Monday, December 06, 2010

He's Gotta Ticket To Ride and The NP Says It's Okay

I had a new patient show up at the office the other day and my office nurse called me into the room quickly. She was concerned when he said that he was a diabetic and that he hadn't been feeling well for the last few days. As my trusty nurse knows to do, she got a glucose reading which said "hi". He also showed her a draining abdominal wound. His color was a a pasty greyish tone and he was slightly diaphoretic.

After obtaining a set of vitals, I told the nurse to prepare to make a call to EMS for transport to the local hospital for this patient. He asks why I think that he needs to be admitted and I proceed to explain the significance of "hi" on a glucose monitor and the likelihood that his sugar was at least 500 and was probably higher and that he needed IV antibiotics, fluids, and monitoring for a few days. With a grateful smile, he said okay. I left my nurse to monitor him and to give report to the EMS for me as I had several other patients that had been waiting.

 After I finished with the patient, I asked my office nurse if the information was handed to the EMS and she was rather upset. She said that the female paramedic walked into the room and said "oh, it's you again to the patient." Excuse me? My nurse responded. The paramedic said,"  We've taken him to the hospital a few times and that the ER just releases him and tells him to find a primary." She asks the patient, "So, what's wrong with you now?" To which he replies, "I'm sorry to bother you again." The paramedic turns to my office nurse who proceeds to give report of a blood sugar of hi and that he has an infection that needs to be checked. The paramedic then proceeds to question whether our machine was right so she goes out to get their machine off the ambulance to recheck our work.

Well.....that just pissed in my office nurse's coffee.. Here's what she said, after of course, their monitor read hi too.

"First off,  this man is a new patient to us and he is very ill. We don't care how many times that he's been taken to the hospital before, if my NP says he needs to be seen, then he goes." Second of all, turning to the patient, "you don't EVER have to apologize for being ill. You are here obtaining primary care from my NP and when you get out of the hospital, you come back and we'll see how you are doing and make a plan from there." She hands the EMT his packet of paperwork and tells the patient "here's your ticket to ride and it'll be okay."

Footnote: He was admitted with a blood sugar of 654 and was in for three days. He came back to the office for a follow up and states that he was feeling much better now. He thanked us profusely for my nurse making him feel important enough to take care of.

How sad is that? I was so angry that a patient was made to feel that they were a bother and that they weren't good enough to treat with common respect. Don't get me wrong, I get a little burned out by some of my difficult patients. You can better believe that they leave my office feeling like they are the only patients of mine to take care of  because that's my job.
If you don't like your job, find another one. Just find another one that's not in health care.


  1. Anonymous11:31 PM

    That breaks my heart! The paramedic should have been reported/written up to their supervisor !!!

  2. I could share a number of stories about EMTs and attitude, but I won't. They have caused a number of problems for my patients and their families by "diagnosing" instead of doing their jobs.

  3. This is a sad case all around. However, I have a prehospital background and see both sides of the nursing - EMS quarrel. The EMT or Paramedic rechecks your work just as the receiving RN rechecks the Paramedics work when they are brought to the ED, I do not think this should be taken personally.

    The attitude of the Paramedic is unacceptable. In this case the patient truly was sick, and required immediate treatment and transport. This sort of behavior lowers the respect of an entire profession. I hope you and your RN do not retain a poor opinion of EMTs and Paramedics, because of this on instance.

    I have never understood the power struggle and contempt among the ranks of healthcare providers. MDs, DOs, NPs, PAs, EMTs all have unique talents and skills that should be synthesized to provide the best care for patients.

    Aside from that, I enjoy reading your blog, thanks for posting!

    - Joe

  4. I would like to post your story to our site. It has a strong statement for all of ARNPs and nursing. Our site is or blog site is please let me know if we have permission.

  5. Thanks for your post. There are a lot of unprofessional people in health care, but who knows the reasoning why this EMS personal acted this way. Maybe it was just a bad day or maybe the paramedic thought she was being funny. This just goes to show you need to be very careful how you talk to people and always treat people with respect.

  6. When EMTs diagnose medical conditions, it drives me nuts. And when I have had such things happen, I have complained to my supervisors and to their service.

    It is highly unprofessional and completely out of scope of practice.

    It's one thing to give report and another to give one's "opinion".

  7. First, thank you for sharing. But on a different note..we are all (EMS, EMT, Nursing, x-ray, etc...) in customer service. We have a duty and a calling to be professional and "do the right thing". Hats of to your nurse for taking the lead and responding appropriately.

  8. Amen to that! Seriously, I've have so many moments like this where I work... such a waste of time, resources, money and jobs when someone like that is working in health care. If you don't care and you are that cynical and jaded then its time to move on!

  9. Anonymous3:11 PM

    Seems like two issues are being conflated here, and it's muddying the waters. Issue number one, was the frustrated EMT rude to the patient. Survey says yes. If that OK? No. It that a sin most of us are guilty of at one time or another with noncompliant frequent fliers? Yes. It's a bit harsh to be wanting to expel people from the profession for that. You might want to bear in mind, also, that while you in an office practice have the luxury of "firing" an abusive or disruptive or flat-out malignant patient, EM personnel do not. Seeing a difficult patient in the office with an appointment is a little more controlled than being on call for their dysfunction 24/7/365. That said, it's my job and I love it. EMT was wrong to be snippy, no question.

    Question two: is your local EMS crew's job to carry out your transfers, follow your orders, and snap off a salute? No. Not at all. What you're just given us is a credible imitation of a physician who doesn't want some nurse questioning his diagnosis or his care plan. They're wrong, and you're wrong. When you are responsible for a patient at the bedside (or stretcher-side), responsible to keep them safe and keep them stable, you have a responsibility that goes beyond just following orders. It certainly includes verifying what you hear in report and making sure it jives with your own observations. It also includes diagnosis, whether or not we chose to use that particular word. You can't get rid of the need for the person at the bedside to reach a reasoned guess about what's going on -- doctor, nurse, medic or basic.

    It would have been more politic to wait until they were in the ambulance and re-check the sugar. But you'd want them to do that, right? Because the first thing we do with a grossly abnormal lab is recheck it. Whomever we are.

    -- EMT-B, then EMT-P, now EM resident

  10. Anonymous8:59 PM

    So your definition of 'receiving primary care' is "Quick! Get an ambulance and get this person to a real doctor STAT!"

  11. Anonymous, my definition of primary care is recognizing when a patient is sick enough to warrant hospital care and to know my limitations in an office setting. Anyone who doesn't shouldn't be practicing medical care.

  12. First Anonymous, Yes I would expect someone to check the sugar a second time, but do it inside the truck on the way to the hospital and not make the patient feel like they are bothering them by making them do the job that they are there to do. I expect others to second guess me. It's how you improve practice. Believe me, I've second guessed several people but not in a rude obvious way.

  13. Anonymous8:29 AM

    Yes, they were rude, that seems beyond question. I hope they were having a bad day, and not in the wrong profession.

    -- A1

  14. Anonymous7:26 PM

    It's refreshing to read a nursing blog that seems to care about patients, so many are full of venom and resentment? Like you say, if they don't want to treat people with medical issues perhaps they should find another field of endevour.