Do you treat your patients or do you care for them?
Have a little think for a moment then read on and see if you still think the same way by the end of the post.
Here’s a little bit of a back story as to what got me thinking about it….
I was working with a new member of staff a little while ago. We were sent to an elderly male who had fallen outside of a bar after he had been spending the evening with some of his friends. He was intoxicated but not drunk as such, and he was my favourite type of drunk….The happy singing drunk.
Anyway, he had a small laceration to the back of his head which had stopped bleeding and probably only needed a little bit of glue to close it up. He also had a small haematoma surrounding the wound. There was no known loss of consciousness, although there was no witness to the fall. He had no neck or back pain and appeared alert and orientated. All of his primary observations were well within normal limits.
It all pointed to a simple mechanical fall after tripping on a lose pavement stone resulting in a minor head injury.
With these sorts of cases it is up to me to decide if it is suitable for my colleague, an ECSW (Emergency Care Support Worker) to go in the back with the patient to the hospital. When this happens and an ECSW ‘observes’ the patient on the way to the hospital, I am still totally responsible, clinically for the patient, even though I am in the front and driving the vehicle.
[An ECSW is trained to be able to assist the paramedic in his/her interventions and care. They can complete all clinical measurements that the paramedic can, and they have a basic understanding of A+P and various clinical and trauma conditions. They are trained to ‘observe’ suitable patients in the back of the ambulance on the way to A&E after the paramedic has completed a full assessment – Maybe this is the same sort of thing as an EMT-B?}
It goes without saying, that there has to be an element of trust between the paramedic and the ECSW for this to work. As the senior clinician, I need to know that if there is any change in the condition of the patient, then the ECSW in the back will inform me immediately so that I can decide whether I need to swap into the back and take over care of the patient.
But, there always has to be a first time to start to develop the trust, and this was that moment.
Once I had completed my assessment and decided that the patient was suitable for an ECSW to care for them en route to A&E, we set off up to the hospital.
On the way, I kept looking into the rear view mirror so I could see the patient and my colleague. It was all very quiet back there. I could hear no chit chat and no questioning for demographic and personal details. As I looked back, I could see the patient asleep in the chair.
I started to get a little nervous…
“Julie……Can you please check that Bobby is just sleeping and not actually suffering from a decreased level of consciousness?”
A quick shout over to him saw him wake up and acknowledge Julie, he then stated that he was just tired and then shuffled in his seat and closed his eyes again.
“He is okay, just a bit tired!”
I decided to keep driving but keep a very close eye on the rear view mirror. I know that the chances of anything bad happening to Bobby were very small, but I just wasn’t happy.
A few minutes later, I still don’t hear any conversation, so I look back and see Julie, writing on the patient report form, but not looking up and checking on Bobby.
Something is nagging away at me so I pull over and ask Julie to finish the drive to hospital. I get the expected dirty look, but now is not the time to discuss why I have pulled her out of the back.
The rest of the journey goes without a hitch. I engage Bobby in a conversation about his time in the Air force in the 1950s (always good for checking someone’s level of consciousness) and I hand him over to the hospital team where he gets cleaned up and sent off home in a taxi with a head injury card.
All well and good, yes?
No, not really, and here is my point.
In these days of ‘respond not convey’. If you are taking a patient to hospital, it is because you have a legitimate concern about them. If there was absolutely nothing wrong with them, then they wouldn’t be going to hospital would they?
Therefore, if you have a patient in the back of the ambulance, they need constant re-assessment. They are in your care and they are your responsibility. You don’t have to take constant blood pressures and ECGs for the vast majority of patients. It doesn’t mean that you have to be actively assessing them throughout the journey, but it does mean that you at least need to engage in some form of regular conversation or interaction with them.
‘Treating’ your patient is performing the interventions that are required by your protocols and guidelines in specific response to a clinical presentation. ‘Caring’ for your patients is to provide much more than an intervention. It is to show concern, empathy, understanding, and interest in them and their lives.
If you care for your patient then in return they feel cared for. They feel as though you actually want to be there and you want to be looking after them. They don’t feel as though they are troubling you and they open up far more than what they would if you are just treating them.
Virtually anyone can treat a patient…Give someone a list of signs and symptoms, then give them the interventions that are required to treat those signs and symptoms and the vast majority of people could do that adequately.
You can’t teach someone to be truly caring, it has to come from within, and if you find yourself in any of the health professions, I would assume that you are one of those people.
However, there are some of us out there who are not carers, and sometimes it is blatantly obvious to see.