On a vaguely related note....
Love it!
Lock up. Feed the dog. Contact the day care centre looking after the kids. Organize respite for the frail husband...the disabled kid. Ring a relative for a lift home. We are potentially the only healthcare professionals in the spectrum of their care who will bridge the gap between home and hospital. Many of our patients spend more time one on one with us than they will with any other HCP. We have a unique opportunity to gain insight into psychosocial, socioeconomic, environmental and complex/mixed issues. As part of a compassionate and efficacious approach.
I've always said one of the most impressive things I saw as a student was not a multi-trauma or an arrest or an RSI but a nanna down...a mechanical standing height fall, with no injuries.
The crew returned the elderly woman to her chair & thoroughly assessed her for injury. Cool. Some providers stop there. Not this crew. They assessed her ability to perform activities of daily living and we chat over a cup of tea about her gradual and subtle, multifaceted decline over the previous six months. It was clear there were issues. The crew impressed me with the following:
- Went through the house correcting dozens of trip hazards.
- Educated the patient on the dangers of falls and the importance of prevention.
- Organised for an Occupational Therapist and district nursing service to assess the patient RE falls risk and evaluate the house in order to provide a number of aids (ramps, railing in the shower, steps etc). This included alerting a local program that provided free walking aids for these sort of issues.
- Called her GP, gained valuable information regarding the pt's medical hx and most importantly discussed her condition (with which the GP was not at all aware) & organized an appointment for several issues including a medication review and increasing mild depression.
- Called a family member and discussed the patient's loneliness, her falls risk and medical decline. The family had not been aware of this or the falls risks because the patient had been stoic. The family was more than happy to offer more support in a number of ways. A local family member was organised to come around after we left and take care of the patient in the short term.
- Eased her distress about having fallen, and had a long chat about her growing depression RE her loneliness and her difficulty in asking for help. Got the patient to recognize for the first time that this was a real problem that needed addressing. Pt agreed that this would be followed up by, and was discussed with, both her family and GP.
All of this of course after extensive assessment and discussion with, and permission from, the patient totaling over an hour's worth of scene time. It was a while ago and I feel like I'm missing something, but you get the gist. We left the woman in her own home, with especially appropriate referrals and followup, much happier, with a complex range of issues having been addressed or subject to a clear care plan.
The patient got what she wanted and what she needed. We didn't waste time, money or resources, either EMS or hospital. All of this was done sitting around a coffee table, drinking tea and chatting for over an hour. The cathartic experience of expressing these problems and the hope offered by making a clear plan to address them (where previously she had felt they were insurmountable) were absolutely invaluable. She said as much through tears as we left. An EMS bachelors degree as baseline education, which includes considerable elements of the above, shouldn't go without a mention but so much of this had to do with the obvious compassion of the crew.
That job stuck with me and went part of the way to inspire my strong interest in the combination of communication & genuine compassion with complex & multifaceted, less than traditional, primary care strategies.
What other stories have people of how they or others combined primary care, referrals and compassion to bring about a warm & fuzzy outcome?
