Mountain out of a molehill?

[emTpromises]

Looking for some feedback... am I blowing hot air or is this a real ethical dilemma?

Got called out to a Dr.'s office for a 68 y/o F difficulty breather. My partner and I were first on scene (we are both EMT-Bs... we run with the County Fire Dept., which brings the medic).

Once inside the empty waiting room with our gurney, we had to wait for the receptionist to saunter over to unlock the door to the back. She pointed us down the hall, stating that she thought the pt. was "back there."

My partner and I found the pt. in an exam room, sitting slumped over in a wheelchair, slow, agonal respirations, drooling, completely unresponsive. I called out into the hallway to the receptionist, trying to find out what status the pt. was in when 911 was called and where the Dr. was, amongst other pertinent pt. info.

My partner and I had enough time to open the pt.'s airway, search her for any med. tags, put her on 15 lpm via NRB and obtain a thorough set of v/s before the Dr. came strolling in, looking annoyed, purse in hand (on a break?). I asked her if the pt. had been A&Ox3 when the Dr. called 911 and the Dr. went slack-jawed, dropped her purse and said, "Oh my god! Start CPR! Does she have a pulse?" (Yes... in that order.)

Right then, FD showed up and took over, putting the Dr. to work gathering the pt.'s records (she couldn't give us any Hx, meds, etc., only that the pt. had been A&Ox3 when the Dr. called 911 because the pt. started breathing rapidly).

Turns out, pt. was a diabetic and BS was 28. Everything worked out in the end. However, I was furious with the Dr. I asked around at the hospital and found out that this Dr. is a primary physician for a number of the con. homes in the area (at one of which this pt. is a resident). After voicing my concerns to a couple of ER nurses I respect and even my supervisor, I was told again and again that this is "typical" and part of the job (especially here in South Central L.A.--poor socio-economics = poor medical care).

In only one year on this job I have seen a lot, including burnt-out workers with poor attitudes, but never a medical "professional" whose incompetence has so frightened me. Is this something any of you have dealt with? Do I learn and move on? Or do I take further steps to report this Dr.?

Thanks in advance for your wisdom...

[mobey]

I promice you one thing...... This will not be the last time this happends.

I have been called many times to clinics that have general practitioners employed that are not capable of handling even a simple hyperventolation. Think about it, some of these doctors have been in the same clinic for 30+ years and have not stepped foot inside an ER since thier practical rotations.

Oh and one other thing, Do you know what they call the guy in Med school who barely scrapes by passing only with the minimum standard?

[spoil:f311f6d1f4]Doctor[/spoil:f311f6d1f4]

[dougd]

Welcome to the fun-filled world of EMS... enjoy your stay.

Seriously though, what were you so furious about? Granted, I find it odd that they thought the issue was serious enough to call for an ambulance yet didn't bother to leave a nurse with the patient. Other than that, the Dr. recognized the patient had an emergent need and the common sense to decide to send the patient to the ED where a doctor with more experience handling such patients (not to mention a full range of diagnostic tests/procedures at hand) than he did.

Now then, if you're upset about having to wait for a receptionist to "saunter over to unlock the door..." well, get used to being upset. It's going to continue to happen. I haven't had any doctor's office pickups, but I've done plenty of nursing home ones. Only once have I been to a run where staff was standing outside waving frantically at us. More often than not, you'll be lucky to find someone who can tell you anything about the patient, or even who called for a squad for that matter.

Oh, and the one time you see the staff standing outside waving you down, you'll look at your partner and both of you will say, "Oh Sh*t!"

[CBEMT]

Dude, if you're getting this worked up over a moron Primary Care Physician (there's a few million of them), you're not going to last very long in this field.

Relax, treat your patient, go to the next call.

[itku2er]

I used to work in a Clinic where we have sent quit a few patients out by ambulance. Yes they are MD's but most are into family practice they wouldn't know what to do in a true emergency. There should have been a nurse with the patient I agree but most offices arent set up for codes etc they dont have to have a crash cart its not required by law. Well at the office I worked at we kept the door to the back locked because of the drug seekers they get real mean if they think they are not getting their drugs.

[emTpromises]

Thanks for the replies.

I'm not upset about a locked door or a worker with a bad attitude. Sorry--my prior career was print advertising and I was trying to paint a picture in prose.

What's bothering me is a Dr. who I feel actually put a pt.'s life in danger. Doug, as you pointed out, this Dr. had the common sense to call 911 but then left the (mobility-limited) pt. alone long enough to lose consciousness and fall into a position in which her airway was compromised.

I can forgive a mistake and even understand a momentary lapse in judgement, but think of the process this Dr. had to go through in order to end up where we were:

Step 1 - "Wow--something is seriously wrong enough here that I need to call 911."

Step 2 - Go to phone, dial 911, explain situation and request help.

Step 3? "Oh, yeah, I... left my lunch in the car/need a cigarette/really have to pee/(insert need here that was more important than a pt.'s status that you felt was serious enough to call 911 for)."

That's what upsets me. This physician has not only taken an oath to "do no harm" but is also charging for the privelege to do so.

So, in a way it's "nice" to know you've all dealt with it, too, but is that all we can do? Just vent amongst ourselves and let it go? In cases of child, elder or spousal abuse or abandonment we report it. Isn't this another form of that? Or am I putting too much responsibility on the physician?

[mobey]

Thanks for the replies.

but is that all we can do? Just vent amongst ourselves and let it go? In cases of child, elder or spousal abuse or abandonment we report it. Isn't this another form of that? Or am I putting too much responsibility on the physician?

All we can do? Nope you can treat the pt and transfer to a facility which staffs appropriate personell.

This is not really abuse but abandonment, maybe.

The problem is that you are far below a Dr.

You are accusing a far higher educated person of being incompetent. Really all the doc has to say is "The Pt. seemed slightly short of breath so I called for a transfer, when I left the room to see other pts he/she was stable and alert. There is no way I could of known he was going to lose Cx. In my 25yrs of medical experience it is my opinion this patient did not need a bedside nurse in his/her present condition when I left the room.

Meanwhile you can no longer find a job cause your known as the one who "Accused a doctor"

Who knows the condition of the patient when the doc left, Really does increased resps demand a bedside babysitter?

[itku2er]

I agree with my Candian friend on this one knowing how the inside of the office works. Would be worse if the MD did nothing and waited untill the patient coded then called 911.

[emTpromises]

Thank you, Mobey. That's exactly what I needed to hear.

One point in response to "Pt. seemed slightly short of breath so I called for a transfer..." Our ambulance company is the county provider for 911 response in the area and also the main provider for IFTs--this was not a call for a transfer, but an emergency, code 3 response.

But, seriously, you're correct. Probably not what I wanted to hear but I get it. :wink:

P.S. Sorry, guys--haven't mastered quotations, yet. Working on it.

[jmp6753]

If this was your first situation like this, it certainly wont be your last in your tenure. Rarely have I been called to a clinic or Dr's office and found the Dr in the room with the patient. Even a critical one. One thing I have done a time or two was make the Dr ride in with me to the ER. Let them explain to the ER Doc why the patient declined so much.

Best of luck!