit not the best, treatment.



So you're telling me that meds have failed buy you think taping an asprin to someone's forhead (placebo) will work?? If you get to that point than nothing will work and you are up a poo creek with no paddle. 

Lie to your patients if you want, I wont lie to mine. It is unethical.


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## triemal04 (Jul 22, 2009)

Sasha said:


> So you're telling me that meds have failed buy you think taping an asprin to someone's forhead (placebo) will work?? If you get to that point than nothing will work and you are up a poo creek with no paddle.
> 
> Lie to your patients if you want, I wont lie to mine. It is unethical.


Noooo...not at all:  





> say that you do have someone who is having an anxiety attack and *your only option is to talk them down...can't give versed, ativan, nitrous oxide, valium, nothing.* *And you can't talk them down,* it's just not happening. Do you just sit back and allow them to continue on as they are, or try something else?


Not everyone will have the option of using drugs in that situation.  Not everyone can be talked down.  What will you do if that happens?  I've got your answer, you'll do nothing, maybe this will get others who read this thinking.
And again:


> The aspirin I agree with...bit overboard.


 (Was agreeing that it was wrong.)


> For the record, taping an aspirin to the pt's forehead was a bit ridiculous and out of line,


I guess I should remember to be completely blunt, leave no room for ambiguities and in the future just say that that was a BS move on their part.


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## TRowe (Jul 22, 2009)

Im split here. I agree 100% this story should not have been posted. I also agree that the acts of the medics were horrible and unprofessional and could even result in their licenses being revoked. 

However, I will say this... How many of you have done coke. As someone who knows all to well the act of doing coke and said consequences, it isn't that off the wall to think the kid was just reacting to the come down. We dont know enough details either way. Sure it could have been a genuine diagnosed anxiety attack. But chances are, from personal and professional experience, it was just the coming down of the coke. Drugs do weird things to people and make them do stupid things and act equally stupid. 

I will cite the incident of the PD who called up dispatch to get fire out there after smoking a couple bowls of weed. He reported that he was dying... The kid was just high... Really high, mind you, but just high. There are some people who shouldn't be doing drugs and some who shouldn't be tending to the care of those who are coked out of their mind. I feel no sympathy for the kid and how he was messed with. The medics should be punished but we shouldn't shed a tear over the kids trauma. Next time, do less coke.


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## dmc2007 (Jul 22, 2009)

For the more experienced members of the forum, keeping this incident aside, do you see a place in EMS for placebos (assuming they were prescribed by protocols)?  Or is MD/DO level education necessary for determining what patients could benefit from placebos and which require actual medication?

Not having much experience in the matter, I'd imagine telling a patient you were administering medications or interventions when you didn't would open you up to all sorts of liability issues.


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## Cory (Jul 22, 2009)

Simply put:

Neither EMT's nor Paramedics are trained in giving placebos.


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## triemal04 (Jul 22, 2009)

dmc2007 said:


> For the more experienced members of the forum, keeping this incident aside, do you see a place in EMS for placebos (assuming they were prescribed by protocols)?  Or is MD/DO level education necessary for determining what patients could benefit from placebos and which require actual medication?
> 
> Not having much experience in the matter, I'd imagine telling a patient you were administering medications or interventions when you didn't would open you up to all sorts of liability issues.


Last resort only, and even then only in certain situations.  Such as an anxiety attack.


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## Sasha (Jul 22, 2009)

> However, I will say this... How many of you have done coke. As someone who knows all to well the act of doing coke and said consequences, it isn't that off the wall to think the kid was just reacting to the come down. We dont know enough details either way. Sure it could have been a genuine diagnosed anxiety attack. But chances are, from personal and professional experience, it was just the coming down of the coke. Drugs do weird things to people and make them do stupid things and act equally stupid.



Admitting to coke use.. probably another thing that shouldn't be posted on the forum.


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## reaper (Jul 22, 2009)

This is where a psychology course should be a requirement! I have never had a pt that I could not clam down, whether by talking or use of meds.

I do not condone lying to a pt or telling them that they are getting a drug, that they are not.

What will you do, when it goes to court and they ask you where you got nitrous on a truck that does not have it?


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## Sasha (Jul 22, 2009)

> This is where a psychology course should be a requirement! I have never had a pt that I could not clam down, whether by talking or use of meds.



The next condition of his question is that you can't call med control for orders for meds because you forgot to stock the drug box or you are in a communication dead zone.


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## timmy84 (Jul 23, 2009)

reaper said:


> This is where a psychology course should be a requirement! I have never had a pt that I could not clam down, whether by talking or use of meds.
> 
> I do not condone lying to a pt or telling them that they are getting a drug, that they are not.
> 
> What will you do, when it goes to court and they ask you where you got nitrous on a truck that does not have it?



Agreed, I may not have the personal experience TRowe has, however I do know from professional experience that someone coming down from even a major coke binge are not beyond talking to.  The fact that the fake nitrous and asa to the forehead tells me that he was not so bad off.  If something can be fixed with a placebo, it can be helped with some understanding and reassurance.  Let's try to advocate for our patients, why patronize them when it does nothing to help.  Now he will go on another binge, and when it's over with he can call an ambulance and ask for a nitrous oxide/asa cocktail to "cure" him up.


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## triemal04 (Jul 23, 2009)

reaper said:


> This is where a psychology course should be a requirement! I have never had a pt that I could not clam down, whether by talking or use of meds.
> 
> I do not condone lying to a pt or telling them that they are getting a drug, that they are not.
> 
> What will you do, when it goes to court and they ask you where you got nitrous on a truck that does not have it?


Neither have I, but that does not change the fact that not everyone has access the meds, and, not everyone will have the ability to use them.  Will it come up in everyones career?  Doubtful.  Will it come up in some?  Yes.  Better to have thought about it before.

And if you are stupid enough to document that you actually gave someone nitrous and not what you actually did, then you deserve everything that happens next.  If you do something you document it, and that includes a placebo.


Sasha said:


> The next condition of his question is that you can't call med control for orders for meds because you forgot to stock the drug box or you are in a communication dead zone.


No, it also could be that you just don't have any...or you do but can't use them either with online/offline medical control...could be you're working on a BLS transfer unit such as the one you were on...  The conditions are only what I said.  Let them suffer, or try a placebo (in an appropriate manner).  I already know your answer.


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## Shishkabob (Jul 23, 2009)

Talk about perfect timing---

Go Ahead and Curse! It May Ease Your Pain


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## CAOX3 (Jul 23, 2009)

Linuss said:


> Talk about perfect timing---
> 
> Go Ahead and Curse! It May Ease Your Pain




Ive know this since I was five years old, swearing always makes me feel better.


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## Shishkabob (Jul 23, 2009)

Strange, swearing always made my mouth taste like soap.


To each his own I guess!


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## CAOX3 (Jul 23, 2009)

It made my behind hurt.


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## Hockey (Jul 23, 2009)

Man, I clicked on the thread read the last little bit of the OP and knew that the moral police would be around quite fast.  I like with MMiz said.  What happens at work, stays at work


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## marineman (Jul 23, 2009)

Sasha said:


> Not everyone gets narcotics, of course not, but everyone should be entitled to pain management. It doesn't matter if your opinion is that they are in pain or not in pain.
> 
> Take the chick in the news section who is sueing 911 because she got shot, no one took her seriously, because she could talk calmly. Not your picture of a gunshot victim, is it?
> 
> ...



You're absolutely correct but until we start carrying Toradol a narcotic is my only option for pain control. And for the record yes I do tell the nurse my full treatment including any placebos used and yes it is documented in my PCR that a patient was given a saline flush and told it was morphine. I document immediately after that their response to the treatment. 

If you read my original post again I said that I use the placebo for those that don't fall within my protocol for morphine administration. You however seem to take people's words too seriously, people lie, they always have and always will and no I will not be the one that gives the drug seeker morphine. Sorry but I believe in practicing responsible medicine not bowing down to anything the patient wants. I am the one with the education, I think I can come up with a better course of treatment than them for that whole 30 minutes that I'm with them.


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## Double-E (Jul 23, 2009)

man, i love you guys :wub:

good, vibrant discussion as always ^_^


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## guardian528 (Jul 23, 2009)

i'm guessing they aren't normally like this, maybe they were trying to be cool for the ride along? maybe like, "look we do fun stuff..." ... maybe? maybe not?


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## Melclin (Jul 23, 2009)

Epi-do said:


> Yes, we have some "stupid protocol" that says everyone that requests transport by ambulance gets a ride to the ER.  I most certainly have taken pts to the ER that I believed would have been served just as well by getting in one of the 6 cars parked in the driveway and driving to the ER, immediate care center, or the family doctor's office on their own.  However, when transporting those patients, I don't do things to humiliate them.  I still do my job - monitor vital signs, get as thorough a history as possible, provide comfort measures, etc.  I don't provide (nor have I ever) fake treatments to my patients.





JonTullos said:


> Go for it.
> 
> Melcin - it's a "stupid protocol" to transport someone that requests it and may very well need it?  Wow.




*Misconceptions:* 
*1.* Melclin thinks it's okay to make fun of a pt to their face.
*2.* Melclin thinks it's stupid to take a pt to hospital that requests it.  

*Corrections:*
*1.*  I never said it was. Don't put words in my mouth. What I argued was that it is conceivable that the medics intentions may not have been malicious, and that it may have been falsely perceived that way by the student observer (this may also have coloured the way in which he told the story). It is also conceivable that, given a set of circumstances, of which we are unaware, this may have been an appropriate course of treatment. We weren't there, we don't know the whole story (in fact we know very little of the story), so I feel that given the possibility of a perfectly reasonable and ethical alternative explanation  of the situation other than that they were just negligently and maliciously trying to humiliate the pt, that you should back of on the condemnation (as long as the issue is humiliation and intent, rather than the lying, which is a separate issue: see final paragraph*). I think it's likely that they were simply jerks (and I did say that), however, I was playing devils advocate seeing as though everyone seemed so keen to demolish the medics based on bugger all evidence. 

I realise it doesn't actually matter, it's not like you're opinions are sending them to jail or anything. I just hate it when people angrily jump to unreasonable conclusions without considering that there might be another side to the story. 

*2.*What I said was: "Why would you take them to the ED otherwise?" [in reference to a good clinical reason]. Then "Unless they were adamant to go themselves" [meaning that the pt wanting to go, is the other reason why you might take them to ED, the inference being that while there might be nothing clinically wrong, their desire to go to ED is good enough. I can, perhaps, see how "themselves" taken out of context could be taken to mean that they would privately attend the ED, but _in_ the context it seemed clear to me, to mean "they wanted to go"]. Otherwise we are perfectly within our rights to tell pt that they don't need to go to hospital and to assist them, if necessary, in seeking more appropriate care.

*More generally if you want to make the argument that lying to the pt is _always_ wrong then I would love to argue the Morality/Idealism vs. Utilitarianism with you, however, I'm not sure this thread is the place for that more general issue.


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## akflightmedic (Jul 23, 2009)

Hockey said:


> Man, I clicked on the thread read the last little bit of the OP and knew that the moral police would be around quite fast.  I like with MMiz said.  What happens at work, stays at work



The moral police... or ethical, educated medical professionals???

And to the other poster (sorry forgot name already) who keeps using an anxiety attack as an example, as that seems to be the only relevant condition for which he thinks a placebo may be the only option...I have this to say:

If they are having an anxiety attack (by this I am thinking you mean hyperventiliating as that what is keeps getting implied) and you have ruled out every other treatable medical condition which may cause hyperventilation (see previous threads on this topic and Vents wonderful replies) and you are unable to talk them down...guess what? The patient will pass out and resume normal breathing, they will also be calmer.

If they are truly in a panic attack with hyperventilation and I am unable to professionally, ethically and intelligently calm them down through the use of several "talking down" techniques, they will pass out and then it becomes a little easier.

At no point will I have to administer fake treatments, lie and say I am giving a drug when I am not, or tape ASA to a forehead. It just doesn't exist in my bag of tricks and I have been pulling from this bag for quite a long time and treated my fair share of panic attacks.

You can not justify these actions, they are unethical in our setting. I am willing to bet that the medics did not document this therapy when clearly we should document ALL treatments, especially if they work...right? So why not this one?


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## SeeNoMore (Jul 23, 2009)

This is depressing. Every patient deserves respect, and if I was that boy and figured out what was going on I would feel terrible.  Our communities trust us to act like professionals. Mistakes are made, errors in judgement etc, that is just real life. But going out of your way to act unprofessional is just poor.


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## Sasha (Jul 23, 2009)

> No, it also could be that you just don't have any...or you do but can't use them either with online/offline medical control...could be you're working on a BLS transfer unit such as the one you were on... The conditions are only what I said. Let them suffer, or try a placebo (in an appropriate manner). I already know your answer.



Even on my BLS IFT we had the option of calling for ALS if needed, which had valium on board. Sorry but the areas I did clinicals in, live in, and work in all have meds for sedation. We are also not five minutes away from the hospital and if you exhausted all your talking out within five minutes you weren't trying hard enough. You can't go "Okay... calm down..." and then two seconds later you are taping asprin to their forhead or telling them you are giving them an experimental treatment. 

And if by some chance talking down and meds don't work, let them pass out. Like AK said they will resume breathing normally upon unconciousness and will be fine.


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## guardian528 (Jul 23, 2009)

akflightmedic said:


> At no point will I have to administer fake treatments, lie and say I am giving a drug when I am not, or tape ASA to a forehead. It just doesn't exist in my bag of tricks and I have been pulling from this bag for quite a long time and treated my fair share of panic attacks.



i'm not in this argument, i've just been observing, but i have a quick question for not just akflightmedic but for everyone.

Are you strictly against using some sort of placebo effect? Maybe you won't use them if lying about drugs, but for more simple things maybe you will? Or do you see them as flat out bad, and never use any sort of placebo? Is there a time for them to be used and a time not to be used?

an example i can think of is when i was working with junior lifeguards, one of them got a little jellyfish sting(around here they just come in the form of little red rashes). usual treatment is to spray with vinegar, but we were out, so i filled the bottle with water, sprayed it on, and told her it was vinegar. she didn't know the difference, and after spraying she let out a sigh like "ahhh, thats better," and went on with her day. 

ok for small things, or wrong whenever?


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## marineman (Jul 23, 2009)

Like I said before if your "bag of tricks" is empty and your patient wants or needs you to do something I have no problem with it. A placebo is never a first choice of treatment but at the end of the day you made your patient feel better. There is a fine line between humiliating a patient and using a placebo though, that line was clearly crossed in this example. 

My example of using the placebo was for a headache, morphine is not in my protocols for a headache so I did what I could with the tools I had to work with.


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## akflightmedic (Jul 23, 2009)

guardian528 said:


> i'm not in this argument, i've just been observing, but i have a quick question for not just akflightmedic but for everyone.
> 
> Are you strictly against using some sort of placebo effect? Maybe you won't use them if lying about drugs, but for more simple things maybe you will? Or do you see them as flat out bad, and never use any sort of placebo? Is there a time for them to be used and a time not to be used?
> 
> ...



When I respond as a medical professional in a box with blinkie things and whoo whoos...I do not have to resort to placebos. There just has not been a need for it when you are educated, professional and have all the tools you need at your disposal.

Will certain treatments possibly make them feel better with no studies to justify it...sure (your example was one, except you lied to her). I simply would have said water has a cooling effect and I will apply it now. No lie, no deception.

Had your treatment not worked, what would you have said? "Oh the vinegar must be expired", or would you then have to tell the truth and go get the right treatment. Will this junior lifeguard respect you now for lying to her, will she lose respect for others in your similar position since she equates an authority figure with more knowledge than her to a liar?

See where this goes?


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## Epi-do (Jul 23, 2009)

Melclin said:


> I just hate it when people angrily jump to unreasonable conclusions without considering that there might be another side to the story.



First of all, I wasn't "angry" when making my comments.  Shocked that someone could be such a horse's butt, yes, but not angry.  Secondly, please share a circumstance where taping an aspirin to a patient's forehead is ever acceptable behavior.  If there is one single, legitimate circumstance then I will be more than happy to give them the benefit of the doubt for their actions.  (And, things such as trying to "show off" for the ride-along is not an acceptable reason.  I am looking for a circumstance that would make this a medically acceptable action for the medic to take.)


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## triemal04 (Jul 23, 2009)

akflightmedic said:


> If they are having an anxiety attack (by this I am thinking you mean hyperventiliating as that what is keeps getting implied) and you have ruled out every other treatable medical condition which may cause hyperventilation (see previous threads on this topic and Vents wonderful replies) and you are unable to talk them down...guess what? The patient will pass out and resume normal breathing, they will also be calmer.
> 
> If they are truly in a panic attack with hyperventilation and I am unable to professionally, ethically and intelligently calm them down through the use of several "talking down" techniques, they will pass out and then it becomes a little easier.


Actually, I didn't mean someone who was hyperventilating; not every panic attack includes hyperventilation, and many only have a moderately elevated respiratory rate, if that.  So waiting for them to pass out...not always going to happen.  As is assuming that if they do, when they wake up everything will be hunkey-dory; what if the problem has continued?  If the hyperventilation was secondary to an anxiety attack and they are still worked up, what do you think happens next?  Now it's a nice cycle of pass out-wake up-pass out wake up and so on...sound like a good thing?  And you should document all your treatments, as I've said, including this if it was used; no reason not to.

Like I said, will everyone need to do this?  Nope.  But, does everyone have the ability to chemically treat that type of problem?  Nope.  Does everyone have the ability to talk to *every* individual person in a way that will calm them during that type of situation?  Nope.  So what do you do? 

Sasha-you can use whatever reason suits you...if it's not been needed in your experience then it hasn't been needed...as I said, not everyone will need to.  Especially with a short transport.  With longer though, the need to treat your pt will increase, and with limited options...what do you do?  But do you know where you'll be working in the future?  Do you know if you'll have the ability to use meds?  It's better to have thought about a problem and found a solution before it happens.


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## Sasha (Jul 23, 2009)

Where will I be working? In a hospital as a nurse, this is just a pas time gig til I start nursing school. Twist it however you want I won't lie to pts.


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## exodus (Jul 23, 2009)

Sasha said:


> Where will I be working? In a hospital as a nurse, this is just a pas time gig til I start nursing school. Twist it however you want I won't lie to pts.



Okay Nurse Jackie! ;] Edit( This is a joke and I am not implying that you will be practicing anything she does, it is a joke... Btw, she doesn't lie to pt's!)

My first ride a long we Tx'd a women with an exacerbated (I can't spell that! Where it comes out...) bowel...


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## triemal04 (Jul 23, 2009)

Sasha said:


> Where will I be working? In a hospital as a nurse, this is just a pas time gig til I start nursing school. Twist it however you want I won't lie to pts.


I haven't twisted anything you've said, sorry.  Try again.  Or don't, either way.


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## HotelCo (Jul 23, 2009)

Sasha said:


> Where will I be working? In a hospital as a nurse, this is just a pas time gig til I start nursing school. Twist it however you want I won't lie to pts.



Sasha, you're single-handedly destroying EMS. ^_^


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## Melclin (Jul 24, 2009)

Epi-do said:


> First of all, I wasn't "angry" when making my comments.  Shocked that someone could be such a horse's butt, yes, but not angry.  Secondly, please share a circumstance where taping an aspirin to a patient's forehead is ever acceptable behavior.  If there is one single, legitimate circumstance then I will be more than happy to give them the benefit of the doubt for their actions.  (And, things such as trying to "show off" for the ride-along is not an acceptable reason.  I am looking for a circumstance that would make this a medically acceptable action for the medic to take.)



Angry, shocked. You know what I mean. 

I already mentioned an example... if you replace thought protecting mask with thought protecting asprin. I can think of many examples. Most of which, I'm sure you can think of and disagree with, so there's not much point really. 

I suspect that they genuinely felt it would help him but they didn't particularly care that the side affect was mild humiliation because he was a drug user. I don't have a problem with that. Everyone gets treated differently based on the kind of person they are, or appear to be. I don't mean medically, everyone gets equitable medical treatment. But would I make a cup of tea for an nice old lady who called me out in the middle of the night for a CC of  'bad dream', yes. Would I for a criminal who hurt himself while trying to rob said old lady, no, he'd get the least care I could medically afford to give him, get shoved into the back of the ambulance, told to shut up, and ignored, failing a life threatening change.

Aside from whether or not they were actually _trying_ to humiliate him (maybe there's a bit of a cultural difference here) health care pros taking the piss out of addicts/users, even to their face, doesn't bother me. I've seen and heard of it happening plenty. If you choose that lifestyle as far as I'm concerned, you'll just have to put up with a little ridicule. As long as you aren't really sacrificing their actual medical care, I don't give a stuff if they feel a bit embarrassed. There are degrees of humiliation that I would probably find to be unacceptable, but taping an asprin to their forehead, especially seeing as though its actually helping them, doesn't qualify as over the top in my view. We'll just have to agree to disagree I suppose.


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## Sasha (Jul 24, 2009)

HotelCo said:


> Sasha, you're single-handedly destroying EMS. ^_^




I know, how horrible! I should be ashamed! How dare I actually want to further my education and go on to an actual profession and not stay in what is widely considered a hobby!

So, I contradict myself. I lied to a patient today. She spoke Spanish. I speak English. Despite telling her multiple times that I don't understand, she talked the entire transport. I smiled, nodded and tried to give her an impression that I was paying attention, even though I had noclue what she was saying.

According to a Spanish speaking nurse, I was smiling and nodding when she asked if we were going to puerto rico. We in fact were going to Orlando.



> Angry, shocked. You know what I mean.
> 
> I already mentioned an example... if you replace thought protecting mask with thought protecting asprin. I can think of many examples. Most of which, I'm sure you can think of and disagree with, so there's not much point really.
> 
> ...



My heart goes out to your patients if you really think humiliating them is okay. We are patient advocates, not advocates only to the patients we like or agree with.

If they were really trying to just calm him down and weren't trying to humiliate him, there are less conspicuous places to tape an asprin. Inside of the wrist, maybe?


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## Shishkabob (Jul 24, 2009)

What, you mean you didn't become fluent in Spanish so that you can better help your patients, like you claimed all people should?


^_^


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## Sasha (Jul 24, 2009)

Linuss said:


> What, you mean you didn't become fluent in Spanish so that you can better help your patients, like you claimed all people should?
> 
> 
> ^_^



Becoming fluent in a language takes time, and I am working on learning Spanish. However my limited vocabulary goes out the window when the patient is speaking far too fast and is confused.

And I never said fluent, I said enough to communicate effectively with patients during an assesment. I can ask the patient if they are in pain, on a scale of 1-10, point to the pain, do you feel short of breathe? and tell them I am going to put them on oxygen in Spanish. Oh and I have the phrase "Hello my name is Sasha, I know very little Spanish" down perfectly. And "Adios!"


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## Melclin (Jul 24, 2009)

Sasha said:


> My heart goes out to your patients if you really think humiliating them is okay. We are patient advocates, not advocates only to the patients we like or agree with.
> 
> If they were really trying to just calm him down and weren't trying to humiliate him, there are less conspicuous places to tape an asprin. Inside of the wrist, maybe?



Well that's good, I was afraid I was going to become a good paramedic, I'm glad I have you here to inform me otherwise. After reading your brief patronizing remarks, I realized how wrong I was and will endeavor to follow in your example of argumentative piety, sweeping generalizations and false dichotomies.

Mostly friendly sarcasm aside, on the topic of the asa on the head, that's probably true. But maybe they didn't think it out and discuss the matter on a forum before hand and they just happened upon an idea to calm a pt down, gave it a shot and maybe some of their frustration manifested itself with that, who knows. I did say I thought it was likely they were trying to make fun of him. I just thought it was unfair to write them off on an anecdote. 

Anyway, I think I've made my point, and we know know you're a pillar of ethical practice, I've read plenty of your holier-than-thou posts before, and if you read mine you might notice that I like to play devils advocate for the sake of a fair argument. There's not much point in continuing the conversation, unless we both like whipping a dead horse.


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## CAOX3 (Jul 24, 2009)

Let me get this right people are trying to justify what these two dingbats did?  A placebo effect.  Right.

Fired.


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## Epi-do (Jul 24, 2009)

Melclin said:


> Angry, shocked. You know what I mean.
> 
> I already mentioned an example... if you replace thought protecting mask with thought protecting asprin. I can think of many examples. Most of which, I'm sure you can think of and disagree with, so there's not much point really.
> 
> ...



Like Sasha mentioned, taping an asa to the wrist, arm, ankle, etc - ok.  To the FOREHEAD - no, there is no other reason to do that than to humiliate/make fun of your patient.

How sad for your patients that you think it is ok to consciously choose to treat some patients better than others, based upon your preconceived notions of their situation.  (And how is that any different than my feelings about how these medics treated this particular patient?)  I am not going to say that I have always treated all of my patients to the best of my ability.  I am willing to bet all of us have given less than our best on occasion.  However, I have never consciously chosen to treat one patient better or worse than another based upon my opinions about their chosen lifestyle or actions leading up to their encounter with EMS.

Since neither one of us are going to change the others mind, I guess you are right and we will just have to agree to disagree on this one.


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## SeeNoMore (Jul 24, 2009)

This is not aimed at anyone, but I also think its worth remembering that wholly worthy people can get themsevles in screwed up situations/periods of their lives. This does not take away personal responsibility, but we should never make fun of, or treat less seriously,  a patient because they are in a bad way. Perhaps your professional conduct and care will be the impetus for a new start? You never know. I was a social worker for a time and believe very strongly that acts of respect and kindness that can seem small can have a huge effect. 

Just food for thought.


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## Sasha (Jul 24, 2009)

I guess in all that education required in austraila they didn't include an ethics class.


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## WuLabsWuTecH (Jul 24, 2009)

Sasha said:


> I guess in all that education required in austraila they didn't include an ethics class.


Not that we have one here either?


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## ffemt8978 (Jul 24, 2009)

Do I really need to post my favorite smilie in this thread?


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## medichopeful (Jul 24, 2009)

Sasha said:


> I guess in all that education required in austraila they didn't include an ethics class.



That seems a little low.


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## Sasha (Jul 24, 2009)

medichopeful said:


> That seems a little low.



So is humiliating patients because you don't agree with their lifestyle.

And no, we don't, we should, but we don't. However you can become an EMT in as little as two weeks here, and Austraila boasts higher educational standards.


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## Shishkabob (Jul 24, 2009)

ffemt8978 said:


> Do I really need to post my favorite smilie in this thread?



I'll do it for you



:birthday:




Amirite?!


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## medicdan (Jul 24, 2009)

Let me stick my toe into this. What are your thoughts on medics telling patients-- "We are going to try H2ONa therapy-- lets see how it helps"-- then running in saline...? In that situation, you are providing a therapy that is within protocols-- not outlandish, and not embarrassing. The medic is neither lying to the patient nor dismissing their complaints or refusing to treat patients they see as "BS".


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## akflightmedic (Jul 24, 2009)

emt.dan said:


> Let me stick my toe into this. What are your thoughts on medics telling patients-- "We are going to try H2ONa therapy-- lets see how it helps"-- then running in saline...? In that situation, you are providing a therapy that is within protocols-- not outlandish, and not embarrassing. The medic is neither lying to the patient nor dismissing their complaints or refusing to treat patients they see as "BS".



So now you are providing a therapy that is not needed...although deemed harmless by the way you state it, you are ok with performing invasive treatments to soothe a psyche as opposed to professional behavior, explanations and procedures or denial of procedures.

Knowing when NOT to do something is just as important as knowing when to do it...this is one of the fundamental differences I speak about when teaching and to me is one of the major differences between training and education.


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## Melclin (Jul 24, 2009)

My bachelor of emergency health does, as it happens, have a number of bioethics components. As did the science degree I started before it, and it came up once or twice in my six years of RE at secondary school. 

So I'm fairly well equipped, as I mentioned, to have the Utilitarianism vs Idealism argument. But this is not the place. Nor is it the place to make nasty, pointless remarks. We disagree, get over it.


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## Jinx (Jul 24, 2009)

Sasha said:


> I guess in all that education required in austraila they didn't include an ethics class.



Sorry Sasha but you're wrong we do study ethics here im currently studying it in my course and it runs for an entire semster at my uni. Meclin may or may not do it at his uni, but please don't lump us all in the same group. I have very different opinions to others on here and think every patient ( yes drug addicts, murderers, paedophiles) should be treated the same as the patients you enjoy treating because at the end of the day my feelings/emotions are my problem to deal with and not theirs. We often get told to treat every patient as though we are treating our mother by our lecturers, some people take that on board others don't. Another part of my course included using self awareness to identify patients we don't won't to or don't look forward to treating and to reflect on why we have those feelings and to deal with them. So for example I felt I wouldn't like treating alcohol affected patients and the reason for that is I have an alcoholic parent. However rather than treat them like :censored::censored::censored::censored: or humiliate them I chose to 'shelve' any emotions I have and treat the patient like any other then deal with my emotions in my own time and space.

Please don't flame me as this is just my own opinion and personal approach to things.  

Cheers

Jinx


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## Hockey (Jul 25, 2009)

emt.dan said:


> Let me stick my toe into this. What are your thoughts on medics telling patients-- "We are going to try H2ONa therapy-- lets see how it helps"-- then running in saline...? In that situation, you are providing a therapy that is within protocols-- not outlandish, and not embarrassing. The medic is neither lying to the patient nor dismissing their complaints or refusing to treat patients they see as "BS".




But thats just wrong Dan don't ya know!??? Jeez, you have to be perfect in this field


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