Read this - and call a taxi
Safer than an ambulance?A new comment has just arrived on the article I wrote some time ago entitled "Read this or die".
The story told in that article was true in every word. The patient died and might not have done had it not been for the obstructive inteference of a foolish, protocol-bound ambulance driver. The article now elicits this response:
Well. Dr C clearly thinks along the lines of Kenneth Clarke the ex-Tory Minister who described Ambulance staff as "glorified taxi drivers". I find Dr C's comments patronising, insulting and ignorant....Oh dear. I was not patronising anyone. I was giving a true example of the dangers of dumbing down. A primary school playground response of "Well, GPs are really bad too", even if true, is not helpful.
Let us assume for the sake of the discussion that we have the worst GPs in the world. Is that a reason to allow ambulance drivers to put patients' lives at risk by playing at doctor?
Only yesterday we had trouble with an ambulance crew. My partner had assessed a patient, discussed him with the hospital physicians, arranged an admission and called an ambulance. The ambulance driver arrived, carried out his mickey mouse medical "assessment" and then told my partner, in front of the patient, that he did not see why an admission was necessary. My partner did not have the time to explain paroxysmal atrial fibrillation, atypical angina and early heart failure and merely said that he would call another ambulance crew if this one would not do as they were told.
Ambulance drivers are put under pressure not to take people to hospital. Their reluctance to take patients in at the request of a doctor is both arrogant and dangerous.
Doctors.net currently has a lot of correspondence on this very topic. I wish it could be seen by the general public. Ambulance crews are valuable, and have an important role at the scene of road traffic accidents but, in the domestic environment, when the problems are medical rather than truamatological, they often apply inappropriate protocols to problems they do not understand.
Safer to call a taxi.
++++++++++++
And read more on this topic in The Death Rattle
67 Comments:
yea but if you arrive at A & E in a taxi you will be triaged by a nurse with a similar protocol, and its far from clear to me that the most urgent cases get seen soonest
no one
no one has a point,
the stupid 4hr target means that managers are more concerned with the patient who is about to breach with the stubbed little toe than by the moribund sick patient about to arrest
the brave new nhs where political expediency trumps clinical need
Dr C - part of the reason for the response to your post could be the terminology you used - as in 'Ambulance Driver'. Now, if I'd been trained as an EMT or Paramedic, I'd be pretty p'd off if someone called me an 'Ambulance Driver'. Why 'Driver'? Why not 'Ambulance Crew' or 'EMT' or 'Technician' or 'Paramedic' as appropriate? What's all the agro between Doctors and other medical staff - ie midwives, nurses etc???
If you don't want 'play-ground' responses - don't entice them with provocative language!
Your Partner could have quite easily explained that he/she had spoken to the appropriate Registrar/Consultant, who had advised that the patient needed to be seen by his/her team and the patient was therefore expected. Here's the referal letter. End of story.
Anonymous said...
Dr C - part of the reason for the response to your post could be the terminology you used - as in 'Ambulance Driver'.
[I did not use that terminology in the original article. Try reading it]
Now, if I'd been trained as an EMT or Paramedic, I'd be pretty p'd off if someone called me an 'Ambulance Driver'. Why 'Driver'? Why not 'Ambulance Crew' or 'EMT' or 'Technician' or 'Paramedic' as appropriate? What's all the agro between Doctors and other medical staff - ie midwives, nurses etc???
[The agro comes when "health care professionals" such as you list above start trying to do jobs for which they are not trained]
If you don't want 'play-ground' responses - don't entice them with provocative language!
[don't be silly]
Your Partner could have quite easily explained that he/she had spoken to the appropriate Registrar/Consultant, who had advised that the patient needed to be seen by his/her team and the patient was therefore expected. Here's the referal letter. End of story.
[You really are a fuckwit, arn't you. My partner is a doctor. She makes the decision that she is sending someone into hospital and informs the relevant team. She does not get her decision validated by a junior hospital doctor who is probably much less experienced than her, and she certainly does not need to justify her decision to an ambulance driver in a green jump suit. She makes the medical decisions, and the ambulance driver does the transport. My partner carries the responsibility for her decisions and will not tolerate some over promoted white van driver in fancy dress telling her what to do.
If there is no doctor on site, the ambulance drivers can make their own decision. On his occasion there was a doctor onsite.
Doctors are getting really pissed off with all these dumbed down fuckwits endangering patients' health.]
John
Dr Crippen - there is no need to call me a FUCKWIT. You really are a very, VERY RUDE man! - God - and I pay your wages!!!!!
Funnily enough, I DID read your original post when it first went up.
Why are your critising these individuals FOR DOING THEIR JOB!!! This is what they are TRAINED to do! You'd be the first to bang on if they got it wrong. It's not the fault of the individual - if anything it's the fault of 'The System' and the training it delivers.... (of which you are a part). If you don't like it go do something else.
I am sure that people like Tom Reynolds appreciate being called an "some over promoted white van driver in fancy dress".
Christ, it must be tough being perfect and so highly intelligent....
lol, i love the people who use the " I pay your wages" argument, a friend working in an A+E department said they are usually the people on benefits and etc. "They are the ones who will attempt to abuse staff while expecting the best medical care available" is something he commonly mentions.
Good article Mr C, also liked the response to the above comments. As ever I enjoy hearing your view and feel for you although I probably can't relate to you. Keep on writing though, I look forward to more posts from you.
Future Doc
if you want the public to see the dispondency and anger of the doctors frequent Doctors.net then open up the membership so others can access it.
Dear Future Doc - way off the mark with the 'on benefits' - way, way off the mark..... and why shouldn't 'customers' expect not to be sworn at by the people they 'employ' (indirectly, that is)?
I respect ALL the healthcare professionals I've been in contact with, in fact, I respect everyone unless they're rude to me, which is why I just don't get Dr Crippin's attitude to healthcare staff other than Doctors. These people have been put in place to do a job - it's not their fault that Dr Crippin doesn't like what they do! Dumbing down of health care is part of the bigger picture, it's not down to the individual Midwives, Ambulance staff and nurses!
At the risk of attracting a storm of invective, John, it surely wouldn't have cost your partner more than 20 sec to explain to the ambo driver the essentials of WHY the pt needed admitting despite not having an arrhythmia or iffy BP at that very second, and also that admission had already been "sorted" w the hospital. Would the ambo people really be that shirty if the doc had said "given what he's got, he could go off with another run of arrhythmias and pass out at any time, which is why we called you to take him in rather than a taxi - it wouldn't be safe?".
I know you can argue they shouldn't second guess the doctors, and I agree, but politeness arguably costs nothing (apart from the 20 seconds), everything goes a lot easier, and the ambo driver would know more afterwards than s/he did before, which would surely be desirable.
In your AAA example, I suppose the counter-argument would be, what if the pt carked it in the ambo on the way to hospital and the paramedic team then had to admit to their bosses that they HADN'T put the BP cuff etc etc on him for monitoring, which all their protocols order them to do? I predict they would get a slapping big-style, even though they were blue-lighting it double whammo as per a doctor's orders. Although you would say with justification that it is the protocol rather than the paramedics at fault, they would still cop for it, methinks.
My god it seems a lot of people are missing the bloody obvious point.
"Why are your critising these individuals FOR DOING THEIR JOB!!! This is what they are TRAINED to do!"
Precisely. These ambulance workers (whatever their grade or title or practitioner name) are not sufficiently trained to be making these decisions that they ARE MAKING.
Just because they are trained for it does not justify it, because they are completely inadequately trained for it!
Anonymous, also we all pay our own wages too by your 'I pay your wages' line- nice.
Stick to the argument and stop trying to justify the unjustifiale.
Are you telling me that you think it is safe for these ambulance staff to be trying to overrule decisions made by much more highly trained, skilled and experience PROFESSIONALS?
sitting on the fence says "John, it surely wouldn't have cost your partner more than 20 sec to explain to the ambo driver the essentials..."
So, bad enough that we have non-medical managers telling us what our clinical priorities are, now we have to just our actions to others who do not have the knowledge to make the decisions that we have to make.
You really have missed the point, haven't you.
Mr Ambulanceperson. Please take my patient to hospital. No, what about pretty please? Pretty, pretty please?
Mr Firefighter. My house is one fire. Please put the fire out. No, ............!
but matt,
they have been 'trained' to become experts in diagnosis and hence should be allowed to ignore the decision of experienced GPs!
FFS what a joke
I think people need to start being more aware of what the end game is: saving the patient's life.
Anonymous, you go on about respecting the job that the paramedic does. Fair enough, but when there's a fully trained doctor on site who's just made a "medical emergency" diagnosis, rather than questioning it, surely the paramedic should give the doctor the benefit of the doubt for the patient's sake?
I've recently heard of 2 patients admitted to CCU by a GP who had scribbled "?MI" on a bit of paper and sent them in. One patient had a migraine and the other had D&V. Neither had complained of chest pain (or indeed pain anywhere else other than the headache for the migraine lady), SOB, sweating, paleness, weakness or dizzyness at any point, neither had a history of heart disease or any risk factors. How did they come up with this potential diagnosis? And why on earth did the ambulance crews listen to them?
Like it or not, Dr C, paramedics are registered health professionals who have a duty to do what is best for the patient, using their own clinical judgement. I don't know enough about this case to judge whether they're right or not, but they are absolutely within their rights to question what's going on, and without making their own assessment of the patient would be negligent.
Garth - "Just because they are trained for it does not justify it, because they are completely inadequately trained for it!
Anonymous, also we all pay our own wages too by your 'I pay your wages' line- nice.
Stick to the argument and stop trying to justify the unjustifiale."
Am I correct in thinking your view is that although the Ambulance personnel/Midwive/Nurse THINKS they're trained to perform a role, they're not really? Only Doctors can perform ALL roles except bottom wiping and clearing up vomit (and the ones they don't want to)? Doctors are always right and everyone should do what they say, all the time?
BTW - how do you 'pay my wages'? - I'm intrigued!
I know someone whose GP completely missed their heart failure and leaking mitral value, treating it as 'asthma' - "I wonder why your peak flow isn't improving...?" Maybe because the patient isn't asthmatic!!! This person is now facing major heart surgery to repair the value.
'Future Doc' - hope the GCSEs go well and you get the A Level grades you need to go to Medical School.
anonymous,
again the point is missed, not a surprise really as you keep doing it over and over again
do you have any understanding of this issue or are you just picking a stupid fight?
"Am I correct in thinking your view is that although the Ambulance personnel/Midwive/Nurse THINKS they're trained to perform a role, they're not really?"
you are putting words in my mouth and chatting absolute crap
PLEASE STICK TO THE POINT
this article is about AMBULANCE staff not midwives/nurses etc
the POINT of Dr C's piece is that these ambulance staff are not trained adequately in the art of medical diagnosis
This means that
1. They are not suitably trained to overule an experienced doctor
2. They are not adequately trained to become medical diagnosticians
If you have some extra knowledge that weakens this argument then please come forth with it, however if you continue to stray from the actual argument then you just appear deeply ignorant and misguided
Yes, doctors do make mistakes despite their lengthy training, what is your point here? Is this the typical lame and frankly numbskull argument that as doctors make mistakes, we should hand out their jobs to any tom, dick or harry who's been on a two week medical diagnosis course?
of course not, this would be stupid, do you also not realise that if doctors make mistakes after this much training then this had quite grave implications for the amount of mistakes these ambulance staff will make after their dumbed down training
I am not normally this rude but your illogical limp argument has left me with no choice, stop trying to justify the unjustifiable otherwise you will continue to look like an utter cretin
The ambulance driver arrived, carried out his mickey mouse medical "assessment" and then told my partner, in front of the patient, that he did not see why an admission was necessary. My partner did not have the time to explain paroxysmal atrial fibrillation, atypical angina and early heart failure and merely said that he would call another ambulance crew if this one would not do as they were told
*******************************
I agree with John to some extent on this matter. When I have arranged hospital admission in the past, I don't expect the ambulance crew to question my decison for admission but do ensure they are given a handover on arrival before transportation. I have thankfully experienced
Sorry!
I have thankfully not experienced a paramedic being so unprofessional as to question the admitting professional in front of a patient.
Dear Gareth - yes, you are rude, for which there is no reason, or point. You're the one getting uptight, not me :-)
I mentioned other HC professionals because Dr C accuses them of 'dumbing down' HC and the NHS. My point being that these individuals perform a ROLE for which they are trained.
YOU miss the point of what I was saying. Being rude to other people, with whom you work, actually achieves nothing. All HC staff are employed to provide patient care. It makes life much easier if everyone gets along and there are ways of approaching those who question your opinion. Dr C mentions in a different comment that Ambulance staff have been asked not to take in patients unnecessarily, and that they make this decision.
If the patient was expected by the Consultant/registrar then it is reasonable for the Ambulance personnel to take them in. If the Ambulance staff questioned this, then I would refer them to that team.
If there are issues with Ambulance staff not taking in patients who are expected, then this needs to be addressed with the Ambulance Trust Management. Bitching about it here does solve the problem. Raising it proactively with people who can do something about it does.
You don't pay my wages because I'M SELF EMPLOYED, and to be honest, from what I've read here, I wouldn't want to work in Healthcare. I worked in the media (TV) for over 10 years and came across some arrogant shits, but some of the comments here make these people look like Mother Teresa!
If you bother you read what i wrote properly then I never said I paid your wages!
In fact I was quoting your initial arrogant and judgemental line! So before you get down from your high horse I suggest you take a little peek in the mirror, the pot may be calling the kettle black.
My point was:
If you say 'I pay your wages'
then by your magestic logic I can also claim to pay my own wages!
( as we both pay taxes )
Frankly you remind me of Jasper Gerard in the Guardian, a journalist who is very happy to judge on issues on which he flagrantly has very little expertise or understanding, a pretty common attribute of someone who works in the media
Unfortunately you are still missing the point with your above post.
Dr C's point is that the government is allowing staff to play doctor without sufficient training in a way that is dangerous, nothing you say addresses this, you are simply avoiding a proper engagement
You suggestion of 'raising it proactively' is laughable. These directives come from the DoH in a rather top down authoritarian manner, if you had any experience of the NHS then you would realise that this is one of its huge flaws, no one listens to the expert clinicians on the ground when they point out dangers on the ground, it's just brushed under the carpet and the shoddy reform continues.
"My point being that these individuals perform a ROLE for which they are trained. "
I am sorry but this shows that you are not listening to anything being said here, your above statement means absolutely nothing and ignores several points already put to you above.
Like many media bods you seem happy to think you know it all in areas in which you are clearly far from expert, you are happy to judge others as arrogant but you are the one picking a fight when you are so clearly out of your depth
Please answer this simple point:
you say:
"My point being that these individuals perform a ROLE for which they are trained. "
what if the role contains levels of responsibility that the individual is not adequately trained to deal with?
This is the point, stop missing it
advanced pratcitioner,
I know several GPs locally who have had critically ill patients refused ambulances by paramedics
one was a ruptured ectopic that almost ended up dying
one was an MI
one was DKA who needed intensive care
the list goes on and on
I won't bore you with my experiences of referrals from a paramedic who thought that eating one peanut had given a chap pancreatitis even though he was completely well and asymptomatic
I won't bore you with the referral I've taken from an indpendently practicing nurse from a WIC who sent a patient with a ?skull fracture? who was completely well and this nurse though he had a visible subclavian vein on his occiput
it is very worrying indeed
Dear Gareth - you assume (ass/u/me) that I still work in the media - I left 'TV land' in 1997 and have worked in a variety of roles since then - marketing/fund raising/admin/IT/mother.
""you say:
"My point being that these individuals perform a ROLE for which they are trained. "
what if the role contains levels of responsibility that the individual is not adequately trained to deal with?
This is the point, stop missing it""
In specific response to what you write above:
Firstly, in whose opinion is the individual not adequately trained to deal with the levels of responsibility they take?
Secondly, if an indivdual is placed in a position where they are expected to perform tasks, or take on responsibilities for something that they are not trained, this is grossly unfair to that individual and to the people they treat. I would expect these individuals to raise these concerns with their management and ultimately refuse to take on this responsibility.
However, this is all very vague and without specific examples, it's very hard to discuss and have any meanful kind of dialogue.
Please could you expand on which areas Ambulance staff are taking responsbility for, where they have no training? If this is a UK wide issue, then these concerns need to be feed back up to the DoH.
We could both give examples of where a doctor or a Paramedic/EMT has got it wrong - this actually achieves nothing.
Garth, as you know 'diagnosis' [by non-medics] is an increasingly important aspect of a paramedics role when it comes to dealing with MIs.
Crews [in our region] attending patients with symptoms suggestive of an acute infarct are mandated to perform a 12 lead.
If the ECG reveals elevated ST segments then the paramedics on scene contact the nearest angioplasty provider so the cath lab can be set up.
These patients by-pass A&E altogether [no pun intended], unless they crash en route.
The paramedics do a great job according to the cardiologists, so we have to give them some credit for the improved outcomes associated with this approach.
I am not trying to be contoversial or provocative but I find it almost impossible to believe that crews are now refusing to transport the sort of cases you describe.
In my experience most health workers prefer the easy life, or will take the road of least resistence - providing this does not jeopordise safety or compromise care.
Dr Crippen seems to be suggesting that there is no further role for ambulance personnel once a patient has been seen by a GP [other than to transport the patient, of course].
I do not know if this position is tenable from a medico-legal perspective and it also seems to rely on GPs getting the diagnosis right everytime.
It's easy to deny there is a problem, but there quite clearly is!
I have seen several cases myself directly and reported by patients. I have heard of numerous similiar cases from colleagues. It is rather too commonplace for anyone's liking.
I have already made clear several examples in my writing, go and read them, as has Dr C.
a/e charge nurse,
indeed paramedics do as you say with MIs,
however this role should not extend towards refusing taking patients to hospital with their chest pain,
Dr C is pointing out that this is what some paramedics are doing
anonymous, if you are asking how these new health care professionals are not trained to do what they are doing safely, then I suggest you go and read what has been written on this topic on many a blog, in fact there have been lots of complaints about the dumbing down of training paramedics/ambulance staff
"We could both give examples of where a doctor or a Paramedic/EMT has got it wrong - this actually achieves nothing."
The utterly piss poor lame duck logic rears its head again.
A toddler would also make mistakes playing doctor, would this justify them being handed new 'toddler' practitioner roles by the DoH- it follows by this shabby line of argument
Also this dangerous policy comes straight from the DOH in a quite knowing fashion, so feeding it back to the DoH will do precisely fuck all. Please get up to speed with the way the government is trying to prevent hospitals actually dealing with patients that need hospital care,
it is simply dangerous cost cutting, and it comes from orders from the very top
It is about time some of you switched the fucking lights on, and realised that the government is playing a very cynical and dangerous game; stop trying to justify the unjustifiable.
"I find it almost impossible to believe that crews are now refusing to transport the sort of cases you describe."
well you're calling us liars then and we most certainly are not.
would you really like me to go into the grim details of the type 1 diabetic who felt rather unwell and was hyperventilating with her ketoacidosis, the ambulance staff felt it was just anxiety and buggered off
she came in herself and had a ph of about 7.2 something and certainly merited her hospital stay
I have nothing to gain my making this up!
I know several experienced GPs who have had stand up rows with the paramedics over similiarish cases
These doctors are excellent clinicians
Carry on living in denial if you wish, but when it's you as the patient I'd bet you would change your apologetic tune
I think that the paramedics would be on shaky ground too.
When I did my hand therapy placement, we had referrals from GPs which said things such as, 'loss of ROM in left little finger'.
On examination/assessment, the patient invariably had Dupuytrens; this calls for different management than other reasons for loss of ROM - the hand therapist could be held liable for blindly following the GP's orders, in much the same way as paramedics could.
From the HPC Standards of Proficiency:
2a.3 be able to undertake or arrange clinical investigations as appropriate
2a.4 be able to analyse and evaluate the information collected.
and:
- be able to assess a situation, determine the nature and severity of the problem and
call upon the required knowledge and experience to deal with the problem
This is for both OTs and paramedics; with the codicil that one has to remain within one's scope of practice.
No, Garth, I am not disputing the experiences you describe, sorry if came over this way.
What I really meant was that I could not imagine any of the crews I have got to know over the years acting in the same way.
We all have an instinct for self preservation and refusing to assist an acidotic type 1 diabetic is simply a recipe for the worst kind of trouble [avoidable negligence with the potential for dire consequences].
In such cases a pre-hospital capilliary blood glucose would exceed the upper limit on a glucometer [33mmol typically], thus providing direct evidence of severe hyperglycaemia at the very least.
In my experience it is rare for paramedics to ignore this test when a diabetic is unwell.
Equally with MIs, paramedics [in general] seem to be aware more than than ever about the concept of 'pain to needle time'; minutes = muscle, etc, etc.
Are you sure they were paramedics ?
I hope Tom Reynolds doesn't find out about it !!!
Why don't they make doctors.net open to the public, so that we might all share the incredible wisdom that emanates from it's pages.
John, if you take offense at being called a health-care practitioner and not a doctor, I don't see why you should call paramedics ambulance drivers.
I believe the Greeks created a word that fits modern doctors quite well- hubris. Also, the Americans have given us then term blowhards, and I think that is also apt.
I went to university with many doctors and they weren't brilliant then and they aren't any more brilliant now.
no worries, I apologise for coming across as an aggressive bastard, the computer does me no favours :)
indeed they were proper paramedics to my knowledge
DKA is tricky, my medical colleagues tell me you can have a nasty acidosis without putting your sugar that high, thus you can get caught out by relying on a glucose
Don't get me wrong I think the vast majority of paramedics would not be guilty of the above and are great.
However it is worrying that there is pressure from above to prevent admissions, it's yet another example of clinical need be riden roughshod over in favour of political needs
It's also worrying that there are staff working in ambulances with less and less and less training
They are being given an impossible job and the politicians will not hbe held to account, the workers on the ground will, if experience of the shady DoH has taught us anything regarding central credit and local blame
Matt wrote...
"...
sitting on the fence says "John, it surely wouldn't have cost your partner more than 20 sec to explain to the ambo driver the essentials..."
So, bad enough that we have non-medical managers telling us what our clinical priorities are, now we have to justify our actions to others who do not have the knowledge to make the decisions that we have to make...."
How is that what I said, Matt? If the patient looked superficially well, but might (because of their condition) suddenly have a funny turn in the ambo en route, surely it would be basic good communication, and in the pt's best interest, for the doctor to TELL the paramedics this?
As we all know, if you treat the non-doctors in the system like morons who are not fit to talk to you they will find subtle ways to pay you back. Professional courtesy costs nothing except a little time and saves bucketloads of aggro.
Garth - If Ambulance crews are taking responsibility for things they're not trained for, then let's hear it! Indulge those of us who haven't read ALL of Dr C's posts.....
sittingon the fence says..."If the patient looked superficially well, but might (because of their condition) suddenly have a funny turn in the ambo en route, surely it would be basic good communication, and in the pt's best interest, for the doctor to TELL the paramedics this?"
I can't disagree with that - in fact I always discuss the handover of patients with the Paramedics.
Now look at John's origional post.
"he (the Ambulance driver)did not see why an admission was necessary."
That's not his (the Paramedic's)job in this situation and he should keep his opinion to himself.
you say "if you treat the non-doctors in the system like morons who are not fit to talk to you they will find subtle ways to pay you back."
What? Causing the patient to die and then pinning it on the Doctor?
This is NuLab's NHS. The Doctors are crap and arrogant and everyone else knows better!
It is becoming increasing difficult to admit a patient acutely to hospital as a GP. We have less hospital beds per capita than any other country in the 1st world but that's not the reason why they are full all the time. No, it's those stupid fucking GP's again. If they didn't admit so many patients, there would be no problem.
So when I try to admit a patient to hospital, firstly I have to justify that to usually a non-doctor and now I have to justify it to the Ambulance Service as well.
In the "old" days, I spoke to a fellow Doctor, and if after discussion the admission was accepted, the Ambulance Service took the patient to hospital.
"Professional courtesy costs nothing except a little time and saves bucketloads of aggro."
Tell that to the Paramedic!
A professional would never, never question another professional's judgment in front of the patient during an acute event (the only exception being if the decision is an immediate threat to the patient's safety).
It undermines the patient's confidence in their care.
So Dr C is totally correct - the ambulance person was completely out of order to question the need for admission in front of the patient.
It just showed how stupid and ignorant s/he was, but undermined Dr C's partner.
No excuse.
Fully agree the driver was utterly out of order disagreeing with the doctor in front of the patient, which was wholly unprofessional.
Also agreed that if the GP wants the pt to go to hospital in an ambulance, and has discd it with the hospital, the pt should go, no questions.
I was only saying that no-one comes out of the story looking absolutely shiningly wonderful. I suppose the doctor does not HAVE to tell the paramedics what is going on. I would have just thought it was good practise and simple professional courtesy.
Sometimes these good habits help, shall we say, "oil the wheels" of the system. We can all stand on our professional rights and dignities, but offering explanatory and clarifying information always works better than issuing curt orders, at least in my experience.
Dr. C has latched on to my comment about Kenneth Clarke, as it re-inforces his own jaundiced view of ambulance staff but has excluded any other points I raised in my message. I have copied it in full for those of you interested in what I actually said...
Well. Dr C clearly thinks along the lines of Kenneth Clarke the ex-Tory Minister who described Ambulance staff as "glorified taxi drivers". I find Dr C's comments patronising, insulting and ignorant. I have served 17 years with my local Ambulance service with 13 of them as a Paramedic. We now belong to a nationally recognised professional body which requires us to provide proof of continuous professional development in order to retain our licence to practice as a paramedic. Our role is also developing to include graduate-level Emergency care Practitioners, taken from paramedic staff within the service, whose skills and knowledge base equip them to make accurate diagnoses, prescribe appropraite medication, provide suitable treatment at home for minor wounds i.e suturing and liquigel skin adhesive, (when was the last time a GP sutured anything)? They can refer patients to clinics. They arrange admissions direct to appropriate wards or refer people to other care bodies such as social services. (Sound familiar Dr.)? This has all come about in response to a growing need for some of the out of hospital treatment the GP's used to provide, that they no longer feel inclined to. Trying to get a GP visit is well nigh impossible in this and, i suspect, many other areas, thus abdicating their responsibilty for the patient who, by being registered to them, is under their care. Even during surgery hours GP's first instinct often is to respond with "well, seeing as you're there, you might as well take the patient to hospital". Or even, as was said to me recently by a GP I have great respect for, "you guys are better than me at treating chest pain". I am not making the sweeping judgements about GPs that DR C is making about paramedics because I have the wherewithal to recognise NOT ALL GP'S ARE THE SAME... neither, Dr, are we. Dr C needs to be careful in his judgement of his fellow health care professionals as I doubt he sees much of what really goes on in the average ambulance workers life. Fair enough, there is evidence that, in a cardiac arrest scenario, the patient has a better chance of survival or at least regaining some cardiac output if CPR is carried out by technicians rather than paramedics because tech's have no responsibility to give ACLS drugs and therefore tend to scoop and run doing effective CPR in the back of a moving vehicle en-route. (No mean feat in itself). I would also like to point out that we are required to follow a nationally agreed set of guidelines and, yes, drug treatment protocols, known as JRCALC, (Joint Royal Colleges ambulance Liason Committee) which is our bible. Now, here's the rub, it was set up and is reviewed by a committee made up of a number of health care professionals including Consultants and GP's.
I am sorry the good Dr. has had a poor experience with the incident he describes but, let he who is without guilt cast the first stone.
P.S. Our blue lights are actually quite big!
anonymous 6:26:00 says
"when was the last time a GP sutured anything?"
Friday!
"Trying to get a GP visit is well nigh impossible in this and, i suspect, many other areas, thus abdicating their responsibilty for the patient who, by being registered to them, is under their care."
Dangerous talk. I didn't abdicate my responsibility. The DOH told me that I could lose that responsibility for £6000 and I said thank you very much.
In my experience, working in an area which prior to the new contract had a very efficient OOH service run as a CO-OP, and now the exact same organization in a different incarnation is still providing the service, is that the increased demand OOHs is nothing to do with GP's. What it is to do with is increased expectations fuelled by our politico fuckwits and NHS Redirect.
"Or even, as was said to me recently by a GP I have great respect for, "you guys are better than me at treating chest pain".
No arguement. So what!
sitting on the fence says
"I suppose the doctor does not HAVE to tell the paramedics what is going on. I would have just thought it was good practise and simple professional courtesy."
This is not about discussing the clinical aspects of a particular case with Paramedics in an athmosphere of camaraderie. This is about having, as a Doctor, to justify yourself to Paramedics.
The tail is swinging the dog.
anonymous,
We are very much aware of the ECP, emergency care practitioner, they are a great example of fisher price HCPs being given roles beyond which they are adequately trained for.
You have shot yourself in the foot by bringing up this example. ECPs are just like many other in a long list of HCPs who are being handed far too much responsibility.
It is dangerous that ECPs can refer to clinic and have a stab a diagnosis when they have such a short and budget level of training.
It is fisher price fucking medicine and it is not good enough.
Matt - the point that Sitting on the fence is making is that politeness costs nothing, yet goes a long way - and if you get what you want at the end of it (ie the pt taken to hosp) then all the better!
In my personal experience, there is alot to be said for 'oiling the wheels' - it also makes for an easier life. Given that you all have to work together isn't that a GOOD thing?
Further to my earlier message, I was taught and ,hopefully new starters still are, that the responsibility for treatment and care of a patient lies with the most qualified person on scene at the time. If its an ambulance technician, then its his responsibility until such time as more qualified HCP is encountered. Certainly , we should respect the decision of any Dr. (I mean medical, not a Dr of Philosophy or something... lol). By and large we get on well with our GP's here and I hope Dr.C's post and its replies doesn't do damage to that relationship. We should accept that nothing is perfect in this NHS and it never will be. My apologies to Matt regarding the abdication of responsibility, but thats how it comes across in the field. So many patients complain to us that their GP never comes out to them any more. How nice it must be to get paid more for doing less! I dont blame you Matt, I would do the same.
I also have to agree that ECP's is a cheap alternative to OOH Docs and that is also not your fault, nor is it ours. When all comes crashing down around their ears, maybe the DoH will take some notice. It is scary to think that we (you and us) are the ones that will get the shitty end of the stick when it all goes wrong. We are being failed by our employers and government. But We all just be our very best at what we do, with what we have. That is my point. Leave diagnoses to the clinicians and physicians.As i said before, we are not Doctors nor should we think we are, unfortunately some do. Probably the same saddo's that put their hi-vis in the rear shelf of their cars!
Squifox
Copied here from my reply to Dr Crippens response to Kenneth Clarke remark. I hope it makes sense to you as it is some time after the above was posted.
Dear Dr C. I wholeheartedly agree that any ambulance crew that contradicts a GP's request for a patient to travel by ambulance to hospital is a fool and in carrying out an assessment of a patient without the full knowledege of his/her medical history is asking for trouble, particularly by then questioning the need for that patient to go to hospital. I can only speak for myself and my experience with other ambulance staff. I have never in 17 years seen or heard of any staff in my service questioning a GP's decision. Sure, we may discuss the need for ambulance transport en-route or after the job, but never in front of the patient or GP. That is completely unprofessional.
As previous correspondents have pointed out, we are under pressure to make as few unneccesary trips to A+E depts as we can. Does the patient with epistaxis (which is often classified by our system as a cat A call, uncontrolled heamorrhage, the same category as AMI) need a trip to A+E when we have treated on scene, stopped the bleeding and they are normo-tensive with no pre-disposing medical conditions? Or the diabetic hypo or asthmatic treated at scene who recovers and does not need further medical interventions? We are duty-bound to take a patient to hospital if they a)need to go b)ask to go c)at the request of a GP/HCP, unless they refuse transport or make a preferred choice to see their own GP/other HCP. We are not doctors and those that like to think they are, I hope, are few and far between. I'd like to think that we can make informed decisions based on knowledge and experience. Of course we are better at trauma than most medcal conditions because, by and large, we are trained to treat what we see, rather than make a diagnosis based on a 15 minute examination with no prior knowledge of a patients medical history. However we can make a judgement based on recent history and presenting signs and symptoms and carry out appropriate treatment required at that time. If you feel so strongly that ambulance staff in your area are failing you, then you should consider making a formal complaint, either directly to your local ambulance headquarters or through PALS. It may well be safer to call a taxi in some cases, but taxis cost money!
Squifox
anonymous 7:01.00 says
"the point that Sitting on the fence is making is that politeness costs nothing, yet goes a long way - and if you get what you want at the end of it (ie the pt taken to hosp) then all the better."
It's not a question of ego's and the Doctor getting what he/she wants. It's a question of the patient (yes the patient, let's not forget him/her) getting what he/she needs.
Question to Paramedic (at Inquest):
Solicitor for bereaved family: Why did not not transport patient X to hospital as requested by Dr Y?
Paramedic: OoH! Dr Y was rude to me. I told him that I thought patient X did not need to go to hospital and Dr Y disagreed despite what it says in the protocol! Doctors, what do they know!
If in my opinion a patient needs to go to hospital then I am not prepared to kiss someone's arse to achieve that aim. I expect the hospital to accept that patient and the ambulance service to transport him/her to hospital. And I would act no differently if it were my mother as opposed to yours.
The Government in this country is determined to deny patients the care that they need and you, by your probably well-meaning but ignorent (as in lack of knowledge- no insult intended) comments are supporting them in this.
On that point, where is the great clamour on the streets for a change in the status-quo as regards the NHS and the provision of health-care. There isn't one! And why not?
What puzzles me why was the case in point, i.e. the ambulance crew questioning the doctor’s judgment, was allowed to arise.
Surely when changes to the ambulance crews’ working practices were considered, planned and implemented somebody (very senior and medical) was responsible for all this. Presumably a project team containing doctors, health service managers, professional/trade associations/unions etc must have been instrumental in setting the whole thing up - defining jobs etc.
Furthermore there doesn’t seem to have been any review to correct problems such as this.
Could this be political meddling rather than managed change? And the NHS IT project is also in one hell of a mess.
Perhaps the journo could pick up on this and get to the root of the problem.
It is not acceptable for ambulance crew to question a GPs decision to admit their patient. In this case our job is to transport the patient while monitoring their condition. That’s it. In return, GPs need to make sure that they only request ambulance transport when it’s genuinely required and most of the time that’s exactly what happens.
If we’re called to a patient who’s dialled 999 and asked for us that’s a different story. Here we will complete our ‘mickey mouse assessment of the patient’ (oh how I laughed) and then decide what the next step is going to be – we might treat them and leave them at home (hypoglycaemic episode for instance), we might stabilise them and take them to A&E (trauma, AMI for example) or we might refer them to their own GP (chest infection they’ve had for a week but it’s the weekend now and the GP’s not available…). Like it or not, in each case we are making a diagnosis and planning the treatment of the patient. I’m not pretending to be a doctor or playing with my ‘Fisher Price diagnostic tools’ I’m just doing my job, the one I’ve been trained to do and one that I’m good at. For the ‘big sick’ patient I want to get them to definitive care (an appropriately trained, specialist doctor and their team) in a better (or at least no worse) state than they’re in now. For the ‘little sick’ patient I want to get them to the most appropriate care for them which might be hospital and might be staying at home. And finally for the ‘not sick’ patient - I want to prevent them using the time and resources of even more NHS staff.
My interest is in doing the best for my patient. Sometimes I meet GPs who I wouldn’t want to treat my hamster. I also meet paramedics that I wouldn’t want to treat him either (no offence to you vets but I’m sure you get the point). Neither of these are typical or representative of the breed as a whole. We operate different parts of the same system and we ought to be respectful of each others expertise and supportive of each others role. We need to be standing together to fight for our NHS, if we turn on each other we’re just playing into Tony and Gordon’s hands.
I guess one problem I wonder about is what would happen with a EMT if they didn't "blindly" follow doctors orders. What kind of process justification has to be in place for that?
John
...By the way, I'm not "Dr. John", just a guy with a question.
John
ambulancemonkey,
you make your point well,
however the problem comes when political pressures are placed on ambulance to not bring patients in
If ambulance staff are diagnosing and making decisions where to take the patient, it must be down with an 'if in doubt, then into A/E' philosophy
With the political pressures I pity the staff who are being forced to keep people out of hospital, especially given their level of training
An experienced quality GP would find it very hard to make the decisions that ambulance staff are making, and this is with much more training on board to help.
Do you see my point?
The government needs to stop obsessing over bloody targets and invest so that AEs are set up to deal with the demand. Unfortunately they know this would be more expensive. After all a better service is always going to cost more!
Anonymous, I completely agree wuth the point you make. It is usual in my area that we take to A+E if there is any doubt. It is best for the patient and it covers our ass if it all goes Pete Tong. We are pawns of the political need to keep costs down and I think this is what Dr crippen was trying to say. However his tone comes across as patronising and arrogant and THAT's what has stirred up some of the responses to his comments. I agree the government is obsessed with targets, hence the appearance of Responders. It is virtually impossible to get to a "life threatening emergency" in 8 minutes in an ambulance so we now have "responders" who can, but then have to wait 30 mins or more for a crew. This does nothing for the patients benefit, who needs to be in a hospital with appropriate medical staff to treat his/her condition as soon as possible.
The scenario he relates where Albert died is terrible and obviously the crew should have been disciplined for what they did. It is inexcusable but, unfortunately, there are a few bad apples in every barrel. Criticise us if we deserve it, constructively if possible. But please dont be rude as in "over promoted white van driver in fancy dress". or "you really are a fuckwit".
Interestingly, reading the various postings, it seems to be the highly trained, intelligent writers (doctors)? who are swearing the most! Talk about playground responses, tsk tsk!
Right, so the next time I get a GP handing over a chest pain patient with zero treatment (which happens to me at least fortnightly), I should strap them in and drive to hospital, leaving them in the back?
These godly figures of medical mastery can't possibly have forgotten to give Oxygen, neglected to cannulate, decided against GTN and opted not to do a ECG for no reason!
Better get my lorry driver arse into the seat, and drive off while the guy dies in the back.
After all, I barely know a person's head from their arse the the only thing any Ambulance Oficers are good for is a road traffic crash.
Good to know *rolls eyes*
Take a look at your own maturity in this area, calling people lorry drivers, foolish "ambo drivers" and "play doctors."
Seems like the majority of Ambulance Officers out there have a more mature, realistic and helpful attutude to Doctor/Ambulance relations than you do mate.
You accuse others of arrogance - might want to consider your own arrogant attitude.
Ha-so! In another post where a correspondent mentions doctors thinking they are "gods", Dr. Crippen says he was "trained in the era when doctors were thought of as "God", singular, capital G"...
I think that says it all!!
If I were to make one recommendation to improve pre-hospital management of angina by GPs it would be to ensure that more patients are given a cardiac dose of aspirin [providing there are no contraindications] before they leave the surgery.
Given the dire risks associated with platelet aggregation during ACS I find it suprising how often this essential measure seems to get overlooked.
Maybe the paramedics, or indeed GPs have a different view ?
I am honestly disgusted at your attitude by tarring everyone in the ambulance service with the same brush. Surely as someone who is 'more educated, more trained, apparently more skilled and has so called more experienced' than ambualnce staff should know better than to do this.
If that is how you think then maybe ambulance staff should start posting stories about GP's/Doctors not performing BLS on a patient that has arrested while in the waiting room at a GP's surgery or on some occasions performing BLS, but it is completely unaffective! Thats just one example I am sure there are plenty more examples from ambulance staff that have been in the job for 20 plus years. I also noticed you failed to mention common sense, something I am certain some Doctors do not have but ambulance staff need plenty of to do their job.
But ambulance are an essential service, they work out of hours and cover weekends, that ofcourse gives GP's Saturdays and Sundays off, unfortunaltely the general public have no choice but to call the glorified taxi service to help them!
This all reminds me of a blog by another egomaniac who was training to be a Uni paramedic. He thought he was beyond reproach too.
Facts - there are some pretty awful GPs out there who have long ago lost the plot as well as some new (and not so new) ambulance staff who don't do the service any favours.
Personally, I'd never question a GP in front of the patient - but that's more to do with manners than anything else. But it's bloody annoying to go to a patients house at some ungodly hour for a GPs referral, only to find that the GP has done the diagnosis over the phone. How's that for 'money for nothing'!! If a patient is poorly enough to warrant hospital care via an EMERGENCY AMBULANCE, then surely the condition warrants the GP actually giving the patient the once over in the flesh?? After all, what obs can be done down a phone line to make any sort of diagnosis?? If my diagnostic tools and skills are 'mickey mouse' then I don't know what the BT variation amounts to.....
I'd even be willing to dismiss this type of behaviour if it wasn't the norm - but it accounts for the VAST % of OOH 'care' that I've seen!!
And let's not forget the numerous CCP calls that get called in from the surgery. OK - I'm not about to take a chance on them and I don't expect a GP to, but surely such a condition doesn't merit the patient being left in the waiting room with NO immediate care being given to their condition?? If we rolled into A&E with a CCP ? MI and the patient just jumped out of the back having been given no treatment, we'd rightly be hauled over the coals - so why do some GPs find it acceptable to just write a letter and NOT give any treatment??
As for handovers - I'm sorry, but they are more than just professional courtesy. If I'm going to take over the care of a patient, then I'd like to know what I'm being given. OK - maybe a lot of it (if it's medical) will go over my head, but a decent set of obs and Hx that I can compare with my own 'mickey mouse' obs will at least ensure that I can monitor any deterioration and act accordingly (where possible). Again - would I roll into A&E and just say 'There you go' to the triage nurse?? I think not......
(BTW, there are some triage nurses and doctors who would do well to actually look as though they're listening to my handovers, not only does it prevent me having to repeat myself when a specialist comes along, it could save them looking like a twonk when said specialist asks them something that they can't answer, but would have been able to had they bothered to listen to what I was saying when I brought the patient in!!)
I don't pretend to be something I'm not, but nor am I bowed into subserviency by someone with letters after (or before) their name. I will treat anyone with the respect they merit from their actions and expect the same in return.
Again - that's just good manners.
I am an ambulance paramedic with 27 years experience...and the arguments between/about ambulance vs. doctor don't seem to have changed very much.
I haven't read every post here..I got to the foul language parts and started to skip over that dross..but this is my take on the situation.
Back when I started, the description "driver in a white van" was probably closer to the truth than we would have liked, certainly when it came to medical situations. We didn't have much equipment, medical training was minimal but we were at least probably better experienced at trauma care than the vast amount of doctors. ( I well remember the GP who took the cannula out of its wrapper, threw away the protective cover, threw away the cannula, inserted the needle into a vein and then complained that someone had plugged it up with a plug of cotton wool !!)
I also remember the ambulanceman who walked an abdominal pain patient to the ambulance. Luckily the patient who had an AAA survived the walk !
Bad and bad on both sides.
Today, things have changed dramatically. We now have very well equipped ambulances, ambulance Technicians authorised to give certain drugs, Paramedics with a much wider range of skills including 12 lead ECG recognition, pre-hospital thrombolysis, a much wider range of drug administration and an awful lot more training outside of the standard courses to get the qualifications in the first place.
Who authorises these skills to be used ?
Answer...Doctors, together with senior ambulance representatives in the form of JRCALC, the Joint Royal Colleges Ambulance Liason Committee. The guidelines and procedures are laid in great detail in a regularly updated manual which is basically the Technicians/Paramedics bible.
That's the training side of it very briefly.
The praticalities of it all ?....
The ambulance crew who disagreed with the GP about the need to take the patient to hospital were wrong, plain and simple. The GP who makes disparaging remarks about the "Mickey Mouse" observations and assessments undertaken by the crew is also wrong.
Our protocols are clearly defined by our management. All patients will have, as a minimum acceptable level, a set of baseline observations taken regardless of any observations that another medical professional may have made. ( The GP who saw the patient 4 hours ago and wrote his/her letter then )
An ambulance crew failing to adhere to these minimal requirements leaves themselves wide open to disciplinary action. Remember who defined these requirements..JRCALC..Doctors, together with senior ambulance representatives.
There are good and bad on both sides of the fence.
I and my colleagues often consider getting a GP to see the patient rather than take them to hospital...until we find out who the GP is, at which point we take the patient to hospital because we know damn well that the chances of getting that GP out are slim to non-existant.
I and my colleagues also sometimes go home, having handed over to another crew, hoping that no-one gets seriously ill during that shift !
The arguments in this forum all boil down to one thing...someone getting pissed off at the way someone else has reacted, either physically or verbally. Throwing aggressive accusations, foul language and sarcastic descriptions serves no-one any good. All you will do then is widen the them-and-us gap. Instead, try to educate with reasoned argument.
I don't like being called a Big White Taxi Driver and I'm sure a GP doesn't like being called ineffective and unprofessional.
Dear Dr
In the pre hospital world we come across the good, the average and the very very unsafe. I question you as a Dr only to provide a safety net for myself and the patient. this comes after seeing many in the community prescribed AB's for their acute lvf after a hasty phone consultation, repeat scripts for someone who has not seen their gp in years, illegible letters from dr's diagnosing over the phone and then perplexed and unammused "specialities" wondering why a chest infection has arrived at the doors of CCU. I've seen SHO's "cannulate" the femoral nerve, reg's cause more damage with a trochar than the patients presenting penetrating injury and consultants strep high take off in an obviously non unwell person with benign early repolarisation. We'll not go into what really happens when a trauma call is put out to most of the hospitals in this country and what really happens when the trauma patient arrives....... I can tell you about asthma patients that have died, infants that have died, the list is endless because certain individuals are to mighty to get out of bed, to mighty to call someone to get out of bed, to haughty after their latest in house pre this or post that course.....
so please don't throw such a hissy fit when someone questions you, no we're not Dr's, but we're not idiots either. And if your house was in impeccable order then i'd accept your comments, unfortunatly it isn't, unfortunatly ours is neither... until that day let's keep it civil.
Doctor,
I find your arrogant attitude to other healthcare professionals (oh and it's Paramedics and Technicians NOT 'Ambulance Drivers') incredible.
Like any job there are people who are both good and bad at the job. There are, unfortunately, many GPs in the area I work in who I wouldn't trust with my own family members. We frequently have to 'bail them out' when a patient arrives at the surgery and actually has something seriously wrong with them. I suppose after years of sitting behind a desk handing out anti-biotics it must throw you when someone comes in with a time critical condition.
Doctor, please try to engage your brain before posting such idiotic blogs as you only make yourself look stupid.
Oh, and take note that I don't have to resort to abusive language to get my point across.
People in glass houses shouldn't throw stones....... I wonder how long it will be before the dear Dr removes these posts.....
http://news.bbc.co.uk/1/hi/england/london/6231574.stm
http://www.google.co.uk/search?hl=en&q=gp+struck+off&meta=cr%3DcountryUK%7CcountryGB
http://www.google.co.uk/search?hl=en&q=doctor+struck+off&btnG=Google+Search&meta=cr%3DcountryUK%7CcountryGB
http://www.google.co.uk/search?hl=en&q=gp+mistakes+harm+patients&meta=cr%3DcountryUK%7CcountryGB
Taken from the other post (you know, the one where Dr 'high opinion of himself alone' makes outlandish attacks on HPCs, especially ambulance crew)
"due to several tasteless and offensive comments I have withdrawn comments on this post, if people wish to debate in the future I suggest they at least remain civil, it seems however that this is beyond some people"
May I highlight a few choice terms from the good doctor himself, as he "remains civil" and in no way becomes "offensive"
"You really are a fuckwit, arn't you" (BTW - when picking people up on grammar - another of your favourite topics - perhaps the use of a spell checker within your own work would be in order - AREN'T has a 'e' in it)
"I did not use that terminology (ref. 'ambulance driver' comment) in the original article. Try reading it"
On reading said article, you find :
"The ambulance driver arrived" closely followed by "Ambulance drivers are put under pressure not to take people to hospital"
When one tries to form a reasoned debate with this 'doctor' you are either met by the kind of vitriole he seems to take issue with in other people's replies, a blatant disregard for anyone's views other than his own - or he just deletes the entire lot in a 'toys out of the pram' way.
Call me a cynic if you wish, but for a doctor to be entirely dismissive of anyone else's opinion, to be so arrogant as to think he alone is the knower of all things and to have such appalling lack of attention to detail is quite scary.
I doubt this post will last, but I do so love hacking away at the crumbling foundations of pedestals, as it seems do many others....
BTW - I would love to know what hospital this 'doctor' works at - just to make sure I'm far enough away from it........
i do understand where this guy is coming from but perhaps the way he put it was out of line.
ambulance people should not argue if a doctor asks them to do something.they are more qualified to make a diagnosis and decision based on there far more experience of dealing with the case, they have, rather than somebody who thinks they know it all. i have come across individuals like this and they are dangerous.
i think ambulance people should know their limitations and not second guess. ambulance staff are more at home dealing with road traffic crashes and the like. how would you feel if a GP came along to an incident and told you that you were doing it wrong, not happy i guess,
until your training is longer than the current time. you must accept doctors training gives them a better understanding or illnesses etc than you have.
Just to come back on the above point quickly. If you'd have had chance to read the replies in the other post, you'll have seen that very point being made by ambulance crews themselves. We work within our remit (at least, the vast majority of us do - there are, after all, good and bad in every walk of life) as do the other HCPs that the good doctor slags off (ECPs, nurses, midwives, etc, etc).
But not giving a complete handover to an ambulance crew is irresponsible in the extreme. If we are, as he suggests, just a mode of transportation, then the duty of care remains with him for a given patient. As such, he should travel with that patient to hospital, before handing over to another doctor. Now we know that doesn't happen - so what is the good doctor suggesting??
As has also been said numerous times, the volume of calls received from GPs surgeries makes up for a large % of day work for the ambulances - and you'd be amazed at how many GPs openly abuse that service or make slap happy diagnoses without having done the relevant observations that would back up their thoughts.
And let's not even go into the number of properly poorly patients who are left without adequate treatment whilst they wait in the GP waiting rooms - with the only interventions being made once the crews arrive!!
Of course doctors are 'better' trained, in that they have far more time to study - but even the most complex medical emergency starts with a simple ABC - so simple, that some doctors seem to think such things beneath them......
yes that might be true brian but it doesnt negate the case the GP was talking about.the answer to all this is to ask the doctor to sign your PRF to say he doesnt want any further clinical interventons performed on this patient. faced with this i would suggest the GP would refuse and have a rethink. i cannot see anything is achieved by arguing with the GP and going against his wishes just for the sake of it.
if you are worried about your professional status and your governing body this also would negate you from any action that might occur as a result of claims of negligence.
to pick up on a point in your post re the time they have to study i would say they have less time to study because of the hours they work training in the hospital setting, than yourselves do with your residential training courses.
Point being missed I think - but I'm taking it you know something about the job, given the use of the term 'PRF'.
I don't know of any crew who would refuse a patient transport to hospital - it's (for want of a better phrase) 'more than our job's worth'. But if I take a patient into MY care, who remains in MY care until they reach hospital, then I damn well expect a handover by the referring GP - it's not bloody-mindedness, it's simple professional courtesy as well as being basic good practice and acting in the best interest of the patient. Surely that's the point??
As I said previously on the other thread, the patient's medical condition may be well beyond my understanding, but a decent basic set of obs ('mickey mouse' ones, according to the good doc), a recent Hx and some details of treatment given will mean I can at least ensure the patient's condition does not deteriorate en route. I can't imagine any doctor signing a PRF to the effect that he/she didn't require me to do anything en route - and I'd be fooling myself if I thought, even with that mythical signature, that I wouldn't be hung out to dry if something went wrong, whilst the doctor got maybe a slap on the wrist (after all, who costs more money to train or replace - me or the GP??)
As for training, my relatively short residential course doesn't even come close the the years a doctor gets - I'm not one for pretending it does. But as someone has already pointed out, this doesn't mean we can be spoken to like something a doctor has trodden in........
Making wildly untrue statements about 'non-doctors' performing tasks above and beyond their remit on a PUBLIC FORUM doesn't do anyone any favours - doing so in the manner that our beloved doc has done so only serves to signify that the NHS still has some dinasours that do the service as a whole no favours - unless, of course, they take their 'seniority' and put it to good use by taking the matter to the people at the top, rather than deflecting all the flak onto their colleagues!!
I've been in the Ambulance service for 13 years & a Paramedic for the last 8.I hold a degree in Paramedic science.
I trained as an ECP (emergency care practicioner) & was based in primary care for 3 years.
In some ways I agree with the Dr's sentiments, I too feel that our education is lacking for the role we are being pressured to undertake.Every course,every bulletin & every meeting is all about 'leave them at home' or 'treat & refer' anything to avoid transport to A/E.
The good Dr needs to drop the attitude but retain the ethos of the arguement.
we do agree on 1 thing the doc was wrong in putting things the way he did but in all fairness it is his own blog and is entitled to say what he wants. what does make me inquisitive is why all of a sudden there is a plethera of ambulance staff when they have never bothered before surely worse things have been said than what this guy is advocating.maybe somebody is just feeling argumentative.
I think the simple answer as to why such articles attract the attention of ambulance staff is that there seems to be a concerted trend amongst many forms of the media to question the abilities of the ambulance service, especially the role of the technician.
A doctor jumping on the bandwagen and calling them 'drivers' (will all that infers) and calling their medical skills 'mickey mouse' does nothing to make their jobs any easier, nor the public's perception any better.
Ambulance staff are increasingly asked to do more for less (by their own management), at a faster pace, for longer and without any back up if the inevitable mistakes occurr.
Abuse by patients is a daily occurence, of both the service in the fact that they think they can call an ambulance for any minor ailment, coupled with the decline in OOH services, the joke that is NHS (re)Direct and general disregard by GPs thinking they can bypass the system in order to meet their own criteria (and increase their salary by hitting their targets).
Yes, that's the fault of a government who are hitting targets, but missing the point and yes, that is perhaps the underlying point behind Crippen's ramblings - but I'm afraid belittling the work done by the rest of the NHS is not the way to make the point. All it does is give some of the 'patient groups' a new angle of abuse to use against the first port of call - you guessed it, the ambulance staff!!
ok but i don't see the police or firebrigade saying how unfairly theyre treated by the public and other professional body's. the answer is unfortunately its todays society and "the way things are" perhaps as a suggestion your unions would be better off trying to get better recognition from other health service worker by fighting your corner and educating the public. brian as i said in my recent post the bloke, rightly or wrongly, still has the right to say what he wants on his own blog, whether it offends or not
p.s anyhow with the new labour leader things will change anyway more important things to worry about
Post a Comment
Subscribe to Post Comments [Atom]
Links to this post:
Create a Link
<< Home