disheartened

[daedalus]

Today I was on a transport, from an urgent care to an outpatient imaging center. The patient was a middle-aged man with numbness in his posterior left thigh and a history of TIA. They wanted to CT his brain.

I like to learn as much as possible. I have found that people are more than willing to teach usually, but today I got a slap on the hand for even asking. We got to the imaging center and loaded the patient onto the table for the scan. When I went to take the gurney out of the room I asked the radiological tech if I could watch the images come up onto the screen because I thought that medical imaging was amazing. She looked at me like I was stupid and told me to leave the room because if i didnt it would be a HIPPA violation. I told her that it was my patient, and that the radiologist was going to have to give me a report on the outcome of the scan anyways so I could relay the information to the MD at the clinic, and that I had access to the patients entire chart and history anyways so there was no way it could be a HIPPA violation. She again told me to leave the room and made it clear I was to stay outside away from the control room for the entire process. This really ticked me off. First since the patient was never signed over to the imaging center, he was still MY patient, and as such, I was in charge of the patients care. I have to remain in full view of the patient the entire time he is in my care, per company policy and common sense. I was in my right mind to demand so, but decided it was in the best interest of the patient just to have the scan done and get back to his doctor. I thought it was rude and I felt like a piece of poop.

Am I wrong in this? Should I not feel offended and is this normal in the medical field? Than how am I supposed to learn?

 

[akflightmedic]

Yes, you were out of line with your feelings/emotions.
Yes, the Rad tech could have been kinder but did act within their right.

First, as stated before in other thread, school and the forms which you and everyone signs, it is HIPAA, not HIPPA.
Personal pet peeve obviously; as its been an actual law sine 1996 and had been debated since 1986; just may be time to start spelling it right.

You asked how are you supposed to learn? The answer is simple. Go back to school.
Please show me where CTs/MRI's, etc are part of the EMT on the job training.

Did you ever consider the tech was having a bad day, or just got a bad vibe from you despite your positive demeanor and how you informed her/him it was well within your right because you were going to get a full report anyways? Trying to play one oneupmanship to obtain your goal backfired as you did not get to see the actual images come out originally. You only got a summarized report.

Yes, the tech was an idiot for claiming it was HIPAA violation, but maybe that was the only excuse they had at the moment other than saying they really do not feel like having you hover over them while they do their job, or maybe they just did not feel like teaching/mentoring that day. You are not a student and it is not their job to do so.

In addition, the eyes on the patient thing is a wee bit overkill. It is not "YOUR" patient as you are not the only singular source involved in this patient's care. The patient belongs to a team of medical professionals, such as the rad tech and for whom the most part have way more education and experience than yourself. Most rad centers and their staff are ACLS certified and equipped, therefore they could recognize the most immediate threat which you are alluding to and provide proper care while awaiting ALS ambulance personnel.

So, since you asked, that left it open for my interpretation and opinion. Yes, your emotions got the better of you and you feel insulted and wanted your story heard. I have heard it and think you were wrong but did the right thing by letting the procedure get done and over with despite it taking you being told twice to leave the room.

If you spend another minute thinking about this and getting personally upset, you may need to go to the store and buy some thicker skin. Other than that, this may be the first time this has happened to you, but I assure you it will NOT be the last!

 

[VentMedic]

Yes she could have been nicer but patients do have a right to privacy that has nothing to do with HIPAA. We even ask family members to leave the room when doing an ECG.

There could be a chance that you might also learn something about the patient's condition before the doctors can do further examination and discuss it with the patient. Unfortunately we have seen that happen where speculation about the patient's disease is given out before confirmation.

However, that is not to say it will be like this every time and all the time. If you transport there again and have a slightly different approach, you may be invited to stay.

 

[daedalus]

Yes, you were out of line with your feelings/emotions.
Yes, the Rad tech could have been kinder but did act within their right.

First, as stated before in other thread, school and the forms which you and everyone signs, it is HIPAA, not HIPPA.
Personal pet peeve obviously; as its been an actual law sine 1996 and had been debated since 1986; just may be time to start spelling it right.

You asked how are you supposed to learn? The answer is simple. Go back to school.
Please show me where CTs/MRI's, etc are part of the EMT on the job training.

Did you ever consider the tech was having a bad day, or just got a bad vibe from you despite your positive demeanor and how you informed her/him it was well within your right because you were going to get a full report anyways? Trying to play one oneupmanship to obtain your goal backfired as you did not get to see the actual images come out originally. You only got a summarized report.

Yes, the tech was an idiot for claiming it was HIPAA violation, but maybe that was the only excuse they had at the moment other than saying they really do not feel like having you hover over them while they do their job, or maybe they just did not feel like teaching/mentoring that day. You are not a student and it is not their job to do so.

In addition, the eyes on the patient thing is a wee bit overkill. It is not "YOUR" patient as you are not the only singular source involved in this patient's care. The patient belongs to a team of medical professionals, such as the rad tech and for whom the most part have way more education and experience than yourself. Most rad centers and their staff are ACLS certified and equipped, therefore they could recognize the most immediate threat which you are alluding to and provide proper care while awaiting ALS ambulance personnel.

So, since you asked, that left it open for my interpretation and opinion. Yes, your emotions got the better of you and you feel insulted and wanted your story heard. I have heard it and think you were wrong but did the right thing by letting the procedure get done and over with despite it taking you being told twice to leave the room.

If you spend another minute thinking about this and getting personally upset, you may need to go to the store and buy some thicker skin. Other than that, this may be the first time this has happened to you, but I assure you it will NOT be the last!

No, no I appreciate the honesty, and it actually makes me feel better to know all of this. While its a simple request to watch a CT scan, I also hate it when people like to help me with my job when there is no need.

The only thing I have to rehash is that if something happened to the patient, such as a bad reaction to the dye, im sure it would still be my butt on the line as the patient was still under my partner and myself's care. I would hope that any mistakes made by the ACLS persons there would not be reflected onto me. But thats a long shot.

 

[akflightmedic]

No I do not think you would be liable. I am assuming you are a BLS crew and as such, once you gave the patient to the rad tech, they are a higher level of care. They are prepared to deal with dye reactions. Your presence is not going to change the situation if it occurs.

How would you even be remotely liable if the patient has consented for treatment, the diagnostic center is performing above your education and scope, and you think you are liable cause you didn't maintain eyes on the patient??

I think you may need to reevaluate a few of these issues within yourself and come to a different understanding of your role within these types of situations, if they should occur in your presence or under your watch.

And Vent as usual touched o a very good point, which I have witnessed myself. I have seen both EMTs and Medics get a little nugget of information and absolutely run with it. They tell the patient what they know on the return trip, before the doctor or anyone else has had chance to analyze it and discuss it with the patient. This is detrimental to the patient's well being and detrimental to us calling ourselves a "profession".

 

[VentMedic]

The only time you might be asked to stay is if you are ALS or part of a CCT where it is your equipment and your meds going into the patient for sedation. Then, you might be considered a primary care giver.

Often, if the procedure has any wait time or will take 30 minutes or more, that crew leaves and another crew will arrive for the return. Or, if they do wait, they often will go to the cafe across the street for a break. Only a few have actually wanted to hang out and observe. I have even offered to have them observe a test (with the patient's permission) such as a Pulmonary challenge on a treadmill or a High Altitude Simulation but few take me up on it if they know there is something else that might be more exciting like food. Of course, for some of the crews that I see many times during the day, I do understand that.

 

[daedalus]

I'm sure that an overzealous attorney could find liability in anybody near the room. Like I said, Im not concerned. I would also hope that EMTs and Paramedics would know the limits of their roles, and not give the patient their interpretation of diagnostic studies above their level of training. I have more common sense than that.

 

[daedalus]

The only time you might be asked to stay is if you are ALS or part of a CCT where it is your equipment and your meds going into the patient for sedation. Then, you might be considered a primary care giver.

Often, if the procedure has any wait time or will take 30 minutes or more, that crew leaves and another crew will arrive for the return. Or, if they do wait, they often will go to the cafe across the street for a break. Only a few have actually wanted to hang out and observe. I have even offered to have them observe a test (with the patient's permission) such as a Pulmonary challenge on a treadmill or a High Altitude Simulation but few take me up on it if they know there is something else that might be more exciting like food. Of course, for some of the crews that I see many times during the day, I do understand that.

It was a wait and return, and the scan was to take less than five minutes. We would be transporting back, and watching a CT scan is more exciting than standing in a white hallway feeling like your being put into time out.

 

[VentMedic]

It may not even be directly to the patient but an "informal" report to the clinic or NH before the final reading is done can be misused.

Even in the hospital, whatever is viewed at first glance in the technician room by even a physician is not a true read until it is examined closer so things are not misinterpreted or missed. The Radiology Technicians know the rules and even if they see something glaring out at them, they are tight lipped. We respect that as healthcare professionals and do not take offense. However that is not to say that they may not "clear their throat" when something pops up to get our attention. Usually it will be something we suspected and can easily identify.

 

[Sasha]

She could have been nicer, but its entirely within her right to decline as it is your patients right to say no if he or she so wished.

What are you really hoping to learn from a CT? What a brain bleed looks like? General knowledge is good, but its not going to help you be a better EMT or Medic in the long run, if you are really curious you would be better looking it up on the internet.

 

[KEVD18]

she was correct in her action, but could have softened the edges a little.

the only report they need to give you is "the patients condition is unchanged. vital signs remain stable and the patient has no complaints." they will transfer a copy of the scan results/fils/cd etc if it is done prior to your departure. they are under no obligation to actually explain the scan and its findings to you. we don't qualify to enter in the conversation with a radiologist. regardless of how many episodes of house you watch, you cant read an mri.

bottom line is, regardless of how you feel on the matter, you're neither qualified not entitled to stand over the techs shoulder.

don't mean to come off as an ahole here, but probably my biggest pet peeve in this business is people not realizing their place. we, as basic emts(or even medics), are at the bottom of the food chain in the medical field. that's not a bad thing, but it is what it is.

 

[Onceamedic]

First of all, I commend your general curiosity. That is a good trait. Don't ever lose it. The tech was rude. People often are and it has nothing to do with you, but rather your role in the health care system. When you're curiosity is rebuffed enough by people who don't want to give you the time of day, hopefully you will be motivated to increase your level of training and learn more. Be a medic. Not only will you learn lots of great new stuff, but people will answer more of your questions for you. You will have earned the right to get more than the kiss off when you ask questions about things that are beyond your scope. If you cannot afford the time/money, whatever to go be a medic, then keep asking questions but don't get offended when other health care professionals tell you to kiss off.

 

[VentMedic]

What are you really hoping to learn from a CT? What a brain bleed looks like? General knowledge is good, but its not going to help you be a better EMT or Medic in the long run, if you are really curious you would be better looking it up on the internet.

I have always encouraged one to familiarize themselves with as many aspects of medicine as possible. You never know what you might learn or who you might network with for a future reference. That is how I got introduced to Respiratory Therapy as a second career. Those who get a very narrow focus of just their limited view of medicine are the ones who constantly complain their "scope of practice is too limited". Or, they are the ones on the forums bashing other professionals because they know no other medical professionals and their job descriptions outside of their ambulance.

If you have ever taken any college level A&P classes or plan to, this is a great way to see a fantastic view of anatomy through diagnostics. It also puts into perspective what is meant by some of those things you read in the chart like "shift". It will also make you aware of certain lab values, disease history and kidney function if dye or contrast is used.

I hope this doesn't discourage daedalus from continuing his quest to see and learn more. It might even be a great challenge to learn how to perfect one's approach to read and handle just about any personality type be it a patient or another medical professional.

Seize the opportunities as they present and don't stop learning!

 

[daedalus]

she was correct in her action, but could have softened the edges a little.

the only report they need to give you is "the patients condition is unchanged. vital signs remain stable and the patient has no complaints." they will transfer a copy of the scan results/fils/cd etc if it is done prior to your departure. they are under no obligation to actually explain the scan and its findings to you. we don't qualify to enter in the conversation with a radiologist. regardless of how many episodes of house you watch, you cant read an mri.

bottom line is, regardless of how you feel on the matter, you're neither qualified not entitled to stand over the techs shoulder.

don't mean to come off as an ahole here, but probably my biggest pet peeve in this business is people not realizing their place. we, as basic emts(or even medics), are at the bottom of the food chain in the medical field. that's not a bad thing, but it is what it is.

I do not expect to read the CT, merely fascination with the concept of a machine looking into the body without opening it. Who knows, it could convince me to go into radiology or turn me away from it. I think its good to see other aspects of medicine other than what we see in or use in the field. It gives us a more worldly view of medicine. Just because the endocrinologist does not preform cardiac surgery, he should have at least observed one in his training as a doctor. I am indeed going to medic school, next fall, and right now I am working on a BA in anthropology so I can further my medical education even further if I choose to go to a mid level or MD school. So yes, I do plan on going to school, but I do not see much of a problem with probing a bit on the way (in moderation I think curiosity is a good quality).

 

[Sasha]

I agree that you should always want to learn, but to get so disheartened and feel bad because a tech didnt want you in the room for a CT? Is what you are trying to learn from it THAT important that you cant go look it up yourself? That you have to take it soo personally? There isnt much you can learn from a CT unless you know whats going on, and what to look for. Maybe Im missing something because I dont find them particularly interesting (I actually find a significant shift to be more sad than exciting) but I dont see what the big deal is.

She was rude, but I guarentee you a lot of medical professionals, like in any other profession, are going to be rude to you.

 

[KEVD18]

I do not expect to read the CT, merely fascination with the concept of a machine looking into the body without opening it. Who knows, it could convince me to go into radiology or turn me away from it. I think its good to see other aspects of medicine other than what we see in or use in the field. It gives us a more worldly view of medicine. Just because the endocrinologist does not preform cardiac surgery, he should have at least observed one in his training as a doctor. I am indeed going to medic school, next fall, and right now I am working on a BA in anthropology so I can further my medical education even further if I choose to go to a mid level or MD school. So yes, I do plan on going to school, but I do not see much of a problem with probing a bit on the way (in moderation I think curiosity is a good quality).

theres nothing wrong with always seeking mroe knowledge. but part of knowing your place is knowing when you're not welcome.

"hey do you mind if i watch"?
"no".
"ok. i'll be in the hall". done deal. from your post, you lingered and argued, at least for a short time. this is where the wheels fell off. now your getting in the way, making a scene and trying to float your basic card as a golden ticket.

ive been in the control room for imaging, radiation etc. ive also been told to wait in teh waiting room. neither had much affect on me.

 

[reaper]

Blow this one off and try again next time. The more the staff gets to know you, the more willing they will be to let you watch.

I get asked all the time, if I would like to see a scan. If I bring in a stroke pt, I like to find out what is going on. I get to know the techs and bs with them all the time. Once they feel comfortable with you, they will let you in.

The hospital is like a city with little gangs everywhere. You have to earn the confidence and respect of each gang. Then you will be aloud to hang out with them. Same goes for the Rn's, trauma teams,lab techs, RTT's and admin staff. Get to know them all and they will help you in the long run.

Don't lose heart, it can take a while and with some it will take bribing. Find out what they like.

 

[daedalus]

ive been in the control room for imaging, radiation etc. ive also been told to wait in teh waiting room. neither had much affect on me.

Now thats where your wrong. When they told me to wait in the hall, I was going to wait in the hall. I shot back comments when I was told it was a HIPAA violation. Thats crap, I deal better with the truth. Also, if you look into my posting Hx, you would see that I have no qualms with admitting -Basic education is crap.

 

[daedalus]

she was correct in her action, but could have softened the edges a little.

the only report they need to give you is "the patients condition is unchanged. vital signs remain stable and the patient has no complaints." they will transfer a copy of the scan results/fils/cd etc if it is done prior to your departure. they are under no obligation to actually explain the scan and its findings to you. we don't qualify to enter in the conversation with a radiologist. regardless of how many episodes of house you watch, you cant read an mri.

bottom line is, regardless of how you feel on the matter, you're neither qualified not entitled to stand over the techs shoulder.

don't mean to come off as an ahole here, but probably my biggest pet peeve in this business is people not realizing their place. we, as basic emts(or even medics), are at the bottom of the food chain in the medical field. that's not a bad thing, but it is what it is.

BUT I watched a whole season of House, I should be able to use a CT scanner by myself

 

[VentMedic]

That you have to take it soo personally? There isnt much you can learn from a CT unless you know whats going on, and what to look for. Maybe Im missing something because I dont find them particularly interesting (I actually find a significant shift to be more sad than exciting) but I dont see what the big deal is.

But, few EMTs with 110 hours of training really know what a CVA or Stroke is except for the very few paragraphs in an EMT book. They toss the word around without actually knowing the anatomy and physiology aspect of it. Many also don't always have a full understanding about how disease processes are diagnosed or what lab values are all about and just believe, as evidenced by some scenarios, that they can guess what is wrong with the patient by the assessment outlined in their text book. Rarely is it emphasized about field or working diagnosis vs differential and definitive diagnosis.

It is also interesting to see how certain head injuries or disease processes are treated. You may see the same or similar patient later on a SNF, NH or Rehab transport and be amazed at what medicine can accomplish.

Few EMS providers take advantage of such opportunities so their knowledge is often very fragmented when it comes to medicine. Many of these EMTs may become Paramedics and might even want to do CCT someday. Those that paid attention on all of those routine transport and became familiar with a broad spectrum of processes and procedures will have a much easier time than someone who thinks a simple overview class and a patch makes their knowledge sufficient. Those that paid attention will always be looking for the "rest of the medicine story" and not just some numbers with a diagnosis.

Another thing to remember, hospital or outpatient staff try to prioritize and fit as many patients as possible into one scanner. Just like when you feel a little pressed for time when your dispatcher says "calls holding", these technicians will have patients, RNs and MDs screaming at them about getting a test done STAT. In the hospital a STAT CT may arrive and the RT has to do a quick turn around on the pt in the scanner and explain to another MD why their STAT pt is getting bumper. Sometimes when I am with a patient in CT, I will hear the RT get chewed by at least 3 different MDs, RNs or patients about their test schedule in just the feew minutes we are there. The ICU RN and I have even found a parking spot with a high pressure O2 connect for the ventilator and electrical outlet for the pumps if our patient is stable just to help the RT out of a jam and we have no place else to be.

Note:
RT - Radiology Technician
RRT - Registered Respiratory Therapist

The HIPAA was not correct from the RT but every state has certain privacy and confidentiality statutes that must also be respected. A patient does have the right to have their test done with as few on lookers as possible. That part is strictly stressed in all procedures done in the clinics and hospitals. It has nothing to do with you. This RT could have been severely reprimanded in some facilities if privacy rights (NOT HIPAA) are not observed. Of course some facilities are more lax than others and some have gotten slapped for violations (again, NOT HIPAA).

If you were to look at the followup "how did we do" questionaires sent to patients, especially out patient facilities, you will notice a question(s) about privacy on there.