Being too gentle?

TechMedic

TechMedic

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Im about to go on my intermediate clinical rotations and I want to improve on what I saw as my biggest weakness during my basics. Needless to say we all try not to harm our patients any more than they already are, but Ive always been too afraid Im going to hurt them and start over-thinking things. Even the guys I ride with make fun of me for it.

Is this a common thing for newbies, or is a sign Im in the wrong profession? I have a clinic rotation in 6 hours to do blood draws, so I hope its not the latter...
 
In what sense are you afraid you are going to hurt them?

You should always be considered of your patient, but there will be times where we need to temporarily cause more pain so the patient feels better in the long run...

Let me ask you this, would you be hesitant to apply a traction splint to a deformed mid-thigh fracture knowing you will be causing more pain to the patient?

If you know anyone who has had to use one, you will know that the moment you pull manual traction on their leg the patient will scream due to the intense pain... But that is just necessary temporary pain which alleviates the pain and discomfort of the previous condition you had found your patient in. I know a few EMT's who were hesitant or refused to apply the traction splint for the discomfort it brings to the patient as you apply it.. But we need to have the patients best interest in mind, and we as EMS care providers know that by returning the leg in its anatomical position we are reducing the patients discomfort in the long run due to the multiple benefits the traction splint provides.

Now on the other hand, if you are referring to causing additional pain in regards to the fact that you can't run an IV line without several attempts etc, then IDK what to say...

Sorry if my reply seems like a bunch of rambling, its 4 AM here and I am rather delirious.
 
wannabeHFD said:
. Needless to say we all try not to harm our patients any more than they already are, but Ive always been too afraid Im going to hurt them and start over-thinking things.

Is this a common thing for newbies, or is a sign Im in the wrong profession? I have a clinic rotation in 6 hours to do blood draws, so I hope its not the latter...
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Yes this is very common. Are you by any chance a really big guy? When I first started my patient contacts I was very very timid. I had basically been tought my whole life that because I'm a really big guy I have to be very careful not to hurt anybody or shake hands too hard or play too rough. When I started treating and evaluating patients I had to unlearn a lot of that. The hardest part of doing this job for me was learning to really get hands on with the patients when needed. Don't worry you'll get it. You just have to realize that our patients are much tougher than you might think and sometimes in order to make them feel better in the long run we have to make them feel worse in the short term.
 
You'll find a balance. Meanwhile, having a bias about not hurting people is not a bad thing.
 
Like I'm almost afraid to touch them. I'm doing good on blood draws so far but I keep missing the vein.

I had one call of a huge black dude with 5 layers of clothes and extreme gout. I'm a little white kid. Even the slightest touch made this guy cry.
 
Don't worry too much about it. After a while, going into people's homes and invading their personal space will become routine to you, as will all the uncomfortable and demeaning things we do to people for no good reason (chiefly backboarding). At some point after that, you'll start wanting to hurt a subset of your patients.

What BBG said might be it, but if not, it might just be that EMS involves violating a lot of the norms of behavior towards strangers, and that takes some time to get used to. Try to keep some of the sense that what you're doing is intrusive; it can help you respect patients.
 
1. Some patients will act out no matter what you do. Focus down and do it right. If they refuse tx, step back.
2. Ever hear the saying "grasp the nettle firmly"? An old English one, means when there's something necessary to do with risk balancing against benefit, your best chance for success lies with working properly but decisively. Doesn't mean rushing or not thinking it through, and you need to know what you're doing for best results.
3. Practice and feedback make perfect. Also increase self-assurance.
 
MrConspiracy said:
it might just be that EMS involves violating a lot of the norms of behavior towards strangers, and that takes some time to get used to. Try to keep some of the sense that what you're doing is intrusive; it can help you respect patients.
Click to expand...

This is an excellent point. We as medical provider are required to do things on a regular basis that we were taught not to do to each other as kids (think causing pain to elicit a response) and it takes a while to get past that programming.
 
I used to constantly remind folks that if we did on the a street what we do on duty, we'd be in prison.
 
Hmmmm

MochaRaf said:
Let me ask you this, would you be hesitant to apply a traction splint to a deformed mid-thigh fracture knowing you will be causing more pain to the patient?

If you know anyone who has had to use one, you will know that the moment you pull manual traction on their leg the patient will scream due to the intense pain... But that is just necessary temporary pain which alleviates the pain and discomfort of the previous condition you had found your patient in. I know a few EMT's who were hesitant or refused to apply the traction splint for the discomfort it brings to the patient as you apply it.. But we need to have the patients best interest in mind, and we as EMS care providers know that by returning the leg in its anatomical position we are reducing the patients discomfort in the long run due to the multiple benefits the traction splint provides.
Click to expand...

I'm not entirely sure that I agree with this... Even with minor angulation and swelling, I've never seen this...
 
Luno said:
I'm not entirely sure that I agree with this... Even with minor angulation and swelling, I've never seen this...
Click to expand...

So you are saying that you have never seen a patient have their pain temporarily intensify during the duration that you pulled manual traction and re-aliged the leg in its anatomical positioning to immediate relive as soon as traction has been pulled?

I have never experienced it myself first hand, as I have never had a mid-shaft fracture. But from the patients own words they have all stated that the initial pull of the traction was a very intensive pain which once done properly immediately alleviated the previous pain.
 
No, I haven't seen their pain temporarily intensify, not to say it doesn't happen, or even to pull the straw that in the tens of splints that I've applied personally, they are anomalies. What I have observed is an decrease of pain or their pain maintains at the same level, but not a sharp increase. For a while, we had so many spiral femur fractures that we were spending the time trying to figure out how exactly these healthy adults were doing it, but then again, it's a story for another day... :D
 
OP, in this job we touch people. Sometimes it is holding their hand, sometimes their genitals; sometimes we will hurt the pts because of a treatment and other times not.

Fact of the mater is 9 out of 10 times they called because they wanted help (the other 1/10th is because somebody else called and now I have to intervene and you absolutely don't want anything to do with me).

You need to tell them what is what, "Mike, I am going to do an IV in your hand here, it is just this straw that will go into your vein, not the whole needle. It will hurt for just a minute but try not to clench or pull away"

(if they say no, then document it)

Or it could be...

"Dave if you try to get up off this cot again I am going to handcuff you to it by any means necessary."

Depending on where you work and the laws in your area you might have to go pretty hands on with some pts.

I am in an urban area and my protocols state that I can't leave somebody if they have an AMS. If you are drunk and altered you are legally required to go to the hospital (if I get involved). You either come willingly or the police come, place a hold, and then you are either forced into my ambulance or you walk into it. If you don't walk- we go hands on.

You will find that because you are in the medical field, people will allow you to look and touch pretty much anywhere- do it because it is your job to do so.


A few notes.... If you suspect a pelvic fracture and you are checking for crepitus don't push really hard... slowly increase your pressure until you are satisfied with your results.
Work with the pt as best as you can, but if you have to go hands on, then fully commit to it.
Most of the time just talk to the pt as you are doing stuff and let them know why you are doing it/concerned, what you find, and what might happen down the road for the pt.
 
You're going to hurt your patients.

It sucks. It really does but its necessary. If I know a move or treatment (such as a needle stick) is going to hurt a patient I make no bones about it. I tell them flat out this is going to hurt but I will do my best okay? Okay.

It's something you have to get used too and know that its not your fault they're in pain, you didn't cause their illness or injury or whatever. (unless you drop them and trust me that is a CRAPPY feeling but it happens.) You're there to provide your service.
 
There is a time to be gentle, a time to be firm, a time to just do what needs doing simply because you know that you'll cause your patient some pain, occasionally, a lot of it. Sometimes you must find a way to do all those things all at once. Never, though, be sadistic. There is never a time to punish your patients for things they did... or you think they did.

I'm most definitely a teddy-bear of a medic, but when I must do something that needs doing, I let my patients know what's coming and I "just do it" to the best of my ability to minimize their discomfort, if that's even possible.
 
If ya'll were interested in an update, I got about 40 IVs and blood draws under my belt now, even one en-route. One thing I have learned so far is that if you get a student at your station, keep them at the center of the action of every call. I only overcame my anxiety when I wasnt given a choice, and I had to face it and given constructive criticism of how to be better. Remember, you were once a student too.

Off topic, I think I want to change my user name....
 
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wannabeHFD said:
If ya'll were interested in an update, I got about 40 IVs and blood draws under my belt now, even one en-route. One thing I have learned so far is that if you get a student at your station, keep them at the center of the action of every call. I only overcame my anxiety when I wasnt given a choice, and I had to face it and given constructive criticism of how to be better. Remember, you were once a student too.

Off topic, I think I want to change my user name....
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That is a wonderful thing to hear. I think many of us remember how it was when we were students, and try to give advice bearing all of that in mind. For some of us, our knowledge has been so ingrained into us that we forget just what it was like to be a beginner. For those people, the stuff that is basic to them may sometimes be very advanced for the beginner. Sometimes the only way to get good experience is to be placed in that position where you must perform. Just remember that occasionally you learn more from your mistakes than you do from doing something right the first time.
 
Great job, keep at it. Hopefully the fact that you care about your patients that much will help you to become a better provider.
 
wannabeHFD said:
If ya'll were interested in an update, I got about 40 IVs and blood draws under my belt now, even one en-route. One thing I have learned so far is that if you get a student at your station, keep them at the center of the action of every call. I only overcame my anxiety when I wasnt given a choice, and I had to face it and given constructive criticism of how to be better. Remember, you were once a student too.

Off topic, I think I want to change my user name....
Click to expand...

Awesome. And good advice for preceptors; I had a bad habit of begging off things when I started working and I improved much more rapidly when I was forced to do the things that scared me.
 
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