A personality problem? Help!

[AnthonyM83]

You remind me of my current partner on the BLS ambulance.

He's very confident person (Ex-Marine) and often comes off very forceful (as you said abrasive) or excited/intense. He's also used to saying what he thinks...and thus has given his opinion one too many times on-scene.

Example: Hypoglycemic. Short transport. Medic couldn't start line en-route. As he opens back doors, asks "Can't you give it glucagon IM when you can't start a line?" Sure, honest question, but also reinforcing medic couldn't get his line, questioning his decision not to give IM yet, and directing medic on what to do. It wasn't a true question...he knew the answer.

Instead, AFTERWARDS he should have asked "Hey, if the transport was longer could you have given glucagon there?" or "What else could we have done if we were farther from hospital?". He should be able to deduce medic didn't use it, b/c he thought he could get the line, but then they arrived at ER....yet he still asked his question, implying medic screwed up.

Also, since he doesn't realize his voice tone/intensity, he needs to feel the vibe of everyone else first (esp. lead medic), pace of the call, tone of the call (hurrying? slow/calm? trying to lead pt to specific diagnosis or asking every question we can?) Then, match it.

Also, since you're new, you should be WATCHING how everyone behaves, interacts, asks questions on-scene...then imitating, rather than setting YOUR own flow based on non-experience. Is it normal for the OTHER EMTs or even medics bring up questions like radian nerve? Sure, you learned a fact in school, but have you seen how it's importance and style of application in field? With several people on scene, why would it be YOU who questions it? (You're the newbie learning how it's done...and asking a question mid-procedure like that isn't learning...it's like you said: questioning.)

As far as the Narcan thing...why would you start talking about Narcan and it's use of oxycodone OD? All probably assumed to show off . . . yet all probably had already thought Narcan before you, but knew everyone else had too, so why say anything. Do we start talking about O2's effects on heart as we approach a chest pain pt (unless we're teaching a ride-along)? No, because it's obvious.

Hope that didn't come off too harsh. Just my blunt opinion on that. It's great that you're working to correct the problem, though. Some don't. I know you want to be yourself, but people also need to go to work and get positive interactions, unless blatantly messing up or someone with standing tells them to correct stuff.

[Eydawn]

Anthony, you make some very good points. I appreciate the feedback, and take no offense to it.

How would you approach watching and imitating when you are pushed to the front of every single call to begin assessments as the initial lead? I keep being informed that I need to come up with a system, and then I'm not given much opportunity to just watch a team and learn how their system works. My first chance to watch someone run a call was my last shift, and I got to watch one fairly simple psych pick-up and transport that didn't need anything more than a set of vitals.

I also think that being told to verbalize assessments and possible treatment modalities and then receiving chastisement when I do so and mention a drug that might be in the patient's future is confusing. Not necessarily wrong, but I'm telling you, it needs to be one or the other. Either we're encouraged to think and cross check what we're thinking to show that we're clued in to patient care, or we just do the monkey skills and shut up. For now, I'm going to try to shut up.

I also would beg to differ that asking a question mid-procedure is not learning, or that it's always inappropriate. I didn't tell the medic I wouldn't stick that vein until it was explained why it's ok to stick there; I did, however, raise a question that I thought was important for patient welfare based on what I had learned. It's like double checking that they're SURE they want you to do that when the medic tells you to put the combivent together for that asthmatic but the patient said they were allergic to peanuts, so Atrovent might not be a good idea unless there's a different thought process going on that I am not aware of.

Regardless of the fact that the medic is ultimately responsible for actions in the ambulance, I am also ethically responsible for any actions I do, so I'm not going to just do something (especially something invasive) because I've been told to if I'm not comfortable with it. On the IV thing, I got it now, I know better. Easy mistake to make, now fixed. But we've been told over and over again to ask questions, to get in there and get involved and try to learn... and it's not serving me well in terms of learning how to be an effective paramedic's bitch, because questions are taken as challenge and I'm always following the medic and what they're doing- not what the BLS guy is doing while I'm distracted with watching the medic.

You see where I'm coming from, Anthony?

--Wendy

[AnthonyM83]

I see the difficulty.

Simply explain difficulty to your instructor and ask to watch him do a mock lead assessment to get the feel for what he wants. Also, Narcan incident might not be a problem by itself, but combined with other incidents, they're not sensitive to it.

Also, make sure you're verbalizing the right things (actions and findings versus discussing a med) DURING the call. Limit considerations to: "I'd call ALS for possible Narcan use" or "I'd consider suctioning due to gurgling" (Even that's a bit much, instead just suction, then state why at a basic level: gurgling. Or "I'd call ALS") Make sure he doesn't want just BLS stuff, too, btw.

Ask your instructor: "What's the best way I could have brought up Narcan?" He might say, "Call ALS for Narcan" or "You shouldn't. Just show me BLS".

Questioning mid procedure, SPECIFICALLY AS A TRAINEE, is the problem. One of the things you're learning in training is how others on-scene question (or don't question)...you're not actually there doing it, unless blatantly obvious. And I submit, there's many things you won't know aren't blatant until you have more experience. Assuming medic isn't new or stupid, his way works...it's been working out years.

You don't know what the medic knows and he doesn't have time to educate you in the moment every time don't know something ALS (and there will continuous flow of those moments).

Medic says put patient with peanut allergy on Atrovent?

That's simple, just say: "He says he has a peanut allergy. Is that okay?" (Neutral tone, not worried, excited, forceful, abrasive)

You'll Yes or No. THAT'S IT.

AFTER, you can learn why it's okay (Medical Director's opinion since you also carry anaphylaxis meds, severity of patient outweighed risk, specific dose, whatever it is)

MAYBE he wasn't aware of the issue...but slim chance every single time he's not aware of the issue AND it's serious enough consequences...we can't just have every call run that way

You need to develop the mindset that there's a lot you don't know. A lot you don't understand. A lot of reasons they know what they're doing. IF after a lot of time and experience, you realize you DO know more, change agency or go become a medic...but keep that mindset or 1) You won't get along and won't enjoy your job or 2) Medics will start owning you when you're wrong and they won't give you as much leeway on-scene to practice assessing and get good.

[crotchitymedic1986]

First of all wendy, you should be commended for even stepping up and admitting, "I might have a problem". Some simple suggestions:

1. Smile. You can tell someone to go to hell as long as you are smiling. Conversely, you can say have a nice day with a smirk and piss someone off. So smile.

2. Ask yourself, do i listen to hear, or do i listen to formulate my response. Many people do not really listen to what is being said, but merely scan through hearing the catch words, to formulate their answer.

Sounds silly, but try listening, and then repeating silently in your brain what the person said before you talk.

3. Dont add in your two cents every time you get the chance -- sometimes, especially when you are the new person, it is better to be silent for awhile. Many people have to add their two cents in during every conversation -- sometimes it is better to just listen and not talk.

4. Pick your battles -- you could wind up 100% right in every arguement you get into with your superiors, but wind up unemployed. I am not saying to compromise your values or morals, but ask yourself should i die on this hill, or live to fight another day ?

[crotchitymedic1986]

Also, you have to realize that many instructors are used to talking TOO people and not WITH people, so sometimes it is they that have the communication issues with their subordinates. Anthony was also right in that all you know is your "book learning" right now. I am not trying to minimize that, but you need to get "experience" before you start questioning anyone on the scene. A better way to handle the situation for now, is at some point after the call is over, go to the instructor and supervisor and say, hey I want to ask you about that call -- i think i was under the impression that we were supposed to do "cde" but you choose to do "fgh", so please help me clarify what i should do in future calls.

And remember, when presented with the option of being right OR being NICE, choose to be NICE.

[Eydawn]

I will *NOT* choose to be nice over being right if it is a matter of patient welfare... having people like me as an individual is definitely a lower priority than having the patient receive the best possible care. We are here to advocate for our patients. But you are right, in that approach is key... and there are good or better ways to approach something if it might be a problem. I do a lot of active listening... and have stepped it up since catching flak in the first stage of my transitional period.

Fortunately, things have been getting better. I've been up front with every instructor about how I've been perceived by other instructors in the program and asked them to tell me immediately if I come across in such a fashion so I can clue in to what is offensive or not. Haven't had a problem with it since... and things have been getting better with different instructors, as well. Yesterday my FI let me actually run calls, sitting back only for advice when asked and prompting me occasionally to get to something that might be overlooked. That really helped me establish more of a rhythm, which means I'm less choppy on scene.

I've also thanked everyone profusely for the advice I've been given and the extra time they've taken to help me with things that I'm struggling with... and it's been a much better experience. Thanks to everyone who has replied... it's been great! You guys are super helpful.

Wendy

CO EMT-B

[crotchitymedic1986]

I would never advice you to compromise patient care. My point was that there are people in this world who HAVE TO BE RIGHT in every conversation, and thus tend to dominate conversations and refuse to see that there may be another way of doing things, or godforbid, they may actually be wrong for once. My point about being nice was for general conversation, not life and death patient care situations. Glad to hear things are getting better for you

[Richard B the EMT]

My point was that there are people in this world who HAVE TO BE RIGHT in every conversation

Sounds like the conversation about having dated Mr or Ms. Right, with the problem being their first name is "Always".

I have had partners (and off the job friends) who are argumentative, and seem to pick fights even when you agree with them!

[spenac]

Sounds like the conversation about having dated Mr or Ms. Right, with the problem being their first name is "Always".

I have had partners (and off the job friends) who are argumentative, and seem to pick fights even when you agree with them!

I do not you lousy Ny yankee. :wink:

[Richard B the EMT]

Spenac, how many times do I have to tell ya? I'm a "Met", not a "Yankee"!