Spitefullness and you

[Michael]

Great question.

With everything said above being true, I suspect that may people become providers expecting it will be easier to rescue, relieve pain, comfort, and generally help or save others than turns out to be the case. Expecting one's urge to be useful (and expecting to be thanked) to be instantly and visibly gratified leads to bitter frustration in those with low tolerance for frustration, and the handiest outlet for that frustration is the nearest dependent captive audience. It happens with caregivers at all levels, it happens among couples, families, in friendships, in teaching situations - wherever people are unaware of and unobjective about their own mixed motives about the ingredient of pride in their ambitions.

When a goodwill offering is rebuffed, that goodwill easily decomposes into indignation, outrage, vengeance. When Cain's offering was rejected, his disappointment turned into murdering his innocent brother Abel, who had done nothing to harm him. It's even the explanation for how evil originally came into the universe: Lucifer, whose name means "The One Who Carries the Light," had been created as the highest angel, but when he discovered his good power wasn't supreme, he furiously set out to overthrow the whole system. (To prevent this from happening, Man was created as a buffer, and continues to be the field of battle between those who have learned seek satisfaction in promoting others' welfare without predictable reward vs. those who are still in the mode of Lucifer's defiant motto: "I shall not serve!"). Much later, when Judas Iscariot's plan to establish Jesus as a political messiah was thwarted by Jesus' rejection of that route to salvation, Judas took fatal revenge.

Anyway, I think Ridryder had it right. Aiding others provides a splendid opportunity to discover one's own hidden agendas, and not everyone is prepared to recognize how much self-seeking is involved in the endeavor. Ungrateful patients (and turkey-like behavior among our colleagues, supervisors, subordinates) test the quality and resilience of our attitude. In 1441, a monk named Thomas à Kempis wrote: "Occasions of adversity best reveal how much virtue or strength each person has. For events do not make a man frail, but they show what he is."

Fortunately, that's something we can improve.

[Just Plain Ruff]

But Ruff isnt denying any patient reguardless of who they are or what they have done just as bad as the medic that did that? Has EMS really gotten to be so mean spirited? What every happened to we are here for the patient and their needs. I agree 100% ruff what goes around comes around but are responsible for that coming around? Doesnt that make us stoop to the level of the "bad ones"?

For previous post so what if we pick up this person 100 times a week for the same thing ISNT that our job? Is that not what we paid for doing? What in the long run do you gain from such acts nothing accept loss of respect for you and your crews.

Absolutely Terri, I'm not advocating that we retaliate against the medic who slammed the narcan because he didn't like us but I am saying that that medic needs some remediation and if it requires a come to christ meeting in the ambulance bay to discuss the finer points of giving a medication then so be it.

I know of patients who sued the hospital and the ER who did not get the treatment that they medically deserved because they sued the physician for just that treatment in the past.

I would never deny a patient a medication if warranted nor would any of the docs in our ER but I know that it happens and it happens all the time.

[crotchitymedic1986]

I think there are several factors at play here, some from the industry side, some from the individual. Here is my take:

1. EMS is still a young industry, somewhere around 40-50 years old, as compared with many other industries that have been around for over 150 years (teaching, firefighter, cop, attorney, nurse, etc..). Therefore our industry is still going through growth pains. We have come a long ways since the early days, but for the most part, we are still an industry that is a subset of another industry (fire or hospital) and there are few, successful, stand-alone EMS providers. This means we still have issues with pay-equity and benefits, and we also still have issues with having a true career ladder.

2. Most of our leaders do not have a formal education. They were just the best paramedics or emts in the company, and were promoted. This creates poor management policies. Many of our organizations tend to lean towards a paramilitary style of leadership, which is the wrong model for the "type-A" people that EMS attracts. Due to this lack of leadership, the leaders are the bitchers and whiners, by default. When you go into work tomorrow see who everyone is gathered around ? Is it the white shirt with a title, or the loudmouth with an attitude ? Whoever they are gathered around is your leader. Who gets the most attention where you work; the employee who does his job well, or the screw-up ?

3. Individually, when we were in high school, we all thought we would be millionaires by the time we were 30. Then you get close to age 30 and realize, damn I am going to be stuck working two jobs for the rest of my life, and I will not be a millionaire. Rather than blame ourselves for managing our finances so poorly that we had to work two jobs, we blame the employer for not paying us enough money to afford two new cars, a $300k mortgage, the boat/ATV/RV payment, and our $100.00 week Starbucks habit.

4. For whatever reason, our industry does attract the back-stabbers and gossipers.

Add all that up, and you get the type of performance you see.

[firedoc5]

Ridryder said one of the main word, EGO. Too many EMT's and Paramedics are in it for the wrong reason. Granted, some may have started out with their heart in the right place, but after a while they get lax and non-complacency that some get to where they forget their patient is the most important.

I've known some who were going to "mess" with the nurses using the patient. The waiting of the Narcan thing is new to me, but we've gotten orders for Epicac which the Medic held off until we were closer to the hospital. On more than one occasion we'd have a patient going through DT's and we'd have them calmed down finally, but just before getting to the hospital or treatment center, he would get them riled up. I would have reported him, but he was the boss.

[HERBIE1]

I never understood the notion of blasting an OD with so much Narcan that they go into instant withdrawal. Most of the time, these people DO get combative, AND many end up showing you what they had for dinner. Why would you want to deal with that?

Yes, in recent years there was also a rash of Fentanyl/Heroin OD's that required 6-10 mg of Narcan- plus a Narcan drip at the ER just to keep them breathing.

Are there bad medics- of course. Are some spiteful- yep, and I've worked with many. As with any profession, there are bad seeds. Not to excuse this behavior, but too many feel underpaid, underappreciated, and certainly overworked. Burnout is a real issue, especially for those practicing in busy urban areas. Such is also the nature of our profession, but as someone mentioned in another thread, we are STILL a young business. How many other professions can say they still have founding members working in the field?

We are going through growing pains, and I would say we are in our adolescence. As with any "teen", guideance is needed, sometimes a firm hand, and the best and brightest of us need to be identified, nutured and mentored so they can lead us to adulthood and address issues like this.

[VentMedic]

We are going through growing pains, and I would say we are in our adolescence. As with any "teen", guideance is needed, sometimes a firm hand, and the best and brightest of us need to be identified, nutured and mentored so they can lead us to adulthood and address issues like this.

Another "we are a young profession" excuse. That still does not excuse individual behavior or a lack of supervisory oversight in their company. EMS is more like middle-aged with 40+ years. Several other healthcare professions have reached maturity in less then 20 years.

Such is also the nature of our profession, but as someone mentioned in another thread, we are STILL a young business. How many other professions can say they still have founding members working in the field?

Several licensed healthcare professions can say that.

What about the partner? Do they approve or just wish to avoid a confrontation or be known as a tattler? Do those supervising the few that do this spiteful things just look the other way and establish it as "accepted"? Do the medical directors not hear about these things from their communications with the ED physicians?

Edited March 25, 2009 by VentMedic

[spenac]

I'm with Vent, age is no excuse. We should treat patients properly. Proper treatment can be saying no to transport as long as you properly evaluate and aid them with getting the type of help they need.

As to narcan many newer guidelines for EMS is push narcan slow and titrate to respiratory. Then the medical doctor under a much more controlled environment can determine how to bring patient on up safely.

[Doug]

Before we all jump on the "aren't we horrible people" bandwagon, I would like to suggest that the proportion of people who are spiteful in our job is no greater than any other field. Time and again I hear residents complain about attendings, ER nurses complain about "those idiots" up in Tele, ALL of those people complain about us or repeat patients. I actually think we do pretty well for ourselves actually, especially when compared to Law enforement and FD.

EVERY job from retail to CEO has folks who are spiteful. How many times have you had to listen to the cashier complain about the customer before you? I've had a bank V.P. complain about other people who came in for loans while I was finalizeing my own mortgage.

Edited March 25, 2009 by Doug

[VentMedic]

Before we all jump on the "aren't we horrible people" bandwagon, I would like to suggest that the proportion of people who are spiteful in our job is no greater than any other field. Time and again I hear residents complain about attendings, ER nurses complain about "those idiots" up in Tele, ALL of those people complain about us or repeat patients. I actually think we do pretty well for ourselves actually, especially when compared to Law enforement and FD.

EVERY job from retail to CEO has folks who are spiteful. How many times have you had to listen to the cashier complain about the customer before you? I've had a bank V.P. complain about other people who came in for loans while I was finalizeing my own mortgage.

Complaining and name calling directed at patients and other professsionals is one thing. Doing something intentionally like slamming narcan because you can just to have a little fun at the patient's expense is something else. I also have known of a couple of Paramedics who enjoy pushing a paralytic without sedation just to "teach" the patient a lesson. There have been incidents of that during field intubations and on CCT. They didn't even try to justify not giving sedation due to BP or urgency.

Edited March 25, 2009 by VentMedic

[fireflymedic]

VENT -

I too have seen the paralytic pushed without sedation, however it was due to medic ignorance thank God. Heaven help if I EVER came across someone who did it for spite or to "teach the patient a lesson". That is one of the worst forms of punishment I think one could give a patient. If they neccessitate a tube and RSI in my book, they deserve compassion. Even if I am doing so for their and my safety it still warrants consideration. I have very little tolerance for the cowboy mentality that EMS has become. Yes, there are some truly good professionals out there, but after having read many of the threads there are many here I can say I hope I never get sick or injured in your town.

As far as the pushing narcan by the doors, charcoal then, etc yes we can all laugh about it and blow off steam saying we would like to do that (especially when you experience an extremely cranky staff on the receiving end and you have a highly belligerant patient) however to do so will not only lead to bad communication between you and the hospital, but also they will no longer view you as a profesional. We keep claiming that it what we want and better pay, yet we are refusing to step up to the plate to require it. Why should they respect us when we can't even respect ourselves? I hardly think these actions are warranted. We all get frustrated, but the mark of a true professional is to overcome those frustrations and treat as you would want to be treated. After all - that narcan patient you had? That may have been my grandma who has severe pain and got overdosed on her first pill etc. I promise you if that is the case and you treat her like that - there WILL be hell to pay. The "what happens in the truck, stays in the truck" mentality must go. Poor providers reported not only service wide, but referred for state disciplinary action and weeded out. Then we can say we treat with respect.