Sunday 5 April 2009

Doctor, doctor...

I have had several cases recently where on arrival at the A&E department we are met by members of hospital staff who are, shall we say, less than aware of the Ambulance Service's involvement in a patient's chain of recovery and survival.
I'd like to see a lot more doctors, especially those in A&E, spending more than just a voluntary shift on an ambulance. I think they should have a week as part of their A&E rotation actually on shift with an ambulance crew. Too many of them seem to think either that all their patients appear magically in their resus rooms, or that Paramedics just scoop the patients up and wheel them in to hospital.
I've had too many cases where the doctors simply don't believe that the patient who was at death's door when the ambulance put in the blue-call* could have made any sort of recovery by the time we arrive at hospital.
Calls like:
- the 9-month-old in anaphylactic shock who had practically recovered by the time of arrival.
- the patient who was in cardiac arrest who's now trying to sit up and talk
- the 30 year old who'd had several seizures who then seemed nothing more than a little confused, or
- the elderly lady who was practically breathing her last, but the doctor was too busy to do anything about it and too busy being incensed by the fact that we'd actually treated her, rather than just picking her up, throwing her in the back of the ambulance and dumped her at the door of the A&E department.
These patients don't recover by magic. Ambulance staff may not be doctors, but we are trained and experienced in treating many acute conditions that enable us to get the patient to hospital in a much better condition than they were initially.
Don't get me wrong. You can't tar an entire population of doctors with the same brush. There are plenty who are very pro-ambulance and understand our role. But there seem to be some out there at the moment who, for one reason or another, despise the Ambulance Service. They seem to hold us in contempt and resent the fact that we actually treat patients.
I, for one, do not appreciate a doctor who doesn't have the common courtesy to listen to a handover. I do not appreciate a doctor who takes one look at a patient as we're off-loading and sucks their teeth at me. I do not appreciate the doctor who, in front of a roomful of people says "It's not possible. You must be wrong about what you think you saw". If I'd have been equally as unprofessional, I'd have announced in the same fashion that I have the evidence that proves I'm right.
So, doctor, come and join the Ambulance Service, just for a few days. Try cannulating in a dark alley, try intubating a patient under a dining-room table. Try giving injections whilst moving at 60mph. Come and learn about all the things we can now do. We are no longer the Ambulance Service of 30 years ago. We are highly trained, highly skilled, and very much a part of the same team that you're on. So come on-side again. You may be pleasantly surprised.
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*Blue-call: Priority call made to the hospital by radio or phone to pre-alert them that we're coming in with a particularly unwell patient. Gives the hospital time to prepare the basics for immediate treatment.

9 comments:

slmiller72 said...

I read this post nodding my head in agreement. Unfortunately, even in the 21st Century we are still deemed as ambulance drivers, not the highly trained health care professionals that we are.

I always feel a great sense of achievment when the patient that was so poorly has now made a pretty much full recovery through your actions and interventions and often through my handover have to reiterate that yes, they were quite unwell when we first arrived! This is, 94% of the time listened to by an attentive Dr on arrival to hospital however, I too have been party to quite the frankly unprofessional attitudes of Dr's and nurses. Fortunately, this appears to be the exception rather than the rule and one that I don't thankfully come across often. Surely, we all have one common denominator? The patient, without whom we would not have jobs.....

There are rumours about Intubation being taken away from Paramedics..... Is this out of need or professional snobbery??? We are up against this daily! So to any A&E Doctors out there - Come and have a day out on an ambulance with me and the author of this blog, see what it is we do, THEN make up your minds before writing us off completely as stretcher monkeys.....

RapidResponseDoc said...

Or, come and work at my hospital, where the ambulance crews are part of our A&E team, and are treated as such. There has to be a significant change in the attitude of doctors to ambulance staff. Maybe blogs like ours will go some way towards doing the deed!

Josh said...

What a great article! I have to say most of the recieving doctors I have dealt with have been fine. I find the real problem is the nurses. They have no respect for what we do and have no respect for us as professional health care workers. I for one am sick of having to justify taking a patient to hospital. At the end of the day I'd like to think we're all part of the same team and have the same goal in mind.

Happy1 said...

As an A&E nurse I have maximum respect for what you guys do. Some people are just full of self-importance and ignorance....ignore them.

InsomniacMedic said...

Thanks to all of you for your comments. Josh and Happy1 - I find that on the whole the majority of staff, both doctors and nurses are very much on-side with ambulance crews. When we go to our local most the regular staff will trust our judgement and listen to handovers etc. I find the problem to be mainly with the Junior Docs who are on rotation, so only have a short time to prove their worth. And for some reason they think that the way to do it is by being difficult with the ambulance crews. The only thing I think any of us need to prove is that we are trying to give the best care for our patient.

Anonymous said...

I hate when, as a doctor who's worked with the ambulance service in the aforementioned dark alleys, deep ditches, urine sodden stairwells and muddy verges, I stand in the A&E department and the rest of the Trauma team can't be arsed to listen to what they're being told...
I wish I could persuade more to do the kind of thing RRDoc and I have done and work in the field...it's VERY enlightening.

Halden H-B said...

Hi Ben,
I've come from the ambulance service to medical school and although I'm still very much in my infancy of 'doctoring', I know exactly where you're coming from. I seem to be forever correcting my peers about what ambulance crews can do, and what ambulances should be used for. In fact I've made it a little mission of mine to ensure that, my year of medical school at least, graduate to respect the green men in the yellow vans. With all this being the case though, you'd think that some exposure to pre-hospital emergency care for medical undergraduates would be a great thing wouldn't you?! You wouldn't believe how hard it is to get hold of. A year of trying, and I'm still no closer...

Keep up the good work, and rest assured that if I ever meet you in an ED many years down the line, you'll have my utmost respect.

Regards

Anonymous said...

There's allus bad'uns all ower t'place

Neldo said...

As a pre-registration pharmacist I know exactly what you mean about doctors' attitudes to other professionals.

Unfortunately, however, I've also had the same with ambulance crew a couple of times. There has been more than one occasion when, having involved the Scottish Ambulance Service as a Red Cross volunteer or as a bystander, the paramedics/technicians arriving aren't interested in any kind of a handover. I try to tell them what happened, obs, the deteriorating condition of the patient, what I've done or even who I am and they'll just turn and walk away. The majority of crew that I've encountered have been professional and friendly, but I've had dealings with baddies a couple of times.