Leaderboard

I had this conversation recently with another member here, and I'll tell you what I told them, right, wrong or indifferent. You are not part of the team. You are the leader of the team. You are not another cog in the wheel, you are the main gear. You can laugh and joke and have fun with the team, but in the end, this is YOUR call. You have chosen to step up to the plate and become a medic, you no longer have the right to share responsibility for your patients care. Your call, your patient, your team to use, including their knowledge when necessary, to solve problems, but not yours to shirk your responsibility off onto. I sucked at this when I first started. I often thought, "Bob has been doing this forever, this patient is in the toilet, I should ask him what's wrong, treat accordingly, and spend the time to learn on another patient that isn't so sick." Stupid, right? But that was my limp dick idea of patient advocacy. To let whoever seemed smartest of most experienced make decision while I was learning. How convenient that I was always the least smart and least experienced so I didn't ever really have to take responsibility. Also, it turned out that my logic was pretty friggin' good most times. There have been many threads here about the patients that we regret, the ones that haunt us. You know what? I don't have any dead patients that haunt me, but there are several from early on when I chose to take the advice of someone else when I was confident that I knew what was going on, and turned out retarding the patients condition instead of improving it..just like I believed that it would. I cringe when I think of walking into the hospital with my patient in much worse condition than necessary and having the nurses/doc ask..."Why did you do X instead of Y??" And the only honest answer I could have given, had I chose to be honest, was, "Because I'm a pussy and I didn't want to be responsible for making my own decisions." I used to try and figure out what I thought was wrong, decide what I thought I should do, compare that to what I believed that smart people around me would do, what the protocols said, what the doc was going to say when I got to the ER, what the jury might say should I be wrong...and finally thought, "Fuck this....I'm not smart enough to run all of those angles. I can only do my best if I commit both brain cells to a working diagnosis and logical treatment plan according to ME." And you know what man? People WILL speak up if they think that you're making a mistake. They really will. Often you will have to choose to continue on your path instead of take their advice, but they can respect that too. And they will keep quiet and jump right up on your band wagon to help the instant that they see that you are confident enough to follow. And you know what else? When you show the backbone to lead, people will actually be supportive, even when you're wrong. Because only a coward that does/tries nothing is going to succeed all the time. You can't have confidence in your decisions until you actually begin to make your own decisions. Until then you will continue to just make yourself scared. Leading seems scary from the outside looking in, but it's really just a paper dragon. Next call, fuck all what anyone thinks and lead. Use those Jr to you and Sr to you in any way that makes sense to you and, judging from your posts, I'm CERTAIN that you will find that you've been running from shadows. I guarantee you, and I rarely feel confident speaking for this amazing group of people, that one thing everyone here is certain of, is that you WILL choose to lead. You can do it today, or you can live through weeks of humiliation first, but it's going to happen. What are you waiting for? Dwayne

Glad to be back, had to bow out for a while to study for my FP-C. With that behind me, I can be a little more active participant.

We don't "need" That's your argument?? Why not use all the tools at hand when assessing resp status? I know damn well any ER doc will ask the $100 question when you present your intubated kid to him. "What was his SpO2 on room air?" Don't you gather a "Baseline" to compare to after treatment? Hmmm.... I guess we don't need a cuff to assess BP either.... Cap refil will suffice. We don't need a thermometer to assess Temp either, skin to skin contact will do. Heck... Why even use EtCO2 after he is intubated, you have a stethoscope! IMO, using all the tools available is part of a complete assessment. Maybe it takes you longer to snap on an SpO2 than it does me though.