Was I Wrong?

[spenac]

Dude, you must be sick or tired, this post has no quality at all.

OP: Just because you get disaplined or fired for something, does not mean you were wrong.

I agree, you have alot to learn from this experience, and many more, but you were not flat out WRONG. You were faced with a moral dillema, and you stood your ground on what you thought was best for the patient. This was not a drug dose, there is not a right & wrong answer. The more dillemas you are faced with, the higher your tolerance will be, and the more you will grow as a professional. You have the pts needs at heart, that means you are in the right buisness. Sometimes the drive to keep people healthy overcomes our compassion to let people die on thier own terms. Ever had someone with chest pain refuse ASA/Nitro? I have.... it sucks! But they are ready to go, and we need to agnowledge thier feelings (NOT assist, might I add!).

I disagree with you and Dwayne in this case. Patient refused medical care. Patient was competent. Refusing to comply with orders in this case had nothing to do with violating ones morals. This had to do with refusing to do the job the OP accepted money to do.

Based on claims this was a moral decision then it allows one to justify ignoring a patients request to not be given a medicine or other treatment.

Doing what I said by talking to the patient and explaining why you feel their choice is the wrong choice is one thing but forcing your beliefs on a competent patient is wrong.

[Just Plain Ruff]

More of my 2 cents

The only thing you did wrong was to refuse to tech the call

Standing up for your morals and ethics is really really hard and it sometimes ends up with us being ridiculed, harassed, written up or fired.

You discussed the concern you had with the patient and he still said that he wanted to go home.

Your next step if you don't think that the patient will be taken care of correctly is to contact either the elder abuse hotline or the social services of the hospital and truly that is the extent to where you can take it.

Unfortunately there is really nothing more that you can do unless you want to go by the patients house and make sure he's ok! I don't think you want to do that.

Chalk this up to a huge learning experience and keep questioning things. I echo dwaynes sentiment that someone standing up for their patient or their morals/ethics is a rarity and I commend you for that.

Keep your morals and ethics intact, this business will sometimes make you question them.

[Lone Star]

Here's my take on the whole situation:

First off, refusing to 'tech' on this call doesn't relieve you of anything. You were still part of the crew that took this patient home.

While it's apparent that you had some concerns about the whole situation, you ARE the patient's advocate...this means doing what's in the best interests of the patient.

Since the patient was CAO x 4 (alert to self, day, time, place), and adamantly refusing to be put into a nursing home (even if only for rehabilitation); you had a responsibility to try to talk the patient into going. This is no different than trying to talk a patient into going TO the hospital for their own well-being.

In your shoes, if I couldn't talk the patient into going (even for a short term rehabilitation stay), then I would have involved the hospital's social worker. There ARE options available to the patient (even if the patient isn't aware of them).

I take great umbrage to those that are advocating the whole ‘just take them/dump them’ stand on this call.

I would rather stand by my morals and ethics (professional and personal) than I would just generate resources for the company.

If we were to respond to a call where we found the patient who wasn’t able to take care of themselves, or not being taken care of, we would be legally bound to report that situation to Social Services so that the conditions could be remedied. How then, can you even ATTEMPT to justify CREATING that very situation?

This is a tricky situation, to be sure. Your partner must have forgotten the very foundations that EMS was developed upon. Do no harm, patient advocacy, compassion and a commitment to education.

[Doczilla]

Nowhere in your post do I see that you communicated your concerns with the ER staff and engaged in a discussion.

You may not agree with the patient's decision, but it is not your decision to make, either. As others have said, autonomy is at the core of medical ethics. The patient's decision does not have to be the right one, only one they are competent to make. You don't have to agree with every decision a patient (or HPOA) makes.

To whom, or what, are you protesting? Your follow up post indicates the ER staff tried to get him to stay. So who sees you stand tall against "The Man" by refusing to get in the back of the truck with the patient? Are you trying to tell the patient that you disagree so fervently with his decision that you will do nothing for him? A decision he has the eminent authority to make?

So you basically took it out on your partner by sticking him with the run. It was a crappy thing to do.

Good initiative, poor execution. Your first instinct should not be to foist the call on someone else. Your first instinct should be to shoulder that burden yourself. Share your concern with the patient and ER staff, share it with the patient, contact his family from home, or whatever. What will you do next time? Quit in protest? What will that solve?

The only time you should dump a run on your partner is a) when he has better skills and the patient is sick enough to require them, your interaction with the patient is such that you don't feel you can provide good care, like if you got into a fight with him or she accused you once of sexual harassment, or c) it's his turn.

A word on protest: it is better to change a poor system from within than just quit. People may care that you quit, but not enough to change anything. Quitting is certainly easier for you. What you did in this case, in a small way, was quit.

'zilla

[fakingpatience]

There have already been many good, well throughout opinions here, but I will add my take on it.

First, IMO, your partner was being a jerk. Many people are saying you are wrong for having your partner tech the call. If your partner hadn't offered to tech it initially, would you have asked them to? Yes, I think that you should have teched it, but your partner seems like one of the "you call we hall thats all" folks. Were you having a bad day with him? It seems very extreme for them to write you up for one call, where you did end up taking the patient.

At the hospital, did you address your concerns to the ER staff? If you had, you might have found out what they had already talked to the pt about/ called for future services. As others have mentioned, if the guy is already signing out AMA back home, has already been talked to about this decision by a few other people, there probably isn't anything you can do to change his mind. Your only option is when you get the pt home, state your concern once again, and ask if he would like to go back to the hospital. Unfortunately, this probably wouldn't fly with your partner that day, and as dwayne mentioned, if this is complete bs, and the guy just wants to be in the hospital, the ER would probably be pretty ticked at you, but regardless of all that, once they patient gets home and sees how hard day to day life will be for him, he may change his mind.

Let me give you an example of a time when we did refuse to take a patient back from the hospital. This was at my old service, where we had a very good relationship with the hospital staff, and knew our supervisors would back us up. I was just shadowing on this call. An ambulance had brought in this pt to the hospital from his nursing home for a respiratory illness (don't remember all the details, but bad breath sounds, low pulse ox...) We get called to bring the patient back to the nursing home. In the ER, the patient looks like shit. Still has increased work of breathing, crap lung sounds, pulse oxing in the 80s on a nasal cannual, we know as soon as we get to the nursing home, the staff are going to turn around and send him back to the ER. My medic partner called the supervisor to give them a heads up on what he was going to do, then went and talked with the RN/ MD in charge of the patient. Turns out shift change had just happened and this MD had never seen the patient. MD came in and agreed the patient was not ready to go home.

[HERBIE1]

Nowhere in your post do I see that you communicated your concerns with the ER staff and engaged in a discussion.

You may not agree with the patient's decision, but it is not your decision to make, either. As others have said, autonomy is at the core of medical ethics. The patient's decision does not have to be the right one, only one they are competent to make. You don't have to agree with every decision a patient (or HPOA) makes.

To whom, or what, are you protesting? Your follow up post indicates the ER staff tried to get him to stay. So who sees you stand tall against "The Man" by refusing to get in the back of the truck with the patient? Are you trying to tell the patient that you disagree so fervently with his decision that you will do nothing for him? A decision he has the eminent authority to make?

So you basically took it out on your partner by sticking him with the run. It was a crappy thing to do.

Good initiative, poor execution. Your first instinct should not be to foist the call on someone else. Your first instinct should be to shoulder that burden yourself. Share your concern with the patient and ER staff, share it with the patient, contact his family from home, or whatever. What will you do next time? Quit in protest? What will that solve?

The only time you should dump a run on your partner is a) when he has better skills and the patient is sick enough to require them, your interaction with the patient is such that you don't feel you can provide good care, like if you got into a fight with him or she accused you once of sexual harassment, or c) it's his turn.

A word on protest: it is better to change a poor system from within than just quit. People may care that you quit, but not enough to change anything. Quitting is certainly easier for you. What you did in this case, in a small way, was quit.

'zilla

I agree with you here, doc, but I will say in defense of the OP, I believe this is a relatively new provider. It takes time to step outside the rigid box of protocols and cook book procedures to realize there are gray areas. Medically, it's pretty easy to defend your position on something like patient care, but in cases such as these, you need to be able to take a step back and look at the big picture. Experience teaches you that the longer you are in this business, the more you see things that make you wonder about Darwin's theory. Do you lecture every 22 year old OB patient on welfare, who is G6P5, with a different daddy for each child- about the wisdom of spitting out yet another kid they cannot afford? What about lecturing the drunk who is slowly killing themself one drink at a time? You cannot help someone who does not want it, nor can you impose your moral code on someone else.

Pick your battles, know your role, know the rules, and know your limitations. Realize it will be a short and very frustrating career if you cannot understand there will be times we simply cannot change someone's mind or keep them from making poor choices.

It's called job security.

A possible choice here is for the OP to propose a plan that their company can adopt in future situations such as this. Have an established protocol where the provider notifies management, who notifies the appropriate social service agency, and follows up with at risk people. I'm quite sure the hospital's social service folks are aware of the situation, and may have even offered possible home health solutions but in the end, it still means it's up to the patient to take advantage of the help being offered.

[Just Plain Ruff]

Real world example.

Picked a patient up from a house that could only be described as a hoarders house. There was trash all over the place, the guy had over 20 cats and he had newspapers dating back 15 years in piles. We barely got the patient out of the house when we picked him up.

He was diagnosed with MRSA on his lower legs bilaterally. Open sores and the like.

He lived alone, liked it and was his own guardian. He saw nothing wrong with his living situation.

So we get called back to take him home. Knowing that he had a nasty MRSA infection and was going back to a biolab level 4 I was very very concerned that we would be back to remove his body from his house.

I expressed my concerns to him, he said thanks but he was fine with living like that and he said "If I'm going to go, I want to be with my cats"

we took him home, carried him to his favorite chair (the cleanest item in his house) and again I expressed concern and he said thanks.

He had no home health aid, refused all their care and offers of help from the hospital.

2 weeks later he indeed died.

The guy was given the option of a nursing home yet he refused, he was given the option of daily home health visits yet he refused.

I knew I had done all I couild to assist him yet my final assistance to him was to put the monitor on him and see asystole.

Did I take him home to his demise, YEP I did, but do I think I was the cause of it? NOPE

Food for thought, patients have the ultimate right to refuse or accept any or no help that we offer.

[HERBIE1]

Real world example.

Picked a patient up from a house that could only be described as a hoarders house. There was trash all over the place, the guy had over 20 cats and he had newspapers dating back 15 years in piles. We barely got the patient out of the house when we picked him up.

He was diagnosed with MRSA on his lower legs bilaterally. Open sores and the like.

He lived alone, liked it and was his own guardian. He saw nothing wrong with his living situation.

So we get called back to take him home. Knowing that he had a nasty MRSA infection and was going back to a biolab level 4 I was very very concerned that we would be back to remove his body from his house.

I expressed my concerns to him, he said thanks but he was fine with living like that and he said "If I'm going to go, I want to be with my cats"

we took him home, carried him to his favorite chair (the cleanest item in his house) and again I expressed concern and he said thanks.

He had no home health aid, refused all their care and offers of help from the hospital.

2 weeks later he indeed died.

The guy was given the option of a nursing home yet he refused, he was given the option of daily home health visits yet he refused.

I knew I had done all I couild to assist him yet my final assistance to him was to put the monitor on him and see asystole.

Did I take him home to his demise, YEP I did, but do I think I was the cause of it? NOPE

Food for thought, patients have the ultimate right to refuse or accept any or no help that we offer.

Exactly. Like was noted multiple times now, it's the fully competent patient's decision, not ours. Ensure they are aware of their options, and that's all we can do. Anyone who's been doing this for awhile has similar stories.such as yours. Not pretty, some situations may cause us a few restless nights, in the end, we help who we can and hope for the best for the rest.

[crotchitymedic1986]

A couple of thoughts that I havent seen yet ? You are looking at the clearly black and white, but are not considering the gray?

1. The hospital can not forcibly admit the patient (unless for psychological reasons). People have the right to go home and wollow in cat poop if they wish. When you do find patients in this condition, it usually takes a Judge's order to get them removed from their hobble.

2. Who says the patient did not have family or a friend who could come sit with them, or an alternative residence they could have went to for that night. His legs were contused, not broken. There are lots of people who live a sedentary life, with a port-a-pottie and a remote control for the TV nearby. I would have gladly deposited him on his sofa or bed, and put the phone next to him so he could call 911 if there were any problems.

3. There is nothing wrong with asking questions or taking a moral position, but you have to ask what will I win by doing so. In your plan, you pissed off your partner, and could have possibly lost your job, but you would have been morally right in your mind. There would have been nothing wrong with raising your concerns, but again, what did you want the hospital to do, once you raised those concerns ? Send a live-in nurse to his house free of charge, admit him to the hospital for a bruise ? Send him to the Ritz Carlton for the night ?

[Bieber]

I'm at work so I'm not going to address every post until a little bit later, but I wanted to write a little if I could and say thank you to everyone who replied, even to those of you who would have fired me. This was a tough situation for me and obviously I could and should have handled it better, but I'm thankful to hear your opinions--even those telling me what I don't like to hear--and I appreciate the support and the feedback. I just found out a little while ago that I passed my written and am now (finally) a paramedic, though I won't be able to start working as one till I get my cards, but even then it's a long road ahead of me as I continue to gain more experience and grow in EMS and struggle to find my way. I'll address some of your individual posts later today or tomorrow but I just wanted to acknowledge everyone real quick and say thank you for your advice.