Attitudes torwards patients

[RielHalfbreed]

Actually no. In 911 the frequent fliers are often the ones that do not pay. And the trip does not qualify for medicaid/medicare because unless you commit fraud that needless transport is not getting paid. So you just spent money and got no return. So guess what they do not feed my family in fact they are also part of the reason we have low pay in EMS.

Actually yes. In services that charge for treatment, unpaid billing is still a key element to how your wages and income are calculated and not in the way that you suggest. Unpaid billing is charged off and used as a loss against the gross income of the service during their year end which reduces their tax liability. So it is not just a blanket loss as you suggest and is NOT the reason there is low pay in EMS.

That being said, if you don't like what you get paid join a different service, *read that private FP service* and get paid more. Then when public service finds itself shortstaffed, wages will see a correction. That would make more sense than preaching to the choir here about how much you don't get paid. B)

Fourth, EMS abuse by frequent fliers frustrates and burns out providers, which ultimately may impact legitimate pts.

It's part of the job. I don't know of a training program for any EMS position here that doesn't outline the probability of EMS abuse and the frequent flier situation. If a provider can't handle it after he or she has been fairly warned what to expect they should never have been in the industry.

 

[imurphy]

I have a simple attitude to them. They keep us in a job!! There will always be druggies, alchos and psychs. And therefore, there will always be EMS!

 

[RielHalfbreed]

I have a simple attitude to them. They keep us in a job!! There will always be druggies, alchos and psychs. And therefore, there will always be EMS!

A fantasticaly logical summation! B)

 

[reaper]

Actually yes. In services that charge for treatment, unpaid billing is still a key element to how your wages and income are calculated and not in the way that you suggest. Unpaid billing is charged off and used as a loss against the gross income of the service during their year end which reduces their tax liability. So it is not just a blanket loss as you suggest and is NOT the reason there is low pay in EMS.

That being said, if you don't like what you get paid join a different service, *read that private FP service* and get paid more. Then when public service finds itself shortstaffed, wages will see a correction. That would make more sense than preaching to the choir here about how much you don't get paid. B)


It's part of the job. I don't know of a training program for any EMS position here that doesn't outline the probability of EMS abuse and the frequent flier situation. If a provider can't handle it after he or she has been fairly warned what to expect they should never have been in the industry.

Sorry, but your charge off is coming no where close to what you are losing. if it did, no company would care about being paid!!!

 

[Aidey]

Fourth, EMS abuse by frequent fliers frustrates and burns out providers, which ultimately may impact legitimate pts. Yes, dealing with frequent fliers is not an excuse for poor attitude, but this is what happens.

Since when were frequent fliers not legitimate patients? People seem to forget it's not our place to decide what is and isn't an emergency, it's the callers place.

 

[Foxbat]

Since when were frequent fliers not legitimate patients? People seem to forget it's not our place to decide what is and isn't an emergency, it's the callers place.

I should have been more clear.
I have nothing against patients who frequently call 911 because they fall and can't get up.
Patients who call 911 to get to a hospital to fill a prescription or because they are being late to doctor's appointment are the ones I am talking about. It does not warrant a trip by ambulance and in many jurisdictions EMS personnel is actually allowed to say "no" to those people.

 

[VentMedic]

I have a simple attitude to them. They keep us in a job!! There will always be druggies, alchos and psychs. And therefore, there will always be EMS!

Maybe one day EMS will look at the "druggies, alchos and psychs" from a medical point of view rather than labels. When a physician and other medical professionals see these patients, a very different assessment takes place. Other professionals know the medical problems that each of these "labels" may present with. The doctor is torn between just doing what he/she can to get the patient back on the street or to make them an inpatient in an attempt to correct more problems. Then, even that can lead to more problems with the withdrawal complications. If these medical professionals did not care enough to do their jobs regardless of the unflattering labels given to these patient by EMS, the hospital beds would be taken up by these patients whose illnesses went unchecked until they were out of control requiring lengthy hospital stays. The patchwork done in the ED by the doctors and nurses are sometimes enough until the next trip.

Others in the medical professions do professional care because they see some medical condition(s) that must be treated regardless of whatever label is attached to the patient. They know the heart, kidneys, lungs and many other systems can fail and a good assessment is needed rather than just applying a label.

Medicine is not always glamourous and it is sad that so many in EMS don't get more of an opportunity to see this since there is so little clinical time even at the Paramedic level. Or, that the education is so watered down that many will not even know what they are assessing or if they even care to if the person doesn't he/she will die on the ride to the hospital.

 

[reaper]

Vent,

I agree that all these Pt's need a full assessment, to find the hidden problems and possibly get treatment for the obvious problems.

I disagree that labeling them is an EMS problem. That we over look the Pt's because of the labels. I have been in ED's all over the country. I have never been in one that the ED Rn's or Dr's have not labeled these Pt's the same way.

This is not a case of other medical professions being better then EMS. They all label Pt's the same way. This does not mean that they change their treatment of the pt or overlook something, because of the label. This also does not mean that EMS changes their treatment or overlook something, due to labels. The true competent medical professional will treat their Pt's, no matter where they work.

Yes, there are bad EMS providers that do not treat them like they should, due to the label. But, there are also bad providers in every area that do the same thing.

Let's push for the improved treatment of Pt's labeled this way and not say that other medical professionals do not do this. We could get the message across in a much more appealing way!

 

[VentMedic]

Vent,

I disagree that labeling them is an EMS problem. That we over look the Pt's because of the labels. I have been in ED's all over the country. I have never been in one that the ED Rn's or Dr's have not labeled these Pt's the same way.

But have you not seen these professionals not treat the patients because of the labels? How many threads even on this forum where it is ofen said "just a ride" to the hospital and that is the extent of the assessment. EMS needs to do be by presenting the medical side of this profession.

I have been in many EDs and have been in EMS for a long time. Some of the stuff I hear from EMS personnel in the EDs, in the refresher classes and at the conferences are not presented by those that have any interest in aiding these individuals medically. I have also heard why several EMT(P)s did not make it through nursing school when they found out they would have to work with these patients up close and in a personal way.

While you may disagree, I think you do know there are some that shouldn't be in EMS because they have no interest in the medical aspect of the job. That is what reflects on how patients are treated and patient care to the individual. That attitude is also one the public will remember the most when witnessing this behavior.

There are reasons why the education is longer with extensive clinicals for other professions. It gives the student a chance to see a broader range of patient care and it gives the instructors and students a chance to see if the student is cut out to be a medical professional. Often, students are weeded out more for their attitudes rather than technical skills.

Those providers in other professions usually don't last long since teamwork is a necessity and often move on when they find others will not join into their pathetic rants towards patients. EMS somehow feeds on this stuff and will take whatever opportunity to label alcholics or IVDAs or even Security Guards rather than examining where they could improve their own.

 

[cfrench]

""Fourth, EMS abuse by frequent fliers frustrates and burns out providers, which ultimately may impact legitimate pts""

Dude, let it go. You have to get past them bothering you. It only makes you unhappy. Every minute spent being angry is another minute of misery for you. It is Sooo much easier being pleasant and non judgemental to them. I am not saying you have to be Mr Sunshine on every call I work in one of those enviroments where you are actually surprised to see someone with insurance that does not begin with the letter 'M'. So I know what other medics are dealing with. If you want to stay in the job for the long haul (28 years for me), you have to just let that stuff go OR leave.

 

[Aidey]

I agree with Reaper on this one. On my last shift we brought in 3 homeless ODs/ETOH intoxication Pts in a row to the same hospital, and when we walked in with the 3rd one, one of the MDs said "Oh no you didn not just bring us another one did you?"

This Doc was obviously making a judgment on the patient, and labeling them. However, I don't think it changed their treatment much.

With some of these patients, aside from a full exam, there just isn't much we can do pre-hospital. Narcan is the only antidote med we carry, and I'm not a fan of using it on chronic users who have good vitals, but an ALOC. Too high of a risk of withdrawing them too fast.

On one of the ODs we brought in his vitals were perfectly normal, but he was wavering between P and U on AVPU, even after narcan. The ED doc got his labs back, confirmed he was on an opiate and ETOH and their almighty treatment was to let the guy sleep it off with a banana bag.

 

[PapaBear434]

I agree with Reaper on this one. On my last shift we brought in 3 homeless ODs/ETOH intoxication Pts in a row to the same hospital, and when we walked in with the 3rd one, one of the MDs said "Oh no you didn not just bring us another one did you?"

Is is possible he just meant that you brought in another patient? I have nurses and Docs say that all the time, and they just mean I'm bringing in another person.

 

[Foxbat]

Dude, let it go. You have to get past them bothering you. It only makes you unhappy. Every minute spent being angry is another minute of misery for you.

They don't make me angry, they are more of an annoyance. If I worked in an area where most calls are like that, I guess I would be angry. And I see people who had been in healthcare (not just EMS) for quite some time and who really, really don't like frequent fliers.
Ironically, those who do somewhat make me miserable are psychiatric and some of the intox pts, who are absolutely legitimate patients with real medical problems. It's not that I don't have compassion to these people; I do. My family member had DD, I have OCD, I know/knew some drug/alcohol addicts (and watched one of them dying of OD long before I got into EMS), so yeah, I feel for them. It's just I'm still not used to get yelled at/grabbed, but this is probably due to lack of experience and I am trying to not to take it personally and not to let it bother me.

 

[VentMedic]

I agree with Reaper on this one. On my last shift we brought in 3 homeless ODs/ETOH intoxication Pts in a row to the same hospital, and when we walked in with the 3rd one, one of the MDs said "Oh no you didn not just bring us another one did you?"

This Doc was obviously making a judgment on the patient, and labeling them. However, I don't think it changed their treatment much.

Did the doctor say you're bringing in another drunk or druggie? Or were those your words?

The doctor and nurses are also making an assessment of the situation in their ED. Perhaps they are thinking of the patients' safety and the safety of the staff. When you have several patients with altered mental status, additional personnel may be needed if nothing else than as a sitter for some areas. Even when a patient is tied to a bed with a posey vest, someone may need to watch the patient in the acute phase of their arrival. If one RN is covering 6 patients, 5 of which have AMS for some reason, that is a heavy load. Remember, as an EMT(P) you only have ONE patient to watch at a time.

 

[Aidey]

I hadn't even opened my mouth when the doc said that, so it had nothing to do with me thank you very much.

So wait, it's now OK for nurses and docs to say things like that because they have a lot of patients, but it's not OK for EMS responders to say that?

 

[VentMedic]

So wait, it's now OK for nurses and docs to say things like that because they have a lot of patients, but it's not OK for EMS responders to say that?

Did the doctor say you're bringing in another drunk or druggie?

If the doctor did not use those words, he/she could have meant another patient into an already overcrowded ED or another patient that must be closely watched with AMS.

Let me repeat myself again since you only picked out the parts you wanted to form your own interpretation.

The doctor and nurses are also making an assessment of the situation in their ED. Perhaps they are thinking of the patients' safety and the safety of the staff. When you have several patients with altered mental status, additional personnel may be needed if nothing else than as a sitter for some areas. Even when a patient is tied to a bed with a posey vest, someone may need to watch the patient in the acute phase of their arrival. If one RN is covering 6 patients, 5 of which have AMS for some reason, that is a heavy load. Remember, as an EMT(P) you only have ONE patient to watch at a time.

 

[BossyCow]

I know one medic who plans his patient care based on the social strata of the pt. The clean little old lady in the nice home in the expensive neighborhood is joked with, smiled at, catered to and fawned over. The same injury or illness in a less affluent neighborhood gets an entirely different medic. He is curt, the care is perfunctory and the conversation is nil. The more socially acceptable(to him) patient may be asked if they need assistance to the gurney and offered help while the less acceptable pt is told to walk, and gets rolled eyes and heavy sighs if they are unable. One patient is asked, the other is told.

Now, the care of both pts is within the same basic guidelines and no case can be made to prove that the care one received was substandard, but the level of care is very different.

If you are a professional and mature individual, you are going to be able to put aside your own prejudices and bias and give the same care to all. If you can't, you will look like the jerk you are.

 

[Veneficus]

We talk alot about empathy and burnout and I would like to venture a thought.

I don't think people get burned out because of what job they have so much as where or the type of system. Whether you are a doc or a basic, I don't think it is your longevity that changes the attitude, but personal satisfaction and growth.

I know some employers still have this idea people will stick around for 30 years and costs of training, orientation etc. But truly, it may be the cost of maintaining a high level of service and image.

I'll bet in any profession people who are "stuck" with no ability to transfer or advance are not the most pleasant to be around.(either as a peer or patient) I think it is amplified in medicine because whether or not we think, we give a lot. There are few people who can always give without getting something back (like job satisfaction) for 30+ years.

You can complain about the pay all you like, but most people with advanced business education will tell you that simply increasing pay will not have long term effect on attitude.

Non EMS providers have a bit more wiggle room. A doc or RN can always switch envronments, even for a while to get a break. Often within the same employer. Both the lateral moves as well as advancement in the prehospital setting is limited. Even a promotion means little without the ability to effect tangible changes in your work environment.

If you move into the hospital other providers constantly tell you you are not an EMS professional anymore and make it harder to move back to the field. So even with the increase in experience and knowledge an in house provider can bring to the field, they often finding it easier to move up than back out.

I cannot count the medics I know that went from field to hospital, to RN, RT, or PT. (strangely enough I do know the ones who went from medic to doc though, but I think because there are so few compared to the others)

 

[BossyCow]

I have a difficult time excusing this behavior as related to job burnout. Two medics that I find most guilty of this were like this from day one. I think it's more a factor of your personality and maturity.

A mature individual will be able to do their job and deal with the stresses, disappointments and challenges that life and the job toss in their path. The ones who allow their bitterness to impact the innocent are not excused by 'burn out' or 'job conditions'. Whether you are a clerk in a video store or a pharmacist, medic or nurse, allowing your dissatisfaction with your working conditions to be taken out on customers is a sign of immaturity and selfishness.

 

[NEMed2]

I agree with BossyCow on this one. I know several people working in EMS ranging from basics to paramedics that have little compassion for anyone who's not well educated & "clean". I also know a few that are beyond rude to other EMS personnel because they think they are the reining king of their service. Do you treat a druggie from the street the same as one from a affluent neighborhood? These people do not deserve their certifications.

Yes, the frequent fliers may be annoying at times, but there is often an underlying issue at hand that makes them that way. Undiagnosed/mismanaged psych issue, depression, misunderstanding of the EMS system itself? I don't particularly like getting up at 3 am to deal with the "general weakness x 3 months", but I treat them the same as I would treat any of my other patients.

It's been said time and time again, but once more can't hurt. If someone is calling 911, to them, they are having an emergency. It is not our place to judge that or try and put our moral standards onto them.