If you had your way, what are the top 3 three things you expect from your medical director? Discuss, discuss!
A surprising (to me) number of people responded with a desire for some respect. I guess that I have been a bit spoiled, because I have not really had that problem. I have had over a dozen jobs in several states. Even when I have completely disagreed with the doctor, or the doctor has completely disagreed with what I have done, there has always been communication. The communication has been been in both directions, up to a point, but all conversations reach an end. Just because I would like to continue the conversation does not mean that the doctor should feel the same way.
I have occasionally been treated rudely by doctors, but usually that is just a misunderstanding. Occasionally, this is just a jerk doctor (we have jerk medics, too), or a topic on which the doctor is a jerk (as medics, we have some topics that we may be jerks about, too), so I do not see this so much as a problem coming from the doctors as much as we are not initiating communication.
My comment was –
I have only rarely had a medical director who would not spend time talking with me – as long as they were not busy. I have also spent a lot of time talking with doctors who are not my medical director. We need to stop being afraid to go up to a doctor and say, “If you have a minute, I would like to talk with you about this patient,” or something similar. Unless I have another call, I can stay with the patient until after the doctor has examined the patient, observe the examination, and ask the doctor what I should have found. Most doctors have taken the time to discuss the care of my patients with me. Is there any GOOD reason we need to leave the hospital immediately? If there is a reason, it is not the fault of the doctor.
In other words, I think that our biggest problem is often ourselves.
Yes, I have worked in Mother May I? systems and I gave more morphine in one Mother May I? system than any paramedic in the neighboring county that had standing orders for morphine.
I had to call to get permission to give even 1 mg of morphine to a 200 kg patient.
I also worked in the neighboring county that had standing orders for up to 0.2 mg/kg morphine for chest pain, burns, and for musculoskeletal pain. For the so called average adult patient of 70 kg (154 pounds), I would not have to call until I reached a dose of 14 mg of morphine. I don’t think that it is common to have adult patients as small as 70 kg, but . . . .
Is the problem that the doctors won’t talk to me?
Is the problem that we won’t talk to the doctors?
Doctors are people. We may chat with them about social topics, but we seem to shy away from discussing medical topics.
Before we start complaining that we do not get any respect from our medical directors, we need to show them that we know enough about patient care to have a conversation.
Maybe as a brand new medic there is a fear that we do not know enough to have a conversation with a doctor. We need to ask the doctors to teach us, so that we do have the knowledge to carry on conversations about medical care.
If doctors teach medics to assess patients better, we can do a better job of treating the patient according the the right protocol – or at least treating the patient in a way that is least likely to cause harm to the patient.
If we learn to just call command and follow orders, why would a doctor think that we know enough to be treated with respect?
I agree that a medical director should reach out to all of the medics that medical director authorizes to treat patients.
Those patients are the medical director’s patients.
But this does not mean that we cannot start a conversation with our medical directors or with any doctors.
When I call for orders for a controlled substance I always try to talk with the doctor afterwards to explain what I gave, what changed, and to thank the doctor for orders, if orders were necessary. With my current protocols, I do not need permission for a lot, but there is still plenty of room for improvement. EMS is continually improving and changing. Our protocols should be as well.