Mateo_1387

I hate absolutes, and have in fact found that any time that I try and construct one the EMS Gods swoop down and make me look like a bigger shithead than usual.

Never palm the breast in a 12 lead, never lie...never, never, always, always, yadda, yadda.

I believe it all resolves around your moral and ethical intent.

What revolves around moral and ethical intent? Coercion, lying, or palmin' breast?

Initially upon reading this, I am going to state this. Your moral and ethical intent may not be what the patient wants. Trying to apply my perspective of moral and ethical intents does not necessarily apply to my patient's standards for morals and ethical dilemmas. Is this illogical?

He asked, "goin'........................to............die?" I said, "No worries brother, we're pushing it back. Can't you feel it?" But yeah, there was almost no doubt in my mind that he was going to die before I got him to the hospital. He didn't, thanks in almost no part to me, but what I really didn't want to do was tell the truth, add to his axiety and increase my already shitty position.

So those that believe that lying is 'always' bad...was the better answer then, "Yeah man, I'm afraid you're going to die, I just can't get ahead of this thing.'?

Whatcha think?

How about a reply like this. "Sir, your condition is serious (Admit the truth) but you are doing a great job working with me to help you feel better (offering a positive and encouraging reinforcer).

Or, just ignore the question and offer a ton of positive reinforcement to help keep the patient focused on following your commands to help him breath better.

Just thinking out loud...

Matty

Lying to a patient - absolutely not. Now using persuasion of things that might possibly happen should they choose not to come with you to the hospital, a totally different issue. Even if the chance is remote or unlikely, I find it well within my bounds to say yes this may happen to you if you don't come with us. If I have to do the dance if I seriously think a patient needs to go I will. Now there is one exception to this rule :

A disoriented or elderly confused patient - some of them can be a challenge to convince to go due to financial concerns, confusion, or just plain stubborness. Also, many are afraid that if they leave their home they won't be able to return to it and would rather die within their home than be placed in a nursing home. Especially if they are having difficulty caring for themselves. I don't lie per se - but dance around the truth a bit - I'll say they'll do their best to get you back home even if I know it's highly unlikely that person will be returning - you never know ! But I don't believe in ever flat out lying to a patient just to get what is productive for you. That's just bad form.

I agree that lying to a patient (in most circumstances) is not the professional method to 'get someone to the emergency room'. We had a thread here recently that discussed points similar to this one and I cannot find it. Anyways, I will repeat what I said in that thread. For starters, I will post the definition of coercion.

co⋅erce [koh-urs]

–verb (used with object), -erced, -erc⋅ing.

1. to compel by force, intimidation, or authority, esp. without regard for individual desire or volition: They coerced him into signing the document.

2. to bring about through the use of force or other forms of compulsion; exact: to coerce obedience.

3. to dominate or control, esp. by exploiting fear, anxiety, etc.: The state is based on successfully coercing the individual.

Pay special attention to number 3. Exploiting fear, anxiety, etc, to dominate or control. In essence, getting the patient to do what we think is best for them. Another way to say it, and this one of my favorites which was stolen from DwayneEMTP, 'gifting them with our advocacy'.

We, as professionals, have an obligation to respecting the freedom of choice concerning our patient's bodies (if they are capable of making decisions for themselves). We, as professionals, have no right or obligation to scare patients into going to the hospital because we know or think it is best for them. The decision is and should be their decision to make. Telling patients things such as 'you will die if you do not come with us', especially being a small remote chance, is coercion at its finest. Informing patients about complications of their medical condition is one thing, using those complications to promote your agenda is something entirely different.

The same holds true for those who threaten medical procedures. 'Wake up or I will put a big needle in your arm' or 'tell me what pills you took or I will have to shove a tube through your nose to your stomach' or 'you will die if you do not hold still' etc are all forms of coercion. We should honestly take a look at how we talk to patients. Sure, compliance may be easier if you use coercion. Taking a moment to talk to your patient, explain to them the why behind why something is warranted go a whole lot further with patient interactions than using some of the above phrases.

Matty

Matty,

does this mean that all women who wear Burka's are terrorists? Do all surfers smoke dope? Are all junkies street dwelling scum?

Generalisations like this are more detrimental & show a lack of understanding. I know many muslims who deplore the reign terror has started, but attitudes such as this will never & can never help.

for clarity, here is a quote as to why some women choose to wear a burka

Where did I say that all women who wear a burka are terrorists? Although my post was not clearly spelled out with /sarcasm at the end, I certainly have not implied what you say. Posts like this are more detrimental to discussion & show a lack of reading comprehension. /sarcasm.

Honestly though, my intention was to convey that I would like to know why the French want to ban wearing a burka before they are bombed (by true Islamic extremists that a certain number of Muslims deplore).

You're telling me you've never thought some of that stuff?

I did not say that, you did.

It was funny at first (it is all about my perspective), but towards the middle and the end, I started thinking a bit more seriously.

It would not. Perhaps our friend works in one of the backward ass systems I have heard of who do not use saline or hep locks and run a bag of fluid whenver they start an IV.

You know the old ambo trick of "more is better" has a perfect application here, not.

That is quite a jump to a conclusion about which type of ambulance service he/she works with. In retrospect, I read the post twice and thought maybe the poster wanted to portray that if a patient is going to be going to the operating room immediately, then he prepares Normal Saline ready for use by the hospital staff. The poster did not state that IV fluids are used with every IV.

Que? Entiendo nada. Paramedicos no necesito inglish. pinche gringos.

Oh and no I have never heard of USA Paramedic exam being in any language but so called English.

Usted escribe en español horriblemente. Uso de la palabra ´pinche´ es de mal gusto.

Si fue otra persona, entonces ADMIN sacaba la palabra. Pero estoy divagando...

OK, lets look at it a different way then.

Should any government be able to dictate how you dress? Should they for example, be able to stipulate the length of a skirt (minimum or maximum)? How tight jeans can be? or how low cut a top can or cant be?

This story is on a Burka, but could so easily effect our day to day lives.

Government can require that you wear a minimum standard of clothing, I reckon they can set a maximum too. Religion sets standards too. Personally, I am thinking it is a bit far to prohibit the burka, but I would love to hear their reasoning before they get bombed or I can make up my mind.

Matty

Yea....

The whole firefighter wearing gear inside of a nursing home asking medical questions looked about as stupid as they portrayed the nurse. I know it is supposed to be a funny, but I just got the idea that the posted video and those similar to it found on youtube are to just make firefighters feel good about themselves. Oh well.

Matty

Hey JD.

I'm just about 1 1/2 hrs from you in Pitt County. Are you taking your class at Wake? There is a member here that took the degree programme there. Enjoy your classes and as firefly stated, don't be afraid to ask questions!!

Oh, and is it true the best thing about Raleigh is the sign that says "Greenville 85 miles"? LOL

I'd have to say the best part of Raleigh is the large selection of restaurants that serve awesome food !

Also, taking I40 to Raleigh just past Exit 301, going around that corner, I know I am back home. Miss that place.

Jake...LoL...no I am not taking my Medic thru Wake Tech...I choose Johnston County. It's a shorter program. It's a little closer to home and it does not require me to retake my basic.

But the truely BEST part about Raleigh is 2 simple things...1) The "HOT" sign at the Krispy Kreme and 2) a Snoopy's Hot Dog...those 2 things right there make this town somewhat livable.

Enjoy JoCo ! I hear they have a decent program at JCC. Good Luck !

I know it's just I get ticked off when I see people say things like "oh its a BLS patient, I won't transport them I am ALS, I will call another truck to do it for me" or "Oh education is fine coz all EMTs handle are BLS patients" etc etc

Just a real pet peeve of mine

Yea, but Fiznat did not say that. Anyways, his question probably was weather or not the patient was a high acuity patient, which typically require advanced skills, or a low acuity patient who does not require all the bells and whistles. Calm down bro, Fiznat is one of our finest posters, give him a break.

(Edit was to fix the last word from beak to break, maybe it was a Freudian slip...)

This was an extreme situation that doesn't happen every day. DUH, I think we all know these medics SHOULDN'T have done what they did. Great thing to point out there rock ... I only hope I have the same courage to do what they all did, should I ever be faced with that situation because I know I couldn't live with myself if I ran away.

Rock shoes is just pointing out what is obvious to most of us. You have to remember we have many members who may not grasp that their actions were dangerous although probably heroic. Someone had to point it out.

Siff, I agree with you though, I'd hope to have the courage too.

This incident just flat out sucks.

Matty.

I think Capt. Stern has a point, even if he does loudly communicate it

BTW WTF is an NCEMT and EMT 4

NCEMT may be North Carolina Emergency Medical Technician.

Hey Kai,

Sorry to hear you are in a sticky situation. I hope it turns out well for you.

I suggest to follow the shut up and lawyer up advice already given (ECHO ECHO ECHO)

May I also suggest that you refer to the policies and procedures book of your company in reference to Internet postings, suspension, and disciplinary actions. Make sure you are being treated fairly. The other thing I suggest is to see if there is any unemployment insurance you are entitled to for work that you miss. Might as well take the money if you are entitled to it.

Good luck to you.

Matty

We are allotted 20 minutes to get back in route to our district. I think they made it the standard because most people at this service write really short and incomplete reports (IMO) so they leave the ER fast. I typically take a few minute over 20 to be in route to district. On the other hand, I write detailed reports. Our supervisor does not complain too much to me about being over 20 minutes.

I know i will get voted down for this but I wont change cause all the americans need to lighten up & not take life so seriously!!!!!!! You guys need peeps like me to continue to take the piss outta you & show you that life isnt that serious

Any scientific evidence the Americans are to blame? Specifically, which Americans are we talking about? I've seen some mean lookin' South American Drug Lords...

1999/2000:FDNY EMS Command, Station 47 (Rockaway). Millennium change, in the supervisor's office, holding our glasses of non alcoholic "champagne" in one hand, and flashlights in the other, as we expected the lights to go out due to the "Y2K" computer glitches.

Good ol' Y2k. Some of my family has kept the holiday scare tradition going. Each year it is something about how everything will go downhill and we will be left with nothing but what is on our backs, at least that is the outcome of each of their predictions. Gotta love those folks...

He is what North Carolina is saying about using the King airway for emergency situations.

NC-KingAirwayFDAOpinion.pdf

Ben what is FML?

FML = Fuck My Life

http://www.fmylife.com/tops/flop

Way to turn Santa Clause in for being a terrorist Dwayne, I hope you can live with your decision...

4 Intubations this year, thanks to the cadaver lab.

OK - so that’s the story. Now I’m going to tell you what had me up this morning thinking about it. This patient has shit for a life. He got to the point where he put a .38 under his chin and pulled the trigger. If he makes it, and I’m pretty sure he will, now he’s got shit for a life and no face. Tell me again why we do what we do.

Thank you for listening.

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

Holy How to get OFF TOPIC, end of life choices, read between the lines and then personal life and family stories btw no mention of any age in the OP, just uncontrolled IDDM, HTN, and NTG requires an internal medical specialty not Paramedics voicing opinions, lets throw a little "depression" into the mix.

You of all people know that threads take on a life of their own.

Ok so Matt you have never told someone to lie still on the LSB and don't move because you could end up in a wheel chair ?

Nope, cannot recall ever doing it. Why do you ask?

Well, I would say there are 2 different scenarios. As a responder, I have no problem trying to "guilt" someone into going to an ER. Tell them the worst case scenario, tell them they may die (if appropriate for their condition), tell them their family is worried they may lose them. If all that fails, and they meet the criteria for a refusal of transport, then you've done all you can, and you need to respect their wishes. Yes, it seems our society has become far more likely to know what's best for someone else- regardless of their expressed wishes or their refusal to comply with seemingly common sense advice/treatment/care. Like you alluded to, since when did making your own decisions become a bad thing?

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.

As a family member of someone who may not be doing what you feel is in their best interests, well, like you said, give them the straight dope, make them understand the possible consequences of their decisions, and then support and love them unconditionally. Is it hard- of course. Nobody wants to see a loved one hasten their demise or live a quality of life you feel is not adequate, but ultimately it's not YOUR decision, it's THEIRS. As long as that person is of sound mind and body, you must respect their wishes. That is what love is all about- doing what THEY want.

I'm sure that most people struggle long and hard with their decisions to forgo treatment or care and don't come to these conclusions easily. They accept their situation, understand the probable outcome, and are OK with it.

We've all had patients who completely frustrate their families(and us) by refusing care, being noncompliant with their medications, or simply do not take care of themselves as we think they should. They made a choice, and we must accept that choice- as unpleasant as it may be.

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…

Ahhhhhh... If they're "popping nitro like candy" because they're having chest pain, due to a blockage. I believe you don't need to worry about insurance to get treated in an ER, which is where they should probably be seen, soon.

Being the mean person I am, I'd just go ahead and call 9-1-1, then hope you get a puppy dog eyed responder than can talk them into going. Perhaps guilt them with talk of how much everyone loves them, and will miss them. Maybe cry a little? Or, you could just be honest " You are going to die."

4c is right. Sometimes you just need a bit of the tough love.

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.