Thought provoking article in JEMS re: Patient refusals

[itku2er]

Cases such as these are just annother example of the laziness, incompetance and stupidity that is so prevelant in our job today. No wonder we can't get any respect. :evil:

I AGREE 100%

T :angel12:

[itku2er]

Every patient should be allowed to go for ANY reason they want, but when they ask "What do you think?" We should be able to say, "Well man, I think you need to go sit on the toilet and make a bowel movement."

Our job is to take anyone anytime to the hospital when 911 is called...if you dont want to do your job...then GET THE HELL OUT......the remark stated above is not acceptable....shows 2 things 1. no compassion. and last but not least POOR PROFRESSIONALISM..... even the bs calls the patient needs to be treated with respect and dignity...to you it maybe bs to them it may be serious.....it is like always in the preception.......

as always just my two cents worth

Terri :angel12:

[nsmedic393]

UMSSTUDENT

I completely agree that if all our medics were properly educated and always had the best interests of the patient at heart than we could acutally try to assist the patient to come to the best decision possible about where they needed to go and how they shoud go there. I am a paramedic advocate and think that there is no limit in what we could do in the field, BUT, i am completely discouraged by these moron medics that are more concerned with getting off on time than with treating their patients or the ones who are just plain old too stupid to know who needs to go to the hospital and doesn't.

As much as I would like to think that we as a whole are capable of taking a simple refusal all these examples presented make me think that for the greater good we should just be taking everyone to the hospital weather they haven't had a BM in the past hour or have a cut on their finger.

With the sorry state of affairs things are in right now I think it would serve the greater good to take away any rights paramedics have to try and convince someone not to go to hospital. People show time and time again that they are wiling to abuse the priveledge of making a good clinical decision for the sake of their next meal so screw us all.

[Dustdevil]

Unfortunately for EMS providers, this reaction can occur to any number of the hundreds of documented phobias. Using your "theory," if a person has arachnophobia and has seen a spider they should probably be transported to the hospital. The only support I can see for the argument is that hemophobia is decently prevalent, and like most psychological traumatic experiences, can have a sudden onset.

Completely irrelevant to your own point. While somebody with arachnophobia may indeed experience a syncopal episode, they do not require medical treatment BEFORE that episode. Therefore, transporting them is not even a factor, unless they specifically ask for it. Conversely, the patient you began this conversation about in the first place has an existing, acute injury and does require medical treatment. Therefore, transporting is a factor. And therefore, your analogy is invalid.

Again, people have friends...have them drive you. Also, AGAIN...this is the patient's choice.

Absolutely, and that was my point. It is their choice. But it is not up to you to "encourage" them to find their own conveyance.

[UMSTUDENT]

Completely irrelevant to your own point. While somebody with arachnophobia may indeed experience a syncopal episode, they do not require medical treatment BEFORE that episode. Therefore, transporting them is not even a factor, unless they specifically ask for it. Conversely, the patient you began this conversation about in the first place has an existing, acute injury and does require medical treatment. Therefore, transporting is a factor. And therefore, your analogy is invalid.

Absolutely, and that was my point. It is their choice. But it is not up to you to "encourage" them to find their own conveyance.

I believe my example was a "lacerated finger." I don't consider that an acute injury needing immediate transport to a facility of higher care. Sorry, a band-aid will fix that. I consider it an "event of everyday life." Seeing a spider is also an event of everyday life. You're obviously not able to read into the context of what I'm trying to report, but that's OK.

Again, I don't expect you, or any other paramedic for that matter, to be able to make these decisions of responsibility for themselves. Most of the paramedic workforce is arguably not equipped to make those decisions. Common sense isn't something a lot of jurisdictions allow their providers to be able to utilize in their protocols. Unfortunately our entire profession has been centered around sets of protocols so stringent that they have told us how to think and approach every single scenario. I see this all the time. Our profession is scared to utilize half the skills they've been allotted because of poor education and a lack of confidence. We use the self-defeatist attitude that since we're not doctors we must not be qualified to make basic, "mom" decisions.

I also never advocated "encouraging" anyone to not go to the hospital. You make the service available, advise them of what you think, and inform them that you, a paramedic, are not a "doctor" and therefore not the definitive level of medical knowledge they may be seeking. You let them make the decision from there. Fortunately for those advocating transportation every time, our profession has done such a good job of making ourselves look like technicians that most people, in my experience, take up the offer.

[Dustdevil]

I believe my example was a "lacerated finger." I don't consider that an acute injury needing immediate transport to a facility of higher care. Sorry, a band-aid will fix that. I consider it an "event of everyday life." Seeing a spider is also an event of everyday life. You're obviously not able to read into the context of what I'm trying to report, but that's OK.

That is a possibility. It was my understanding that you were describing an injury which did indeed require treatment at the hospital, and that you were saying it was perfectly okay to tell them they should get a friend to drive them or to drive themselves. In that case, I stand by my statement of disagreement. But if you were talking about somebody who does not at all require medical evaluation or treatment -- no stitches, no nothing -- just a bandaid, then yes, I agree with you.

[UMSTUDENT]

That is a possibility. It was my understanding that you were describing an injury which did indeed require treatment at the hospital, and that you were saying it was perfectly okay to tell them they should get a friend to drive them or to drive themselves. In that case, I stand by my statement of disagreement. But if you were talking about somebody who does not at all require medical evaluation or treatment -- no stitches, no nothing -- just a band aid, then yes, I agree with you.

Then we agree for the most part. I don't feel that lacerations that require stitches for cosmetic reasons should necessarily be treated as an emergency. As a child, I had plenty of injuries that would have required stitches in order to "avoid scarring."

In each instance my mother yelled at me for being stupid and asked me if I wanted to get stitches, advising me that some further pain and a lot more of my time would be had in a hospital. I chose to forgo the stitches every time and have a few blemishes on my knees because of such.

I think a lot of my anger comes from the fact that, as a child, I was taught that it was only acceptable to call 911 in the most extreme circumstances. I was made aware at a young age that other people had more serious injuries and to sort of self-triage. Basically, unless mom was not around for some odd reason it went like this:

1. Consult mother

2. Get yelled at for doing something stupid. Jumping off tree house, playing ninjas with baseball bats, etc...

3. Wash it

4. Put a band-aid on it.

5. Go on with life.

I was taught that it was kind of embarrassing to call 911 unless it was serious. In my time in EMS I've seen people call 911 for the most simple of injuries. Basic stuff that could have been taken care of with some soap and a band-aid. It's almost as if our culture doesn't have a consciousness for what is truly serious. The same thing applys in regards to accidents. A car can be flipped over an embankment and a women running around screaming outside and not one person will stop to help (Yes, I've seen this too).

[Dustdevil]

You had 911 when you were a kid? :shock:

You're younger than I thought!

When I was a kid, if you had an emergency you had to saddle up and ride into town and find the sheriff.

AND WE LIKED IT!!!

[Cookie]

UMSTUDENT I think you have too much anger to be in the field of Emergency Medicine.

[paramedicmike]

I think this article discusses an important aspect of EMS. However, I don't like the premise on which it was written.

From the article:

This article explores the inherent dangers of "no transport" situations and addresses incidents when EMS providers decide that transport is not needed or encourage a patient to sign a refusal form.

It sounds to me like the author is maligning the very people for whom she writes. Or she's misinformed at best.

Why are EMS providers deciding that transport is not needed? Further, anyone who would *encourage* a patient to sign a refusal shouldn't be working in EMS to begin with.

Refusals are a touchy situation to start. Any refusal taken should not be taken lightly. All the paperwork should be filled out. Documentation of a refusal should be even more detailed than a normal PCR might otherwise be.

We should not be deciding someone doesn't need transport. Further, we shouldn't be encouraging refusals. If you're going to take a refusal, make sure that everyone knows the potential for harm by not seeking care. And do a complete and thorough documentation of the call.

I agree with Rid, too. Damned if you do. Damned if you don't. There's so much potential for harm to come out of not transporting someone. I realize we can't force them. But it's just so much easier if they go with us than if we let them stay home.

-be safe.