Thursday, August 15, 2013

The Complacent Medic

I am sure a lot of you have had run-ins with what most of us call the “Lazy medic.” I could almost guarantee that most experiences with this said person will be of similar nature. We are speaking of those medics that refuse to start an IV because it is too late at night to bother, someone who downgrades a call to BLS that should go ALS because they are tired, or those who refuse to give a pain medication because cracking that dreaded seal on the drug box would result in them not only having to go to the hospital pharmacy to restock, but then they would have to audit the drug box. Oh no! Does this mean they have to do their jobs? Anything but that! Oh the horror!

I had one experience of laziness that I could not explain. We got called as a BLS unit to the scene of a female patient who had symptoms of nausea and vomiting for 4 consecutive days. On the scale of sick or not sick, this woman landed in that red hot sick zone. This patient was severely dehydrated to the point where, not only could we not hear a blood pressure, her radial pulses were impalpable. We called ALS, made the intercept, and gave our report. Our medic then promptly told us this call didn’t require ALS, and that they would just go on the ride to “make us idiot basics feel better.”

Excuse me?

This medic then initiated IV access, and instead of giving this woman a bolus of fluid, he locked the line. Really? I will end this story there, but you could imagine how irate I was. Not only was my competence questioned in front of a patient, but my patient didn’t even receive the care she needed.

This story raises a couple really big questions.  How does one get so complacent that they forget what their job is about? How does someone get to that point, and why is it that when these people get called out on their deficiencies they immediately take a defensive stance, puff out their chests and promptly assure everyone that their years of experience is all that matters.

Ah, paragod syndrome. Yes, I said the dreaded made up word, paragod. I do not use this term lightly. There is a large difference between years of experience and knowledge, and years of complacency. Some of the most respected medics are those who never forget where they came from, and realize every day is a new experience.

Now this raises another question, how does one come to the point of such arrogance? Some blame it on burn out, some merely believe they have seen it all, and therefore they are allowed to dictate which patients will actually get their full attention. I don’t know about you, but I think most of us have had that patient that seemed like they were fine, and upon further evaluation gave you the instant “pucker effect.”  Think about it.

We once got called out mutual aid, primary ambulance to the next town over for the man experiencing dizziness upon standing. Activate the instant eye roll folks, here is another BS call, right? Wrong. We get on scene, start evaluating and find that the patient is conscious alert and oriented and his blood pressure is 156/84. His pulse? Well crap, his pulse was a mere 26. That’s right folks, 26. Instant pucker.  Now if we treated this as just another BS call, we would have missed a major problem. Now, what happens when we become complacent? We get too comfortable, we let our guard down, and when we are at our most comfortable, we mess up and kill someone. Are you seeing my point? Some medics, and even some basic care providers let their foolish pride dictate their patient care. This is a problem. When one gets to the point that their treatment options are the only thing they will consider, it’s time to move on. Many times have I spoken up and made suggestions regarding patient care that had been considered by an open minded medic, and used because it was a good option that in the end worked well for the patient. Communication saves lives folks!

Now, how do we fix this problem? And, yes this is a problem. I believe the first step is to constantly remind yourself of these few simple things:

*       You were new once. Which means, you too at one point were the thorn on the rear quarters of your preceptors.

*      You will never stop learning. Each patient and each event has different variables.

*         Nothing is ever textbook, because someone looks fine, doesn’t mean they are fine.

*         You are not god’s gift to EMS.

This job is not all about experience. It is about being open minded, and knowing that you will never stop learning. Experience is only a part of the equation that makes up what we do. Constant education, and frequent scenario based training is what sets you up for a successful career. Competence, and confidence are great aspects. All I ask is that you learn the difference between confidence and out right arrogance. Your coworkers are your sounding board, without teamwork our jobs would be impossible.

I did not write this as a personal attack on anyone, but to merely shed some light on this ongoing issue. I think we all at some point get too comfortable, and require a reminder that we are about to do more harm than good. Our jobs are not about how much we can show each other up, it is about providing high quality pre-hospital patient care. The patients are why we are here. So, the next time you have that patient that looks fine, and you believe shouldn’t go to the hospital, cover your bases sometimes things can be more than they initially appear to be.

Stay humble folks!

RU-Responders Unite

1 comment:

  1. Pretty fair picture. We are in this to do a job, do it to the best of our ability, not to judge, but to care for those who need our help.