Misdiagnosis May Have Been Death Sentence

[VentMedic]

How many Pt's have been DX with a certain disease or condition, by a Dr. Only to find out they were wrong!

This can be said of every person in the medical field. It all comes down to knowledge and experience. Know when to say to something and when not to.

Paramedics are not Rn's. Rn's are not Dr's and Dr's are not GOD! Every one has those people that have no clue about what is going on. They all also have great ones in every group.

I don't put all medics in a group as good or bad. I don't put all Rn's in a group as smart or stupid. I don't put all Dr's into a group as good or Gods. You judge them all on a one on one basis.

Tell me you have not known bad apples in all groups?

RNs and RRTs KNOW what they are allowed to discuss and not discuss with the patient. We also know what the physician wants disclosed about the patient's treatment plan until he/she has a chance to discuss it. As seen on the EMS forums, many in EMS don't receive the same quality training or read their P&Ps.

RNs and RRTs also work from off of a working or clinical diagnosis in many situations. The patient has a right to know the details of their care as long as it is not detrimental to the immediate situation. With experience you become a master at providing comfort and instilling confidence with few words while providing care. Talking to a patient is essential but choose your words carefully.

If anyone has read a physician's note on all of their differential diagnoses or tried to figure out what direction the diagnosis is taking by the diagnostics, you may find that one may never know the actual root cause of an emergent situation. It may takes days, weeks or even months to derive a conclusive definitive medical diagnosis and then it may not be a single diagnosis.

If a doctor messes up on the diagnosis, he/she has the education and diagnostic data to better explain how the diagnosis was derived. As I said before, there are many different diagnosis possibilities for the same signs, symptoms and even similiar diagnostic tests.

Humans are complex and it would be great if the only diseases out there were the few that are mentioned in a Paramedic text.

 

[mycrofft]

If I sent every chest pain to the hospital the jail would be empty.

If every chest pain at an ER was seen first, everyone would c/o CP. Does every hospital do CPK etc on every chest pain? And expect to get paid for it? Statistically speaking, chest pain being cardiac in origin is not as common as chest wall pain by a long shot, and I am guessing esophageal pain is more common, although closer. As I say, show me the bodies on the sidewalk, because 70% of MI's present as clinically dead (probably due to delay secondary to denial...or being told you have reflux....).

Meld your observation and vital signs with the hx, shake well in your head, open your mouth and reassure the pt unless you need to scare the whizz outta them to do as you say.

One clinical sign I never hear about, but have used, is the irregularly strong pulse. If you get stray systolics, go for an apical while you GENTLY plap the pulse. You are not unlikely to feel and maybe hear some pulses stronger or sounding different from others, maybe even stray systoles crowding up on others. Even if the pulse rythm is regular an EKG can be surprising at that point.

 

[reaper]

RNs and RRTs KNOW what they are allowed to discuss and not discuss with the patient. We also know what the physician wants disclosed about the patient's treatment plan until he/she has a chance to discuss it. As seen on the EMS forums, many in EMS don't receive the same quality training or read their P&Ps.

RNs and RRTs also work from off of a working or clinical diagnosis in many situations. The patient has a right to know the details of their care as long as it is not detrimental to the immediate situation. With experience you become a master at providing comfort and instilling confidence with few words while providing care. Talking to a patient is essential but choose your words carefully.

If anyone has read a physician's note on all of their differential diagnoses or tried to figure out what direction the diagnosis is taking by the diagnostics, you may find that one may never know the actual root cause of an emergent situation. It may takes days, weeks or even months to derive a conclusive definitive medical diagnosis and then it may not be a single diagnosis.

If a doctor messes up on the diagnosis, he/she has the education and diagnostic data to better explain how the diagnosis was derived. As I said before, there are many different diagnosis possibilities for the same signs, symptoms and even similiar diagnostic tests.

Humans are complex and it would be great if the only diseases out there were the few that are mentioned in a Paramedic text.

I never stated that there were not multiple Dx to a pt.

Please do not group all Rn's and RRT's into one group. While there are many out there that are excellent at what they do and have the knowledge to do their jobs. You also know that there are just as many that have no right treating a stray dog.

I will never defend Paramedics in a group. There are good ones and there are s***t ones. Same goes for Rn's,RRT's,PA's,RNP's and Dr's.

Just because the standard of education in a single group may be low or high, does not mean all are that way.

I did state that you need the clinical experience to know when to talk with a pt and when to divert a question. I do not disagree with you on that basis.

I just do not like all Rn's being grouped as educated and highly trained. All are not. Same way as all Paramedics are not undereducated and do not have the knowledge to treat a pt correctly.

I never mentioned anything about being able to fix a pt! I am a firm believer in continued assessment at a hospital, for any pt I treat. But it is not wrong or illegal for me to discuss a possible Dx and treatment with a pt, if I feel it will help in them deciding on continued care. That is part of our job as a Pt's advocate. We are to do everything legally within our power to get that pt to the care they need.

If a medic signed off a pt complaining of chestpain and sob, without doing everything in their power to convince them to go to the ED. Then they should be run out of the profession. As they do not have the best care of their Pt's in mind!

 

[VentMedic]

Please do not group all Rn's and RRT's into one group. While there are many out there that are excellent at what they do and have the knowledge to do their jobs. You also know that there are just as many that have no right treating a stray dog.
*********************
I just do not like all Rn's being grouped as educated and highly trained. All are not. Same way as all Paramedics are not undereducated and do not have the knowledge to treat a pt correctly.

Get off your high horse! My statements were NOT about who is better than who in what profession but what is SAID TO THE PATIENT and the many possibilties for diagnoses.

That is largely what the news article was about also.

RNs and RRTs are aware of what they can discuss to the patient and what they can not but it doesn't make them any less educated or professional than a Paramedic. There are not such clear boundaries in EMS and some do not fully understand what should, can and can not be said or the timing of saying it.

You can tell your patients whatever you want. Just remember that the other EMS agencies have their own medical directors to write the specifics for their P&P to which they must follow.

 

[reaper]

Get off your high horse! My statements were NOT about who is better than who in what profession but what is SAID TO THE PATIENT and the many possibilties for diagnoses.

I am not on a high horse! I am not stating who is better. I stated not to put blanket statements over a single profession.

That is largely what the news article was about also.

Rn's and RRTs are aware of what they can discuss to the patient and what they can not but it doesn't make them any less educated or professional than a Paramedic.

I never stated that it made them any less professional. Not all Rn's are aware of what they can and can't discuss with a pt. This comes with experience, unless they are programmed with a chip at graduation! A good Paramedic will learn this, the same way the Rn's do, no different!

There are not such clear boundaries in EMS and some do not fully understand what should, can and can not be said or the timing of saying it.

That is where the education and experience comes into play, in both fields.


You can tell your patients whatever you want. Just remember that the other EMS agencies have their own medical directors to write the specifics for their P&P to which they must follow.

I know that all agencies are different. I was responding to the blanket statement of " you will be fired or sued for talking to a pt about your Dx of the situation" It is up to each provider to know their services P&P's. It is also up to them to learn the when and why of talking to a Pt.

I did not make statements here to argue Medic vs RN. I just stated that I am tired of grouping together of a profession, when there is to much difference inside it!

 

[daedalus]

This is still a CNN worldwide headline.

Not good for our image people.

 

[rhan101277]

Yeah you have to be very careful what you say. How do you handle people, who constantly ask what is wrong with him? Just say I am not sure, we are going to get him to the hospital as soon as possible. The general public thinks that when an ambulance shows up that those are some of the best trained people available. People should try to live up to that standard by acting in a professional manner. I guess the best answer would be, I am not sure what is wrong with him/her, it could be serious or not a doctor will know for sure when we get to the hospital.