Mateo_1387

Out of curiosity, how do you know this guy has shit for life? I think we do what we do for a variety of reasons, which probably change in importance over the years. The reasons I think we do this job is because 1. There is a level of excitement 2. It can be a challenge 3. It is a field job, not a desk job 4. There is the love for science and medicine 5. We have the privilege to meet all sorts of interesting people Just to name a few... I wanted to tell you at first that it is not logical to base your happiness for the job on the calls you run, but that just does not seem true. I think your question is not so much 'why do we do what we do', but rather 'why do I (Kaisu) do this job'. Only things I can think to tell you are that you do this job because you agree with numbers 1-5 and you realize that you can do this level of work. Your patient made a poor decision (IMO), and you were there to care for the patient at the beginning of his road to becoming as healthy (as possible) both physically and mentally. The patient seems to have had a psychological breakdown and demonstrated that pathology by attempting suicide. It is a neat aspect of our job that we are a part of their hopeful recovery. I do not know what else to say to you except it is not your fault the patient appears to have failed at suicide. I dunno, good luck to you. Matty

You of all people know that threads take on a life of their own. Nope, cannot recall ever doing it. Why do you ask?

Using guilt to indirectly force a patient to accept medical care is coercion. This topic reminds me of a quote by DwayneEMTP in his thread he started about treating diabetic patients. I think the quote applies to this case. DwayneEMTP said "Now, I'm comfortable that my treatment was strictly patient advocacy based, but do we have the right to advocate for patients against their properly mentating wishes? Or to withhold the opportunity to properly mentate, when it's within our power to give it, so that we can gift them with our advocacy? (Yikes, sounds terribly arrogant when put that way, doesn't it?)" ( found on this thread http://www.emtcity.com/index.php/topic/16244-moralethical-dilemma-concerning-a-pts-right-to-refuse/page__st__20 ) The bold section of the quote is what I am in reference to with this discussion. Although his discussion was about an unconscious diabetic patient, I want to ask the same question (although modified) for this thread. Are we being an unbiased patient advocate and informing our patients of their choices, or are we using coercion 'so that we can gift them with our advocacy'? As health care providers, we, IMO, have a duty to respect the individual rights of our patients when they form a decision about their health care. Informing a patient that their condition could worsen and possibly result in death is completely different from cramming 'you are going to die' down their throat, in hopes they will go to the hospital. Although sometimes difficult to do, as patient advocates, it is the duty of the health care provider to respect their wishes. We should, in a non-coercive way, inform our patient about their medical condition, as limited by our knowledge. Patients should not be lied to, made to feel guilt, scared, or threatened to accept medical care. Better ways are available to talk to patients that are more compassionate and productive. One example would be to try and understand why the patient is reluctant to refuse care. Stating to the patient, ‘I am here to respect your wishes, but I would like to talk with you about your reluctance to accepting medical care, would you please explain why?’ shows the patient that you are their advocate and that you are interested in the thought process behind their decision. After the patient explains why they do not want to go to the hospital, you may be able to take a different approach to ease their possibly unfounded reasons for not accepting medical treatment. So, I have a story to share with you. Some of my family members, including my grandparents, which this story is about, have a very negative view on allopathic health care treatments. To a degree, their opinions make sense, but it is taken to an extreme at times. Most folks would probably call them nuts for their opinions (and my oh my, there are some interesting ones, PM me if you’d like to hear) but I love them anyways. So, on with the story. My grandparents are 77 and 81 years old, they both have high blood pressure, and grandpa is a diabetic. Grandpa is a stubborn ol’ man, and certainly difficult to talk with. Grandpa when first diagnosed as a diabetic did a great job of controlling his diet and checking is glucose levels. About a year down the road though, he fell off the wagon. That is where it all started. I would confront grandpa with all my wonderful medical knowledge (sarcasm) and try to, in essence, coerce him to take care of himself. With his stubborn belief that allopathic medicine does not work, combined with my poor attitude and even less experienced view on life, we would lock horns. It was certainly uncomfortable for us both to reach that point. Recently, I was visiting with the grandparents and was looking for a yogurt container in their refrigerator. Grandpa informed me that I could have his beer in the refrigerator. Screech ! In my mind, I am thinking wtf? Grandpa does not drink alcohol, although he used to indulge back in the day, he quit back in the 80’s. So, I had to ask, ‘why do you have beer in the refrigerator’? He informed me that my father bought it for him, because he asked for it. After asking why he wanted one, he informed me that he could not quench his thirst, and that he would drink the beer to quench that thirst. I was shocked. This seemed very out of character for my grandfather. T hen it hit me. I looked at him and said ‘Grandpa, I bet you 10 bucks it is because you blood sugar level is high, no scratch that, I bet 200 bucks. You drink this beer, it may help for a small amount of time to quench your thirst, but it will cause your blood sugar to raise and your thirst to become worse.’ This conversation was going to lead to one ending, we were going to lock horns again. It was bound to happen. That is when I gave him the choice, I asked him ‘do you want me to explain it, or do you want me to shut up?’. His reply ‘Shut up’. I could handle being told to shut up, what I could not handle was that my grandfather was suffering from his diabetes and doing nothing about it. This really bothered me. It also made me do a bunch of thinking. I wanted to bring the discussion back up with my grandfather. That is how the spider web of thought started. I had to question myself about why I wanted to bring it up to my grandfather. I realized why, it is because I wanted him to be treated for the diabetes. I wanted him to be around for years to come. The reasons were purse selfish in nature. I ended up talking with a friend of mine about the situation, which made me think more. My friend and I discussed that it is difficult to watch a family member not take care of themselves when faced with a medical problem, especially when we know what should be done. We also discussed how the treatment or lack of treatment will affect his happiness. Grandpa may feel like he is being restricted at his age from enjoying the privilege to eat what he wants, when he wants, and through gifting him with my advocacy, he may place that blame on me. A person’s vice may be drinking alcohol, smoking, using drugs, unsafe sports, and the like, Grandpa’s vice just might be eating what he likes to help him enjoy his later years of life. I had to ask myself ‘am I willing to push him to unhappiness to fulfill my personal agenda?’. In short, the answer is no. As Herbie said, I show him my love when I respect his decisions. My friend recommended to me that I approach him with the follow; 1. That I love him. 2. That I respect his decisions and happiness. 3. That I am there to answer any questions I can about his health. 4. That I will help him in any way possible if he decides that he wants to make a healthy change. Those three things are what my grandfather needed to hear. That I love him, that I respect his happiness, and will be there for him. Although initially difficult to comprehend at first, I am happy that my Grandpa is happy. In the end, that is most important. Good luck to the OP ! I hope this helps…

Be careful to not use coercion and scare tactics. Sick people do not need to be faced with 'you are going to die', especially when you do not know the end point of their demise. I would not want anyone to sell me something by coercion, not my care, and especially not my health care. My suggestion would be to sell the idea to your family member that benefits them. This may be telling them about possibilities that may ensue from their unattended medical problem, selling them the idea that they will not have to pop nitroglycerin all day long, or that you love the person and want to see them around for years to come (of course if they are willing too, LOL). Sometimes though, they may not want medical attention, and rather you are the one who wants them to be seen. Have you accepted that if they are happy with their current situation (after they have been informed) that you are happy for them? It may be something you think about.

wa alaikum salam

Thanks bro, you too !

Try flying with an Arab sounding name.... "please sir, come with me, we have a 'short' line for you."

Not only does a degree offer you the science classes such as A&P, Chemistry, and the like, the EMS classes themselves are generally better than those found in a continuing education course. Where con ed classes skim subject matters to give a real basic understanding of medicine, the degree classes will spend semesters teaching you the ins and outs of medicine, tying in the concepts learned in the A&P, chemistry, and other such classes and how they relate to patient care. Going through school your way will make you better just because of those science classes, but going through with a degree would make you so much better.

Just out of personal curiosity, any idea how many people are coming to the US for medical care when they have socialized care at home? I hear that claim thrown around a lot, but have never had any numbers to explain the claim. I only ask out of curiosity. Interesting article you posted Ruff. Thanks for sharing.

Ha. Just a joke. Anyways, I am not sure what the answer is, but I think we agree that we should work our side of the problem (the calls) instead of just doing the bare minimum of the job.

The Fire Department I agree with you storm. Question is, what are we going to do to fix it?

Another good reason to give a negative point would be for posting bad information or advice. I disagree with bad information and advice.

If you are capable, a BS degree is worth your time. Classes such as A&P, Biology, and Chemistry will help you with the understanding of the fundamentals of medicine. The more you know about medicine, the more confident you can be and should subsequently provide better patient care. One thing I would consider is how long to you plan to stay in EMS. A lot of EMSers end up quiting after a number of years. Dedication to a BS degree may not be worth it if you do not last in the profession. Out of curiosity, what is your other degree in? Some of those classes may count towards a bachelor's degree. Benefits for a BS degree depends on your area. Personally, in my area, it does not make the biggest difference. But there are some locations that require a BS degree just to teach. With a BS degree in EMS, you may also have better chances at administrative positions. I am sure there are areas that do pay more for a BS degree, but I am not familiar with any or how much more money they pay for one. I do not know what online program you are referencing, but the one I am familiar with that offers a four year EMS degree (Western Carolina University), offers an online degree, and you do pay for the credit hours. You may be in reference to an online associates degree through a community college that is cheaper, but I am not sure.

#$%&. Oops. My mistake. I honestly thought you were referring to the part about the impression, and I did not reread the part about the intent. However, measuring someone's intent can be subject to an individual's viewpoint, but, it seems obvious to most people that the intent is to promote a high standard. That being said, your sure got me on that one point, now how about the rest of my points and posts? Bold point # 1 Do you feel the same way about the tone of Dustdevil's (the old Dust, that is) posts? How about AK's? Ridryder's? From what I know of the first two and remember from the third, they were all honestly and blunt in what they say, many times echoing what each other posts, including Vent's. Bold point # 2 I agree that these probably should not be EMS calls. The fact is that we do respond to those calls and when doing such, we should provide a basic service of trying to provide the patients with resources to rectifying their situation. If someone is calling because they cannot care for themselves, we should be alerted that this small issue may be part of a bigger issue that needs addressed. If I receive a call through lifeline for sour milk, can't find their glasses, or the like, one of the first things going through my head is 'will this person be able to care from themselves if the situation is worse?' In essence, we are again a part of a link/chain/continuum of health care that is going to initially have to investigate the situation and direct the issues to the professionals who need to handle the situation. Herbie, disagreeing with somebody and directing personal attacks at them are different things. I honestly would not take someone's comments so personally. This, for the most part, is an anonymous forum, and as such I do not have anything to honestly prove to anyone, except that I can participate and grow with the rest of the posters. Ventmedic would not know me if I walked up to her on the street and slapped her. I do not expect her to know me any better on this website. There are a few folks I have met from this site, whom I would feel insulted if they attacked me as a person having known me, but that only includes a select few. But the people I have met have questioned my assumptions and helped me with many issues, but have been kind enough to leave out the personal attacks on character. One of the greatest things about this site is the feedback one can get on any slew of subjects. The feedback can be invaluable to help oneself question their practices and thoughts on matters. We get better together when we engage in beneficial argument that questions our ideas, assumptions, and presents facts. When Ventmedic says something along the line of 'The Paramedic does not have the education to....', it is not arrogance speaking, it is not a personal attack, but rather in a general sense, the truth. As others have said before, EMTCity has become relaxed in the past years to the point where all kinds of garbage passes by on the board, without being questioned. Many remember the olden days and wish to see it again, so expect for your posts to be scrutinized. Herbie, we will not be any better as a group if persons such as your self do not actively question the assumptions of others. As I said before, when someone does not post something you care for, bring it to their attention in a logical format and make them rethink their position so they can reply to you and make you rethink your position. I hope you stick with us, we can always benefit from various viewpoints. We can leave the drama for the chat room.

Thing is that is what they said about Co. and Fl., and a few days later everything was posted on the city....hmmmmmm.

I never said I interpreted her intent. I simply stated my impression of her posts is that they are upfront and honest. Interpreting her posts is not that hard either. She did not say 'tskstorm, HERBIE1, fix these people's complex social issues. It seems obvious she promoted finding a solution to your problem, which is answering lifeline calls for non emergency reasons, rather than just bitch about it. This may mean that you push the issue up the chain to get it fixed. Fixing a service issue (non-emergency lifeline calls) and fixing complex social issues are two very different things. I think we agree, to a point. In order to fix your problem of answering these calls, Ventmedic recommended contacting the local agencies dealing with these patients and to educate the lifeline services on the proper use of emergency services. Again, this is probably a push it up the chain deal. Not saying for you to do all the leg work, plus run a busy shift, but rather to start working on improvement to fix the problem in your service and at the same time get the correct resources to the patient. Exactly the point trying to be made. Its not all about you having to do the work. Something as simple as pointing someone in the right direction is a good start to fixing issues. Many EMS agencies work along side of police departments and fire departments, some go and provide educational classes to help them understand the roles of EMS and vice versa. Why not use the same techniques when dealing with other agencies? Why not take a few minutes to point the patient towards the correct resources? It seems that in the long run, the amount of money used to truly fix the problem will be less than to answer the calls and just 'dealing with the problem'. A few extra minutes on scene to help point someone towards the correct resources should decrease the number of calls, thus keeping ambulances available for more urgent/emergent type calls.

I love how you credit you wife, then come over with a 'coworker'. hmmm... You think Lucas will get mad if things do go wrong?

Truly professional experience with the education to back it up is what I am talking about. Where is the condescending attitude. Consider yourself an equal to whoever is condescending, that way it doesn't feel so bad. This paragraph honestly does not makes sense. Regarding assumptions, I am assuming you are in reference to the post about the South American medic who discussed a possible case of neglect by a doctor. You should go review the thread, it turned out quite interesting. And how do I know you are not lying, since this is an anonymous forum? Some things you just have to accept as being the truth, even though it may not be (and no, this quote cannot me used against me in the court of religion, whenever that debate comes up ) I do not claim to be an expert either. You said "when someone tells me what will or will not work in a busy urban system, they had better be familiar with the what goes on in such a place.". Why? What if I am not familiar? You gonna be condescending to me? Huh, Huh? I do not believe anybody said for you to make it your job to solve 'complex social service issues'. I believe the intent of Vent's posting was to one, make everyone consider how the patient feels and two, consider ways to help your system reduce these calls, which probably includes more work than a normal everyday shift (and of course griping about it). This may mean doing some extra work for your agency's benefit by contacting the necessary people to correct the issue. Maybe it is just a difference in viewpoint, but my impression of Vent's posts is that they are upfront and truthful. Maybe Vent does have to heighten her ego every so often. It does not really matter. Grow some thick skin, gain knowledge from the posts, study up on it, and come back with something that will make her think, so that she can come back with something to make you think. Matty

You still owe me that beer before you move.

I used to not care for her posting style, but then I realized two things... 1. When you see the name Ventmedic, it grabs your attention and makes you read what she writes. The cool thing about reading her posts is she puts some attitude and passion behind what she says, as do some of the other posters on this site. 2. Second thing is, I learned to not feel intimidated by what she says. I realized after a while that she is not going to lower her bar anytime soon for somebody who has lower standards than she does. It also came to my attention that in many ways, we see more eye to eye than I previously thought. That led me to conclude that she is not 'holier than thou' but rather has 30+ of professional experience over me, thus truly being out of mine, and most people's leagues. I would also imagine she has more 'professional' experience than the majority of posters on this site (and I am not talking about wacker experience either ). Just my thought though. Everyone is entitled, I guess... Matty

Our replies were tame compared to some stuff posted on this site.

I will definitely be there for the Thursday session. I have to request the 8th off to make it to the Wednesday session.

That was quite funny. I doubt the hero gene would be recessive, but rather Dominant. But then again, maybe recessive, ya know, follower mentality and all... To your question about screening drivers, I do not have an answer. It sure sounds like it would create a good ethical debate. You might be right and the whole 'driving gene' may be bogus. I'll wait and hear what the science says before a knee jerk reaction as to the validity of the claim. If we banned women from driving, does that mean they stay home more?

True that, but some families like to benefit from the death of their 'loved' ones.