HOSP-ITALITY ABUSE

[VentMedic]

My "type" takes excellent care of people who request my help- regardless of what their problems are. Look at the original article again-tell me what type of "help" are those patients requesting?

A significant part of our jobs is education and social work and I am more than happy to do that. I can refer them to any of a dozen shelters or agencies if that is what they want. THEY DON'T. Like a smoker, a drug addict, an overeater, or an alcoholic- you can offer someone all the help in the world, but until THEY are ready to accept it, they will not change their behavior-even if you are a well intentioned social worker wanna-be.

If I wanted to be a social worker, I would have followed that path as a career.

Again- save the bleeding heart, holier than thou lecture.

It doesn't sound like you have much respect for anyone unless they fit your "type" of patient.

You seem to be stereotyping homelessness and addicts. Have you looked at the homeless population lately? You may even find a few EMT(P)s in the crowd. Many of these people call because they don't know what else to do. When you have lost everything including your dignity, there isn't much left.

Get your head out of your arse and take a good look at the world around you without such jaded opinions on humans who are less fortunate then you and enough with the "not my job" crap. The other posters have given good examples and I gave one example but I can come up with a lot more. We are in the health care profession and not just in it to thump our own egos by picking and chosing who we decide to save today.

Edited July 13, 2009 by VentMedic

[Eydawn]

Vent is not holier-than-thou... she just is able to empathize with this particular population despite how irksome they may be in the short term to us as medical providers. She's also trying to show that no "population" of people is perfect-- we are all human, and we all have flaws. Without exception. I'm too blunt, for example... and it's not always a good thing. I can also box myself into being a little bit arrogant because I'm smart. It's something I work on.

Herbie, don't be such an @$$hole! I'm serious, man. I'm sure you're an excellent medic. You're probably very intelligent. But you're sounding like one of those people who doesn't understand a holistic approach to medical care, and since you don't understand it, you scoff at it and go off on those who are trying to (at the very least) broaden your mental horizons a little bit. It also sounds like you've developed a prejudice against the homeless because you know they drain your system... but have you tried to think PAST your prejudices and get inside the problem? Or are you just reacting to it?

Medicine is not just about being right. It's about communicating with your patient and determining what your patient *really* needs. Have you ever noticed that people who are upset respond better to treatments once they calm down? Sometimes patients need more than what we have written in our protocol books. Sometimes, a patient needs you to just *really listen* instead of hunt-and-peck for the pertinent parts. Many of the homeless are mentally ill, developmentally disabled, or otherwise combating something they may NEVER let you in on... and without addressing some of those underlying factors, handing them the information on a shelter is going to do nil point zippity...

Just saying. Don't fall into the trap of arrogance- that you must be right since you're a good medical provider. Some of these frequent fliers may have been something you can't even imagine before they descended to where they are now. Show some humility!

Wendy

CO EMT-B

[HERBIE1]

It doesn't sound like you have much respect for anyone unless they fit your "type" of patient.

You seem to be stereotyping homelessness and addicts. Have you looked at the homeless population lately? You may even find a few EMT(P)s in the crowd. Many of these people call because they don't know what else to do. When you have lost everything including your dignity, there isn't much left.

Get your head out of your arse and take a good look at the world around you without such jaded opinions on humans who are less fortunate then you and enough with the "not my job" crap. The other posters have given good examples and I gave one example but I can come up with a lot more. We are in the health care profession and not just in it to thump our own egos by picking and chosing who we decide to save today.

I guess you missed this part:

My "type" takes excellent care of people who request my help- regardless of what their problems are.

I'm not stereotyping ANYONE. If someone asks for help, I am first in line to offer whatever help I can. If a person has a psych history and is noncompliant with their medications, how does your dime store psych assessment help them with their problems? What about an alcoholic? You would probably need a detailed personal and family history to even scratch the surface as to why they decided to start drinking to excess. Point them in the right direction, make them aware of their options, notify the ER, and let the people who are properly trained take care of it from there.

I'm not qualified to do social service or psychiatric needs assessments, nor do I have the resources to accommodate their needs. I'll leave that to the experts like you. Our job is to evaluate their immediate needs, provide whatever care we are capable of, transport them to the hospital, and point people in the right direction if possible, and when pertinent.

I would never presume to understand the complexities of managing a CHF patient's long term care for example, so what makes you think I am qualified to make assumptions and/or recommendations for treatment about a person who may have life long substance abuse problems and/or chronic and complex psychiatric and social issues? I think YOU are the one with the inflated ego here. I happen to know my limitations. I am very capable in my chosen field, and put my skills up against anyone's, but I'm not arrogant enough to think I know more than I do.

What exactly do you think we can do for someone with our limited contact with them- especially when their problems most certainly transcend a "simple" issue of homelessness? We don't provide definitive care for medical issues, and we certainly don't have the training to provide for and address the many issues someone who is homeless may have. Even ER's only point someone in the right direction- they make a cursory evaluation, make referrals, and may even provide for the next step if the person is willing to agree to further long term treatment. If you want to be a social worker, a therapist, or a minister then get the requisite training and change careers, but don't forget what your role is as a prehospital provider.

Do you also free lance as a cardio-thoracic surgeon in your spare time?

[CBEMT]

Happens every day around here. The trauma center even satirically (and unofficially) named the ETOH/drug/psych unit of their new ER after one of the most prolific abusers, "Ron Salvatore."

There's no solution for people like Ron. They've been homeless for years, decades in some cases, and substance abusers for longer than that. Despite Vent's good intentions (and mysterious pot of gold to pay for her social solutions), Herbie is ultimately right- most of them will never change. They'll keep bouncing in and out of the ERs, until one day something goes wrong, and they die- just like Ron did, bleeding from the head on the sidewalk after falling down drunk for the 90984357347587345738475th time.

And then someone else takes their place, and the cycle begins again.

I have an extremely liberal friend who used to live in Seattle. The first time I visited, I commented on the number of homeless in a city with a reputation such as Seattle's. She growled and said, "There are SO MANY social programs here it's crazy. If you're homeless on the streets of Seattle it's because you want to be." Simplistic, perhaps, but even she knew that there's a limit to what good intentions and social spending can do.

Edited July 13, 2009 by CBEMT

[HERBIE1]

Vent is not holier-than-thou... she just is able to empathize with this particular population despite how irksome they may be in the short term to us as medical providers. She's also trying to show that no "population" of people is perfect-- we are all human, and we all have flaws. Without exception. I'm too blunt, for example... and it's not always a good thing. I can also box myself into being a little bit arrogant because I'm smart. It's something I work on.

Herbie, don't be such an @$hole! I'm serious, man. I'm sure you're an excellent medic. You're probably very intelligent. But you're sounding like one of those people who doesn't understand a holistic approach to medical care, and since you don't understand it, you scoff at it and go off on those who are trying to (at the very least) broaden your mental horizons a little bit. It also sounds like you've developed a prejudice against the homeless because you know they drain your system... but have you tried to think PAST your prejudices and get inside the problem? Or are you just reacting to it?

Medicine is not just about being right. It's about communicating with your patient and determining what your patient *really* needs. Have you ever noticed that people who are upset respond better to treatments once they calm down? Sometimes patients need more than what we have written in our protocol books. Sometimes, a patient needs you to just *really listen* instead of hunt-and-peck for the pertinent parts. Many of the homeless are mentally ill, developmentally disabled, or otherwise combating something they may NEVER let you in on... and without addressing some of those underlying factors, handing them the information on a shelter is going to do nil point zippity...

Just saying. Don't fall into the trap of arrogance- that you must be right since you're a good medical provider. Some of these frequent fliers may have been something you can't even imagine before they descended to where they are now. Show some humility!

Wendy

CO EMT-B

Obviously you have the wrong opinion of me, but I won't lose any sleep over it. If I had an ego or humility problem, I would have quit this business a long time ago. I remember fighting with nurses who thought we had no right to intubate patients or operate on our own without a doctor standing over us.

Sorry for being honest. Read my reply to vent- no need for me to repeat myself.

My point was, in our limited time with patients, other than offering them help, and advising them of some of their options, what else do you think we should do? Of course many homeless people have tons of underlying issues, and contributing factors that resulted in their situation. I know I am not capable of handling those issues- I leave it for the experts.

Like I said, I knew many intimate details of the lives of these frequent fliers. Do you think they need to be told that they aren't dealing with their issues in a healthy manner? Do you think they need to be told that the reason they may be a chronic alcoholic is because their parents abandoned them at an early age, or that they were sexually abused as a child? People spend years in therapy to sort out issues such as these. Most of the time, they know EXACTLY what brought them to this point in their lives, but they simply aren't ready to do anything about it yet. If and when they are, and ask for assistance, I'll be more than happy to help in any way I can. I'm more than willing to listen to their stories and offer suggestions, but that's the limit of my expertise.

[VentMedic]

I would never presume to understand the complexities of managing a CHF patient's long term care for example, so what makes you think I am qualified to make assumptions and/or recommendations for treatment about a person who may have life long substance abuse problems and/or chronic and complex psychiatric and social issues?

This is my point Herbie1 You are only looking for the acute emergent situation like CHF when you see these patients and if you don't see something emergent, you may blow them off as BS. Many patients themselves don't realize what problems they have. They just know they don't feel good. Some are passed off as having the flu or hungover when actually they are working on sepsis. The other issue you seem to be seein is only a social problem with alcohol and not the illnessness that can be very emergent but are not adequately covered in EMS education since it actually does not cover medical emergencies, either acute or evolving, to any great depth. These patients need a doctor first and then maybe a chaplain.

What exactly do you think we can do for someone with our limited contact with them- especially when their problems most certainly transcend a "simple" issue of homelessness?

docharris gave a great outline of things that can be addressed. I mentioned systems that are also doing this. It doesn't take much to set up a database or paper trail of repeat offends or to have your agency establish referral forms for a welfare check by some social service agency. It can either be turned into the ED or to your supervisor who can deliver it to the appropriate agency. This may not be much but you might be able to make a difference for one patient. I don't try to change the whole world. I just try to see if I can make a difference one patient at a time.

I think YOU are the one with the inflated ego here. I happen to know my limitations. I am very capable in my chosen field, and put my skills up against anyone's, but I'm not arrogant enough to think I know more than I do.

What do you want to do? Have an intubation competition? See who can start the most IVs in 10 minutes?

There is so much more to being a healthcare professional than just "skills". When you have chosen not to see beyond just the skills and perceive those as what is limiting you, there is not much more agruing anyone can do with you. You yourself have placed yourself in your own little world with a limited view of how times and medicine are changing.

[HERBIE1]

Happens every day around here. The trauma center even satirically (and unofficially) named the ETOH/drug/psych unit of their new ER after one of the most prolific abusers, "Ron Salvatore."

There's no solution for people like Ron. They've been homeless for years, decades in some cases, and substance abusers for longer than that. Despite Vent's good intentions (and mysterious pot of gold to pay for her social solutions), Herbie is ultimately right- most of them will never change. They'll keep bouncing in and out of the ERs, until one day something goes wrong, and they die- just like Ron did, bleeding from the head on the sidewalk after falling down drunk for the 90984357347587345738475th time.

And then someone else takes their place, and the cycle begins again.

I have an extremely liberal friend who used to live in Seattle. The first time I visited, I commented on the number of homeless in a city with a reputation such as Seattle's. She growled and said, "There are SO MANY social programs here it's crazy. If you're homeless on the streets of Seattle it's because you want to be." Simplistic, perhaps, but even she knew that there's a limit to what good intentions and social spending can do.

\\Points to nose

Thank you CB- someone gets it.

[VentMedic]

Happens every day around here. The trauma center even satirically (and unofficially) named the ETOH/drug/psych unit of their new ER after one of the most prolific abusers, "Ron Salvatore."

There's no solution for people like Ron. They've been homeless for years, decades in some cases, and substance abusers for longer than that. Despite Vent's good intentions (and mysterious pot of gold to pay for her social solutions), Herbie is ultimately right- most of them will never change. They'll keep bouncing in and out of the ERs, until one day something goes wrong, and they die- just like Ron did, bleeding from the head on the sidewalk after falling down drunk for the 90984357347587345738475th time.

And then someone else takes their place, and the cycle begins again.

But then the article didn't go indepth to what has been tried. Maybe he was just caught in a system of whiners and not doers.

Since Miami and SF are both very attractive places for the homeless, it is a struggle. Yet, we don't just give up and say the hell with them. We constantly try to find solutions and find the ones that can be helped. It is when you become so jaded as some appear to have, that is when you lose your ability to identify healthcare problems and separate them from the social issues.

I have an extremely liberal friend who used to live in Seattle. The first time I visited, I commented on the number of homeless in a city with a reputation such as Seattle's. She growled and said, "There are SO MANY social programs here it's crazy. If you're homeless on the streets of Seattle it's because you want to be." Simplistic, perhaps, but even she knew that there's a limit to what good intentions and social spending can do.

And I love Seattle because of how it has dealt with the homeless situation. Your friend seems to only see those on the street or what she may perceive as failures or losers. She doesn't mention how many thousands Seattle's programs have helped. Nor does she mention how many days those still in the street have NOT occupied a hospital ICU bed because even if they do live on the street they may still get care at some of the clinics.

[CBEMT]

But then the article didn't go indepth to what has been tried. Maybe he was just caught in a system of whiners and not doers.

Funny how everybody who disagrees with you is a whiner, uneducated, etc etc. I live in one of if not the most liberal state in the country. You think nobody's tried?

And I love Seattle because of how it has dealt with the homeless situation. Your friend seems to only see those on the street or what she may perceive as failures or losers. She doesn't mention how many thousands Seattle's programs have helped. Nor does she mention how many days those still in the street have NOT occupied a hospital ICU bed because even if they do live on the street they may still get care at some of the clinics.

The ones that are still on the street are the ones that will always be there, much like the two skells in the Post article. Those are the ones that you think can be reached, if only we spend a little bit more money. It's just not going to happen. That's the real world.

[VentMedic]

Funny how everybody who disagrees with you is a whiner, uneducated, etc etc. I live in one of if not the most liberal state in the country. You think nobody's tried?

Then post some facts. What have you and your state done?

The ones that are still on the street are the ones that will always be there, much like the two skells in the Post article. Those are the ones that you think can be reached, if only we spend a little bit more money. It's just not going to happen. That's the real world.

You have not addressed any real world problems or provided must information except to point out the bad about cities like Seattle which is trying. Maybe they can't help everyone, that doesn't mean that city and their system is a failure.

So what exactly have you brought constructive to this discussion?

I just don't get people who must constantly criticize those who want to take healthcare, including EMS, to a now level with a higher awareness for issues that do affect even EMT(P)s in someway. If you view it as "not your problem" or "not your job" why bash those to do establish programs to track the repeaters and see if referrals can be obtained? If a provider sees a health issue more than just intoxication, why criticize someone for doing a thorough assessment? Seriously, what is with the attitude towards seeing what can be done instead of just saying no to every suggestion?

Edited July 13, 2009 by VentMedic