Posted by: medicblog999 | November 14, 2010

How do you want to be seen?

This is the first of two posts.

What type of Medic are you?

How do you want to be seen by your patient?

I woke up all of a sudden with a feeling as though someone was plunging a knife deep into my guts and slowly twisting it around and around. At the same time, I knew that if I didn’t manage to get to the bathroom, there was going to be a whole lot of mess in and around my bed.

Sitting on the side of the bed, I flicked on the bedside light and looked into the mirrored doors on the wardrobe at the far side of the room. I looked as white as the sheets on the bottom of the bed. I rubbed my face with my hands which quickly became covered in the cold sweat that was pouring off my forehead. I could feel the bedclothes wet beneath me from the moisture that was coming from the pores all over my body. The room was spinning,

I knew this feeling well, I had been in hospital for this same thing 3 times in the last two months, but was still waiting for someone to tell me what it was. Sure, I had plenty of doctors telling me what it wasn’t, but that didn’t really help the dread I was now feeling, knowing that yet again, I was going to be off to the hospital.

Sarah, my wife, sat up in bed then cuddled into me

“Oh, honey…..Not again!”

“Call me an ambulance Sarah, I need to go back in”

I stood to go through to the bathroom. As my feet touched down onto the carpet and I pushed up off the bed, my world span in circles and I dropped to my knees. Sarah was there in a second, phone to her ear talking to the Ambulance Service.

“No, he has just collapsed, please send an ambulance”

I lay down on the floor placing my head onto the carpet. The pain was intense, I couldn’t remember it ever being this bad.

After what seemed like an age, I heard sirens approaching. I prayed that they were for me.

Sure enough, I glanced towards the curtains and saw the strobing effect of the blue lights as they entered the street. Not long now……..

Sarah ran downstairs to open the door, and shortly after, I could hear the muffled conversation of a male voice in the hallway.

As I lay on the carpet, I opened my eyes and looked up to see an ambulance man standing next to Sarah.

“So whats going on then?”

I explained what was happening as best as I could. I told him about my past hospital visits, how I was going for more tests soon and how poorly I felt. I tried to explain what it was like, but to be honest, I don’t think he was listening to everything I was saying. Every time I had finished telling him something, all I got was a ‘Aha..’. He stood there, at the door way to my bedroom with his hands in his pockets, looking all the world like the last place he wanted to be in this world was in my bedroom.

The pain started to come back again and I cried out..

“Please…..can you just do something for the pain!”

“Alright mate…..in a minute….I just need to see what is going on first”

I could feel myself feeling sickly again and instead of pleading for pain killers, I decided to concentrate on not vomiting again.

Next thing I knew, I had a clip thing on my finger and he was pulling the sleeve of my top up and putting a blood pressure machine on it.

I heard him asking Sarah questions….

“So he has had this pain before?”

“And he was last in the hospital last week?”

“Since this pain is not new, is there a reason why you didn’t call the doctor instead of ringing 999?”

I could feel myself starting to get angry..

“Look, can you please just give me something for the pain. I called 999 because I needed help and I need it now ok??”

“Right mate, just calm down ok! You’re not helping anything by shouting at me ok? I will get you something for the pain in a minute. Just calm down and concentrate on your breathing a bit.”

Calm down and concentrate on my breathing??? Why wont he just do something for my pain? I looked over to Sarah, and I knew that she could tell how sore I was. It was her turn to speak up.

“Im sorry, I don’t know your name, but he really does need some pain killers. Can you just give him something? When he goes to hospital he usually gets some Morphine which really helps his pain”

“I cant give him any Morphine because if I take the pain away, then the doctors wont be able to see how sore he was and where the pain was. The ambulance wont be too long. They will get him up to hospital so the doctors can sort him out “

After that, he sat down on the end of the bed and just started writing on a clipboard. The pain was unbearable, but as I lay there looking at him, I knew there was no point in trying again to get him to give me something. He didn’t care! Why is he even in this job?

After a little while the nausea returned and I started vomiting, over and over again. I really did think that I was dying. I know people say that men like to exaggerate, but this honestly did feel like It was the end. I started begging the paramedic to help me, but all I got in return was again to be told to ‘calm down’ and ‘stop forcing your vomiting….If you relax, the pain will ease a little’

Eventually, the proper ambulance came and I swear that I saw him roll his eyes a little as he was explaining to the other two ambulance men that I had “some abode pain, but he has had it many times before. He has been back and forth to the hospital but they cant seem to find anything wrong. Oh….and he says that the only thing that helps him is morphine! “

“Ok matey, lets get you up off the floor”

The two new ambulance drivers came to either side and put thier arms under mine and hoisted me off the floor. The world started to spin again, and the pain came flooding back as I was forced into a standing position. Sarah looked horrified.

“He cant walk, look at him, he is going to pass out”

“He will be fine love, we will help him down the stairs. Sometimes it does them good to get up and about when they have a bit of tummy pain”

With that I was led down the stairs and onto the ambulance. I guess I should be grateful that they let me lie down on the bed.

“So, my mate says that Morphine helps the pain?”

“Yes, it usually takes the pain away..”

“Ok, but this time, I am going to try you on a special gas which will really help”

I was instructed on how to use the gas, which did help the pain, but whenever I stopped breathing it in, the pain came back.

Before I knew it, I was on a stretcher in the corridor of the hospital. The ambulance man came and took the gas away from me and then started talking to the nurse again. I could hear him tell the nurse and everyone else in the corridor what was wrong with me, and again, he seemed to be concentrating on the fact that I keep coming back and asked for Morphine. Does he think that I am making this up?? Does he think that I am a junkie???

But you know what?

I was past caring, I was in hospital now, and maybe some one trained to look after people was going to come and help me know.

A nurse walked up to me..

“Hello Mr Jackson, my name is Sophie and I am going to look after you tonight.”

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Responses

  1. [...] This post was mentioned on Twitter by John Broyles and Shelly Wilcoxson, Medic999. Medic999 said: New Blog Post : "How do you want to be seen?" – http://bit.ly/9qbkrN [...]

  2. This is a fictitious story right.

    • As always with this blog, the story is fiction based on fact, but in this specific case, I have made up the character to share what it must seem like for some patients who dont get the medic that they maybe would have hoped for.

  3. I was a patient this past summer. Fantastic post, and I can’t wait to read the rest.

    • Hi Epi,

      I hope your experience was better than this one though?

  4. Little Girl-

    Can’t speak for Mark as to whether this is fact or fiction, but I have seen it in fact many times and be denied pain medication based on some antiquated treatment modality based on a book that is over 80 years old. I myself have suffered from this type of situation and I saw a dearest friend suffer in this way as well, only to get no help from the people you call for that kind of help.

    • Well said Sir.

      Im sure that every medic around the world has seen this happen at times. Which is why I asked at the beginning – what type of medic do you want to be. In the next post, we will see how a different approach to exactly the same patient can change the whole experience to a positive one.

  5. Patient observed to be seated on edge of bed, leaning far forward, arms wrapped around abdomen. Patient is surrounded by a wastebasket, a bucket, and a mason jar, all filled with watery emesis.

    Patient: “I have been vomiting for four hours. This happens a lot, I’ve been seen by several specalists, and no one knows what the problem is. Zofran works for me. Can you please give me Zofran?”

    Paramedic: “Of course. I need to check you out quickly and get a set of vitals. Do you want me to give you the Zofran IM now, or do you want to wait a minute and I’ll start an IV?”

    Field Trainer: “She’s fine. Walk her out to the rig. And quit letting your patient run your call. She’s manipulating you.”

    • Grrrrrrrrrrrrrrrr!!!

      That makes me so angry to see/hear things like that. It would take a strong student indeed to stand up to a trainer like that.

    • Strong Student indeed needed…and I’m not always that strong student. Makes me feel…

  6. i really think that we should not judge the pain factor , we should evaluate the patient with the facts and also with proof , if i can with test figure out the patient is a putting some kind of a show i will give him the best i can get him . it is NOT my job to go out protocol just so i prove the patient was rung

  7. Mark, excuse the words, but this is a bloody awesome post. Awesome in the sense that it reminds me of the type of paramedic I DO NOT want to ever become, under any circumstances! Looking forward to the flip side in your next post.

  8. Are there patients that manipulate the system in attempts for narcotics? You better believe it. Are there patients who truthfully need the help that we can offer? You better believe it. Our jobs as paramedics is not to deny everyone pain medications. Our job is to differentiate the ones that are abusing the system from the ones that really need us. Figuring that out takes time, becoming good at it takes a lifetime. I’m sure that I’ve made the right call denying some patients narcotics, but I’m also sure that there’s been cases where I should have, but that’s why it’s called practicing medicine, no one gets it right 100% of the time.

    • No offense, but in the interest of debate, is it really our job to figure out someone who NEEDS narcotics from who WANTS narcotics?

      No, it is not.

      It is it our job to determine the difference?

      No, it is not.

      Is it our job to diagnose, treat, and relieve the symptoms?

      Yes, it is.

      The TRUE system abuser isn’t the one that calls and fakes pain for drugs, the true abuser is the one that uses us as primary care. The supposed junkie I can understand. Calling for a cold is just down right dumb.

  9. The horrible part is that we are all trained to watch for drug-seeking behavior, and believe we see it when it’s not there. So, like you described in your article on “splashed sadness” we wind up gaining “splashed jaded-ness” as well, as part of our training.

    Lt James Rosse
    South Schodack Volunteer Fire Department

  10. So what if a junkie gets 10mg of Morphine! I would rather that every time, instead of a patient in pain being denied analgesia. And I tell this to all of my juniors!!

    • I wish I could give a junkie 10mg. That would mean I was probably giving more than that to the people who actually need it. As it is, I’ve gotten one 10mg order in my career for someone who needed about twice that.

    • I agree, people think they are “feeding a habit” as opposed to “treating a patient.”

  11. [...] 999 posting an interesting “fictional” case over at his blog, and I wanted to take a moment to share a few quick tips to seem a little less [...]

  12. Thanks for posting this. It’s nice to see credibly written scenarios where providers have terrible communication skills. Communication skills (reflective listening, open ended questions, etc) are one of the things that my current school harps on us about. Even ignoring the pain management issue, there’s a lot that could be learned from the just in terms of how to communicate with patients, which was something I touched on over at my site in response to this case.

  13. I had a partner a while back who was subbing and he was just so intent on all patients wanting pain meds must be drug seekers including the one 12 yr old who had cancer! I dropped him in record time and honestly told him look I think it is time for you to change jobs because you have lost all human compassion. On my truck I want my patients to look back and know that I did everything I could to the best of my ability and with compassion. the minute I lose compassion I am going to move on.

  14. Well, fortunately I have good connections in the hospital that I can utilize to train my eyes more carefully on seekers. This is why I teach students to form bonds with the people in the hospital. They can teach you things, and they can also provide information. Call into the hospital on the phone and speak to one of the nurses. I’m bringing so-and-so into the hospital, and was considering dosing with some narcs, know anything of a history on this pt? If the pt is a frequent flier who is seeking, good chance the nurse is going to know the pt by name.

    • Once again, you are transfixed on this idea of looking for seekers, and you focus so much on looking for a seeker (which isn’t our job) that you fail. I worked for a system that had a policy to treat pain regardless of cause or location, and we never had any seekers. As a matter of fact, studies have shown seekers will go directly to the ED as opposed to calling an ambulance for pain meds.

    • Well you’re making a great generalization that I’m looking for seekers. That is where you’re completely wrong, and don’t understand the concept of being aware of seekers. The reason that seekers will not call and ambulance most of the time is because they have dealt with a paramedic who was aware of their behavior and believe their co-workers are equally trained to recognize that. Personally that tells me something about the system that treats pain regardless of cause or location is afraid that their medics aren’t able to preform an adequate field diagnosis. I find it very hard to believe that you never had any seekers, and clearly your system was different to have your ER be the seekers first stop for pain medications, than what I deal with on a daily basis.

    • The reason they don’t call is because they can’t sell our medications, and our narcotics and benzos are short acting and limited supply. Not good enough for a high or to make money, so they go to the ED to get a script for meds they can sell in great numbers. Simply being observant is sufficient to identify those who may have a drug problem or using them for illegal means.

      Pain management is poorly done in EMS, and the NAEMSP agrees, and thinks we should do more of it.

      On a side note, if you’re afraid of being fooled so you deny all but the most obviously of injured pain medications, you should read this :http://www.nytimes.com/2010/06/08/health/08mind.html

  15. Thought I might link up your scenario to an incident that happened here:
    http://au.news.yahoo.com/thewest/a/-/newshome/8332502/paramedics-ignored-my-pain/

  16. [...] is part two of this post – If you havent read part one – click here, then come back to see the flip [...]

  17. Mark, Great post as always. We can’t be the judge and jury for all patients. Sometimes we will be providing to the “seeker”. But, we learn from that. You start to learn who the seekers are. We had a patinet we would see on a regular basis. Always had chest pain. Most of us knew that in the end, he wanted morphine. I always explained that morphine would not help as much as the nitro and wouldn’t give him any. He would get to the hospital, and they would usually not give him morphine either and he would pull out his IV and storm out. The medics and the ER would do everything that you should for a patient with chest pain, except give narcotics.
    In relation to the comment about analgesics and abdominal pain…If the physician can’t do a propper assessment and differential diagnosis because the pain is relieved, they should not be an emergency physician.


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