Coming so soon after the recent episode of the EMS Handover on Respect, this post brought the whole topic back to the forefront of my mind again. I know what it’s like to care for people who are responsible for their condition yet refuse to take responsibility for their actions. I know what it’s like to try and help someone who refuses your help. So I’m not unsympathetic to the plight that Buckman describes – it’s an impossible situation at times, made worse, it seems, by the litigious nature of American society. I’ll try my best to not let this descend into a rant on what’s broken about the US healthcare model in my opinion – I’ll just say that I’m glad that I live in the UK and work within the British healthcare system.

The extreme polarisation of the term “patient care” you write about at the start is something that I haven’t seen in the UK – perhaps I haven’t been working with the system long enough. But I find that extreme views are rarely beneficial to anyone, mainly because they seem to define the issue in a very monochrome way and, as Dr Ben Goldacre says so often “It’s not quite that simple…”. I’m not suggesting that the care that you personally offer is deficient in any way, just that any extreme is bad.

I do think that the concept of patient care is somethign we should hold dear to us and is key to providing effective treatment to our patients. There’s a difference between clinical treatment of a medical condition and actually caring for the patient. I think I’m lucky that coming from a first aid background, there were and still are times when there were no interventions that I could make within my skillset that would help that patient, so caring for them was the only skill I had left.

Having said that, I agree that we shouldn’t mollycoddle patients – some people need some tough lovin’ to get the point across and to help them make the jump across the uncomfortable gap of change. If your description of your medical system is accurate, that it’s a system where you can’t be honest without patients for fear of reprisals when that honesty is truly in their best interest, then I fear for that system. The system is failing to provide the best care for the patients and is crippling your ability to do so. Somethign needs to change.

I don’t think that “Do what I say or else” is an appropriate stance for a medic to take. Yes, let’s move them out of that ICU bed into a ward where they can receive palliative care, but don’t make them pay for it. This gives far too much power for a doctor who is of a bullying nature over the patient’s decisions.

I agree, something needs to be done to curb the growing trend of patients who absolve themeslves of any responsibility over their condition – but this is a problem that we see in society as a whole, not specifically in healthcare. Forcing people to take a specific course of action in their healthcare is like using a sledgehammer to crack a walnut when you’re trying to fell a tree – it’s both overkill and yet far too little at the same time.

We’re facing a growing problem where the lack of personal responsiblity in society is stressing our healthcare systems to the limit and we need to find new solutions to these new problems without compromising the care that we offer patients.

Just my tup’pence.

“There’s been reports of a casualty across the road. I’m going to be staying here for better comms.”

We all nod and head off. I grab the radio I’ve got and call in to get a radio check and I’ve barely finished when we find our casualty. A 7 year old girl with breathing difficulties. We’re on it like a shot, oxygen and a nebuliser mask out, I’m on to control to get some backup, Mum is upset and panicing. No air ambulance available and the nebulised salbutamol is having little effect. There’s no county ambulance either and our vehicle has a puncture. There’s a quick conversation – I arrived at this incident in my own vehicle, we’ll transport mum and daughter in that. We’re moving, rapidly through the trees whe the radio comes to life – there’s an ambulance en route to us now…

We’re still packing up and debriefing from that job when the radio comes to life again. “We’ve had a call nearby for a young child that’s fallen, no parents, friends have raised the alarm but are not with her.” We look at each other and we’re off again, this time I’ve got the purple gloves on my hands as we head through clouds of gnats. We find her next to a few old logs which she’d been climbing on. She’s 9 years old and looks quite healthy. She’s complaining of a bump on her forehead and a painful ankle. I talk to her, practice my new skill – talking with kids. I’m not good at it and I’ve been practicing. She responds well, I’m on a winner. I check her over carefully and she reports a painful neck. She’s talking to me and I’m adding up her GCS in my head as she tells me she’s feeling sleepy. GCS of 15, she’s alert and responsive…wait what?

She’s feeling sleepy.

Despite the warm summer evening and the gnats crawling all over me, my attention is focused on her as I slip my hands onto her neck and hold her head still. I look at the stump she fell off – 2 feet? 3 feet? A colleague takes over her C-spine management as I get oxygen going – but she doesn’t like the mask on her fact. She’s content to hold it near her mouth and breathe the cold gas though. We package her up and move her down to the road to be met by a county ambulance. I’m all smiles and chatty and she’s responding well.

We haven’t even started the debrief when somone runs up to us. “Come quickly, it’s my friend – he fell off the stile, I think he’s hurt!” We head down, shaking our heads and find a gentleman lying on rocks next to a river. He’s fallen some 2m and is complaining of a lack of sensation in his legs.

Fuck.

I’m running this incident as my colleagues deal with first aid. I request backup from Ambulance control to be told that there’s no land ambulance available. They check on a helicopter for me as we request more people and more equipment. Our landrover pulls up, blue lights flashing and cars slow down on their way past, their occupants staring at a blue-shirted throng of rescuers arranging to move this man onto a stretcher from one of the most awkward positions I’ve ever seen. It’s not long before he’s on a stretcher and moving. We look at the fence – it’s in our way. Bolt croppers are called for and the fence is ready to become a casualty of this incident.

“Ok, hold it there folks.” A voice calls from behind me and the ‘casualty’ pulls his collar and spinal management kit off.

“That collar’s really uncomfortable.” He says, rubbing his neck. I turn around and find ‘mum’ and our two previous casualties grinning behind me. The exercise is over and we’re talking amongst ourselves about how it went. There’s lessons to be learned – there are always lessons to be learned. But we have three people who are alive and kicking (in the scenarios) because of the care we gave them.

As we head back to base I’m thinking that I’m glad I got to practice on children tonight. I’m rusty in dealing with children, but I seem to be getting the hang of it. I shudder as I think of the moment when my casualty told me she was feeling sleepy and know that I’m better prepared for the next one. Chances are, the next one won’t be practice.