Achilles
Forum Moron
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Pt w a Dr for a wife??
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DesertMedic66
Forum Troll
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You got T-boned and your partner kept driving? cough cough Hit and Run cough cough
NomadicMedic
I know a guy who knows a guy.
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Ok. Admittedly my reply was a bit harsh, but I find the OPs unapologetic tone ridiculous.
Maybe if it were phrased like this, "a few years ago I had a call that could have gone better... Here's what I did..."
Maybe then I would have looked at it differently. Instead, I see a guy who appears to see nothing wrong with any of the issues that were pointed out and gets defensive when asked how he would behave today, with more experience and education under his belt.
The majority of the job as an EMS professional is to serve as a patient advocate. That is job #1. If you're doing the right thing for the patient, without ulterior motive, you're doing the right thing. If you can't do that, well... I guess you'll have to stick with referring to a concerned patient's wife as a "Douche" and try to rationalize your poor behavior on an Internet message board.
Maybe if it were phrased like this, "a few years ago I had a call that could have gone better... Here's what I did..."
Maybe then I would have looked at it differently. Instead, I see a guy who appears to see nothing wrong with any of the issues that were pointed out and gets defensive when asked how he would behave today, with more experience and education under his belt.
The majority of the job as an EMS professional is to serve as a patient advocate. That is job #1. If you're doing the right thing for the patient, without ulterior motive, you're doing the right thing. If you can't do that, well... I guess you'll have to stick with referring to a concerned patient's wife as a "Douche" and try to rationalize your poor behavior on an Internet message board.
OP
OP
911fixer
Forum Probie
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Just because i mentioned she was a douche, does not mean i disrespected or treated her wrong in any way. I was polite w everything i said .. in case u missed the whole i was afraid to lose my job or the company contract part. I was walking on eggshells w this guys wife.. i did know his pmh, why he was there to begin with. And ya pts or proxys can request a facility within reason, and furthermore chest pain as a basic as far as i was trained at the time should always be considered a cardiac problem, until proven otherwise by a higher level of care. And as for the hit and run.....we were hit and the other guy took off, but he also called our dispatch and everything was taken care of.. so there are parts of this lil episode that may have been left out...so the people that are trying to make it seem like i dont know how to do my job, or how to treat people and there families, are wrong to even try to judge me, nobody on here knows me from a hole in the wall.. i have had numerous letters and cards of thank you sent to a few different employers for treating people w respect, reguardless if the call or outcome,....as a matter of fact even this 94 year old guy on this call thanked me for everything...his 46 year old wife started w the attitude, my partner and i were very professional. And nobody on here was there so thats that.. u dont know as much as u may think fellas
Achilles
Forum Moron
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Anybody watching Full House right now? That always calms me down 
h34r:
h34r:
VFlutter
Flight Nurse
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You are right, we were not there ourselves nor do we know you personally. But you posted a scenario on an Internet forum. Like it or not you are going to be judged. Not only are we going to judge the scenario but also the way you present yourself, your grammar, and your vocabulary. To be quite honest regardless of the scenario the way you presented yourself was atrocious. All of your posts sound highly unprofessional.
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I see this as a crew who put their own concerns ahead of the patient's.
You failed to remember this woman was the patient's wife and probably his sole support for emotional care. You and your partner both chose to argue and disrespect the patient's wife in front of him which shows little concern for his chest pain.
The hospital staff is also at fault when they allowed you to conduct yourself in an unprofessional manner over the patient. They threw her out without getting any information from her when she probably was his DPOA. The nurse who looked up the wife's credentials in the computer is clueless to the fact that hospital databases will list the services the physician is allowed within the hospital and not their life's achievements. This was the patient's WIFE. Yes she identified herself as a doctor just the same as most EMTs and Paramedics identify themselves when the hospital cares for a family member. Some EMTs and Paramedics always show up in uniform to visit their family member even when off duty. We don't throw them out although we may make them wear a gown over their uniform if they had been working with patients all day.
You failed to remember this woman was the patient's wife and probably his sole support for emotional care. You and your partner both chose to argue and disrespect the patient's wife in front of him which shows little concern for his chest pain.
The hospital staff is also at fault when they allowed you to conduct yourself in an unprofessional manner over the patient. They threw her out without getting any information from her when she probably was his DPOA. The nurse who looked up the wife's credentials in the computer is clueless to the fact that hospital databases will list the services the physician is allowed within the hospital and not their life's achievements. This was the patient's WIFE. Yes she identified herself as a doctor just the same as most EMTs and Paramedics identify themselves when the hospital cares for a family member. Some EMTs and Paramedics always show up in uniform to visit their family member even when off duty. We don't throw them out although we may make them wear a gown over their uniform if they had been working with patients all day.
Ace 227
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As has been said several times, it is the patients right to go to whatever facility they choose, within reason. If you truly felt that it was critically detrimental to your pt's condition to go 15 miles out of the way, have the pt or his wife sign a refusal form specifying they are refusing transport to hospital y.
I know you said you don't remember the exact values but what were his vitals like? Stable? WNL? If your pt was stable, perfusing well, and without apparent dyspnea or immediate life threats, then I see no reason why you needed to run this call in emergent or why you couldn't wait for ALS and let them deal with the wife.
As a paramedic now, why not address how you would handle the call differently? I find it a little odd that you refused to and a little odd that this call was from "10 years ago".
Also, maybe I'm expecting too much, but I would think in the world of computerized PCRs that your grammar, spelling, and punctuation would be a little better, regardless of what you are typing on. Paragraph formatting is helpful as well.
I know you said you don't remember the exact values but what were his vitals like? Stable? WNL? If your pt was stable, perfusing well, and without apparent dyspnea or immediate life threats, then I see no reason why you needed to run this call in emergent or why you couldn't wait for ALS and let them deal with the wife.
As a paramedic now, why not address how you would handle the call differently? I find it a little odd that you refused to and a little odd that this call was from "10 years ago".
Also, maybe I'm expecting too much, but I would think in the world of computerized PCRs that your grammar, spelling, and punctuation would be a little better, regardless of what you are typing on. Paragraph formatting is helpful as well.
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MarshalFoch
Forum Ride Along
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Similar to the OP, I work BLS in Massachusetts in and around the Boston area. I know my company has a protocol system for where you can transport someone to, and what you need to do or document if you deviate from that. Any hospital within 20 minutes is acceptable, if it is appropriate. And I can tell you that in the Boston area almost any hospital is within 20 minutes unless it is going from south of the city to north or west.
If the desired hospital is further than 20 minutes away, the patient must have one of a few reasons listed to need to go there. One of those reasons can be that the hospital has the patients information and doctors familiar with them (in other words, their preferred hospital) and you must call medical control. So there is no situation in which you cannot transport someone to their preferred hospital unless they need some form of care it can't provide that another facility can, you just have to call medical control. I don't know about all the companies in the area, but from what I've been told by others who work there at least two of the other large ones have the same policy.
I don't know the particulars of the case the OP posted, but I find it hard to believe they could have wanted to go to a hospital that much further away. That being said, because of all the hospitals in the region it can make you feel uneasy to transport past what can easily be several facilities to go to a preferred one when so many private companies stress CYA.
Still the first and often most important BLS skill is customer service, and in this case the crew performed poorly from the description. Patients will sometimes want to go somewhere other than the nearest facility, and almost all of the time it is not a problem. The few times it has been an issue, it has been easy to diffuse by simply and calmly explaining to them why I believe hospital X is a more appropriate choice than hospital Y, not just saying "My protocols". Think of how that sounds to someone hearing it, that is their loved one you are caring for and OEMS protocols or company policies are simply not an excuse they are going to take for an answer. I haven't had it happen but if that didn't work then there is always medical control, and if medical control agrees with the patient then wonderful, I've absolved myself and are deferring to a higher medical authority. If not, just the title doctor usually makes people on the phone a lot more amenable. That is what my protocols say.
DrParasite
The fire extinguisher is not just for show
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are you kidding? tell her to GTFO, if she wants to treat the patient, you can go home. otherwise, get out of the way and let you do your job.
Actually, there are quite a few ways to handle the call. first off, once you get involved in an MVA, you are OOS. call another ambulance. don't transport, unless you have the consent of law enforcement and your agency supervisor.
Treat the wife as the patient's wife. She is obviously emotionally attached to her husband, so she will function as a wife more than a doctor. that's also why most doctors have ethical rules about treating family members. so while you can probably get away with ignoring her medical commands, as the spouse she has certain expectations.
Remember, when it comes to an issue with you or maintaining a contract, a private company will fire you in a heartbeat, even if you are right, even if you did nothing wrong, even if the complaint is you hurt someone's feeling, or they inferred an offense that wasn't there.
Other than that, treat the patient to the best of your ability, following your protocols as best as you can. Make the patient leave happy, make the family be happy with you.
When in doubt, call a supervisor to the scene. that's what they get paid the big bucks for. Sometimes just having a supervisor there can help diffuse a situation. Plus they have the operational authority to deviate from your normal protocols, or back you in enforcing the existing ones.
Actually, there are quite a few ways to handle the call. first off, once you get involved in an MVA, you are OOS. call another ambulance. don't transport, unless you have the consent of law enforcement and your agency supervisor.
Treat the wife as the patient's wife. She is obviously emotionally attached to her husband, so she will function as a wife more than a doctor. that's also why most doctors have ethical rules about treating family members. so while you can probably get away with ignoring her medical commands, as the spouse she has certain expectations.
Remember, when it comes to an issue with you or maintaining a contract, a private company will fire you in a heartbeat, even if you are right, even if you did nothing wrong, even if the complaint is you hurt someone's feeling, or they inferred an offense that wasn't there.
Other than that, treat the patient to the best of your ability, following your protocols as best as you can. Make the patient leave happy, make the family be happy with you.
When in doubt, call a supervisor to the scene. that's what they get paid the big bucks for. Sometimes just having a supervisor there can help diffuse a situation. Plus they have the operational authority to deviate from your normal protocols, or back you in enforcing the existing ones.
NomadicMedic
I know a guy who knows a guy.
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I'm assuming you're just kidding about the "tell her to GTFO" ...
You are just kidding, right?
You are just kidding, right?
DrParasite
The fire extinguisher is not just for show
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oh absolutely. total joking and that should not be taken literally by anyone who wants to maintain their employment at their current position.
damn, should have made that clearer....
Sublime
LP, RN
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I feel like the OP has been over criticized in this thread.
Although I also feel like some things are kind of strange... such as you saying you're now a paramedic and this was an old scenario that happend while you were a basic, but you're just now posting this and can't provide an explanation of how you'd handle it now. And also you were t-boned on the way but still continued to the hospital...? And you could of presented it better but oh well.
To me it seems like you were just an inexperienced emt-b (which only gives you so much knowledge on how to properly handle this call) who was presented with an out of the ordinary scenario which you weren't prepared for. You sound like you did what you thought was right and you did an ok job in my mind (ignoring t-bone incident here).
In a future situation you should call med control immediately. This would of been your get out of jail free card. You would have your medical directors support. As far as the wife, her being a doctor is irrelevant. If she can make medical decisions for him you have to listen to her... if not go by what the patient wants.
Although I also feel like some things are kind of strange... such as you saying you're now a paramedic and this was an old scenario that happend while you were a basic, but you're just now posting this and can't provide an explanation of how you'd handle it now. And also you were t-boned on the way but still continued to the hospital...? And you could of presented it better but oh well.
To me it seems like you were just an inexperienced emt-b (which only gives you so much knowledge on how to properly handle this call) who was presented with an out of the ordinary scenario which you weren't prepared for. You sound like you did what you thought was right and you did an ok job in my mind (ignoring t-bone incident here).
In a future situation you should call med control immediately. This would of been your get out of jail free card. You would have your medical directors support. As far as the wife, her being a doctor is irrelevant. If she can make medical decisions for him you have to listen to her... if not go by what the patient wants.
VFlutter
Flight Nurse
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I don't
Sublime
LP, RN
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That's fine. I just don't feel he should be fired and such as others have stated.
I think sometimes people forget what it was like to be new and inexperienced.
Ace 227
Forum Lieutenant
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Maybe a form of "vetting" should be required since his tag says he's a Paramedic...
I'm sure its been suggested in the past and there is a reason why it hasn't been implemented. I just thought I'd mention it.
Bullets
Forum Knucklehead
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Both of these are wrong...The patient was conscious and alert, therefore the patient's family can go pound salt when it comes to care and treatment decisions. In most cases where i have family interjecting themselves in patient care, they are asked to leave twice, then they are removed.
I have had family tell me all manner of reasons why i should listen to them, that they have a POA, very few are legitimate
If family identifies themselves as a doctor and they are telling me what they want done, they are informed that i will submit to their decisions provided they ride with me as an acting physician and i get all of their information for my chart.
See above....ive told family's this many times, and i am still employed. Just have to do it in a way that they think they are being helpful
VFlutter
Flight Nurse
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Agree to disagree. Patient satisfaction and patient outcomes are improved when family is allowed to be at the bedside. This is why many ICUs are revising their visitor policies and most are going towards open visitation.
They can interject all they want as long as it is not interfering with the care I am providing. I will do my best to explain why I am doing things my way.
In my experience many of the family members have legitimate concerns, as in this scenario.
For example if my grandma had to be taken to the hospital I would want to go with her. She is alert and oriented but has no clue what her medical history is, her medications, etc. If the EMT throws my grandma, who has pulmonary fibrosis, on a NRB @ 15Lpm when her SpO2 is 90% then I am going to say something. If they want to take her to a hospital that is not where her Pulmonologist is then I am going to say something. If they say "It is our protocol, GTFO" then things would get very heated.
ExpatMedic0
MS, NRP
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I do not mean to stray to far off topic..... but,
Another interesting point is that in most states if an off duty MD demands to take over patient care they can. So long as you state that they accept all responsibility and stay with the patient until patient care is handed over to another MD.
Your particular state or medical director may have specific rules or protocols for this and which MD's are allowed.
From that perspective, if she identified herself as an M.D. and this is verified somehow, shes calling the shots. As long as she accepted full responsibility for the patient, its her show now, your unit is effectively commandeered by the MD. Any ideas on this perspective, if the doc was a shrink?
Another interesting point is that in most states if an off duty MD demands to take over patient care they can. So long as you state that they accept all responsibility and stay with the patient until patient care is handed over to another MD.
Your particular state or medical director may have specific rules or protocols for this and which MD's are allowed.
From that perspective, if she identified herself as an M.D. and this is verified somehow, shes calling the shots. As long as she accepted full responsibility for the patient, its her show now, your unit is effectively commandeered by the MD. Any ideas on this perspective, if the doc was a shrink?