Feedback to EMS from ED physicians - another perspective

[Aidey]

There are many definitions for "subservient".

Given the generally positive tone of the author's article and his apparent good faith, I do not think it reasonable to automatically assign the most negative possible meaning to his intent.

There might be many definitions, but the obey unquestioningly is the primary definition in the couple dictionaries I looked at. If he meant something besides obey unquestioningly he should have used another word.

His comment about giving the public better heros than the empty headed idiots didn't come off as very positive either, which probably contributed to my interpretation of his use of subservient.

Even if he didn't mean obey unquestioningly, that is how it is being interpreted, and not just by people on this forum. It was a very bad choice of words.

 

[Arovetli]

i think Veneficis or one of the other doctors gave that number, but it wasn't anywhere near 80%... Again, I didn't find a the source, but 80% still seems like a high number.

It is not a global number or one to be broadly applied. It comes from a community hospital I know of with good outpatient/snf connections and in a town where there is an academic medical center that gets all the bs ambulance runs.

Still, just to see that in some cases there really is big bucks coming from EMS.

However disregard that number and think of how many sepsis, stroke, trauma and MI patients EMS brings. Those are big money patients.

 

[ah2388]

This thread is awfully disappointing.

I read this article a few hours prior to discovering this discussion.

There is a responsibility on both sides of the fence here to desire more from EMS providers. I find it troubling that so many on this forum seem to have "written off" what is largely a group of dedicated healthcare providers.

There are some within this discussion group that by their own admission have never worked in EMS, but are surely involved at some other level during the course of a patients care. I find it disturbing that those I've described are so critical of the performance of providers they couldn't possibly pretend to know nor understand.

It might sound like I am making excuses for the shortcomings in the EMS systems being discussed (and surely they exist). I would agree that it probably comes across that way, but my intent is to convey the idea that we must ALL take responsibility for a patient's care.

Pre-hospital providers work in a challenging environment, a dynamic which is only compounded by a seeming lack of willingness to elevate entrance and continuing educational standards. I consider myself to be pretty observant, and notice regularly the egos which present at various levels of medicine. There is no level I can think of that is not guilty of presenting whether it EMS, nurses, physicians, administration, etc.

Learning and Ego's do not co-exist well in medicine. It is far to easy to be critical of an event or trend and do little to nothing to change it or prevent it. Our patient's deserve better. We are critical because we care, but why not translate that feeling into something constructive.

As it relates to this specific instance, I think Skip Kirkwood hit the nail on the proverbial head. If we invest a bit in the positive, it goes a long way to breaking down the walls that allow us to comfortably provide constructive feedback.

 

[Akulahawk]

This thread is awfully disappointing.

I read this article a few hours prior to discovering this discussion.

There is a responsibility on both sides of the fence here to desire more from EMS providers. I find it troubling that so many on this forum seem to have "written off" what is largely a group of dedicated healthcare providers.

There are some within this discussion group that by their own admission have never worked in EMS, but are surely involved at some other level during the course of a patients care. I find it disturbing that those I've described are so critical of the performance of providers they couldn't possibly pretend to know nor understand.

It might sound like I am making excuses for the shortcomings in the EMS systems being discussed (and surely they exist). I would agree that it probably comes across that way, but my intent is to convey the idea that we must ALL take responsibility for a patient's care.

Pre-hospital providers work in a challenging environment, a dynamic which is only compounded by a seeming lack of willingness to elevate entrance and continuing educational standards. I consider myself to be pretty observant, and notice regularly the egos which present at various levels of medicine. There is no level I can think of that is not guilty of presenting whether it EMS, nurses, physicians, administration, etc.

Learning and Ego's do not co-exist well in medicine. It is far to easy to be critical of an event or trend and do little to nothing to change it or prevent it. Our patient's deserve better. We are critical because we care, but why not translate that feeling into something constructive.

As it relates to this specific instance, I think Skip Kirkwood hit the nail on the proverbial head. If we invest a bit in the positive, it goes a long way to breaking down the walls that allow us to comfortably provide constructive feedback.

I would suspect that many times, the "damage" was done by those who came before us and poisoned the well from both sides of the ED doors. No matter who started the problem, it's going to take a LOT of effort to undo that.

 

[ah2388]

I would suspect that many times, the "damage" was done by those who came before us and poisoned the well from both sides of the ED doors. No matter who started the problem, it's going to take a LOT of effort to undo that.

No doubt, but given the challenges many have faced..the hill isn't that high

Get to it!

 

[Carlos Danger]

There are some within this discussion group that by their own admission have never worked in EMS, but are surely involved at some other level during the course of a patients care. I find it disturbing that those I've described are so critical of the performance of providers they couldn't possibly pretend to know nor understand.

I am curious which of those who've commented on this thread have also admitted that they never worked in EMS?

Also, even if some here haven't done EMS, is it really necessary for someone to have done someone else's job in order to have expectations of that person, or to be able to relate to them professionally?

I interact with people everyday whose job I've never done, but I don't think that makes it wrong of me to have certain expectations of those people.

By the same token, the vast majority of my patients don't do (or really even know) what I do, yet they certainly have plenty of right to expect a certain level of performance from me.

 

[Christopher]

I am curious which of those who've commented on this thread have also admitted that they never worked in EMS?

Also, even if some here haven't done EMS, is it really necessary for someone to have done someone else's job in order to have expectations of that person, or to be able to relate to them professionally?

I interact with people everyday whose job I've never done, but I don't think that makes it wrong of me to have certain expectations of those people.

By the same token, the vast majority of my patients don't do (or really even know) what I do, yet they certainly have plenty of right to expect a certain level of performance from me.

As you rightly note, it really doesn't matter whether somebody has worked in EMS or not, or even if they regularly interact with EMS.

The observations (generous; nb: read as "rant") made by the author in his article are then generalized to all that ails EMS.

In the area I work the issues raised are the problems of yester-decade. It really made the article hard to accept as any useful starting point for dialog.

I've made this point a few dozen times elsewhere, on varying topics, but if you do not have proper oversight for any organization then you will most assuredly have problems. Perhaps the author has never been to a "community access hospital", because he'll see the same problems he saw with the EMS crews.

What was he really asking for?

- Closed loop feedback? Yep, that's a pretty integral part of any system of care.
- Collaboration among interfacing organizations? Yep, that's pretty standard.
- Clear identification of cross-cutting responsibilities? Yep, that's pretty standard too.

I'm not sure what the author was trying to point out that is new about "problems with EMS". They were all old news or straight up sentinel events for any component of the healthcare system.

All I learned was he really needs to sit down with the stakeholders in his system and work to get them back onto the same page: consistent patient care from activation of 911 through discharge home and followup.

 

[Brandon O]

The compelling part of the essay, and the chief reason I linked it, was the physician's description of the economic and administrative disincentives to risking complaints from EMS. His point is that perhaps EMS has a privileged position, able to control the flow of customers/patients to the hospital.

This influence, good or bad, is one of the only effective methods we typically have for promoting change from our ED colleagues when they're reticent. Like most things, it should be managed and there's potential for abuse, but I'd hate to imagine a world without it.