I had an EMT friend call me the other day with a problem sheís having at work. After listening to her and being less than helpful, I thought that Iíd share this with you and see what youíd all have to say about it. Iíll give you my advice to her, but I didnít honestly have all that good of advice to give her. Letís see what you think.
My friend who weíll call her ďAnnĒ even though that may or may not be her real name, is a former partner of mine. Sheís a cool girl. Sheís as much of the caring, kind, and competent EMT as youíd ever want in a partner and sheís also pretty fun to work with. I liked working with her and was sad to see her move away. I was happy for her when she got this BLS 911/Transfer job on a ďbig cityĒ ambulance service, but sheís had some troubles there. Now, Iíve worked with her for a year as one of my regular partners and I know sheís good at what she does. I also know that the reputations of all of the ambulance services in this ďBig CityĒ arenít all that stellar. Frankly, Iíd take her word over theirs if I was pressed to answer a about it.†
She called me and asked my opinion on what she should do about a situation thatís developing with a new partner of hers up there in the big city. She explained that this guy is a know-it-all type who encourages RMAís (refusals, Against-Medical-Advice, etc) on almost every patient. She says that he wonít touch anything unless itís a true emergency and tries to dissuade every patient who he feels is beneath wasting his valuable BLS time on. She says that itís reckless and that he does it to excess, even when itís clearly not in the patientís best interest in her opinion. She says that he rationalizes it by saying that the patients wonít pay their bills anyway, and that some of these patients are simply being a burden on the system in general and that heís just doing his job.
And I can understand thatÖ to a point. I mean, who among us has ever rolled their eyes as a drama-filled patient tries to overplay their conditions to get sympathy and a transport or simply doesnít even try and expects a free ride to three hots and a cotÖ I get that. In fact, I see it all the time. It bothers me to no endÖ and yet I rarely, if ever, encourage an RMA.
In fact, there are only certain times that I ever will encourage a refusalÖ and that is when there is a clear benefit to the patient not be transported to an ER via ambulance. I will do this at times when the patient will be better served by something like an urgent care center, or by a quick trip to their primary care doctor. Iíll show up, provide a full and detailed assessment, and actually talk to the patient about their options for medical care. Iíll tell them that maybe the stitches they need would be done faster and cheaper at the Urgent care down the street than at the ER, or that their need for a simple x-ray or throat culture could be handled somewhere else. Iíll even tell them when I think they can save money and still be safe by being transported to the ER via private car rather than by my ambulance. I feel comfortable doing that when itís clearly in the PATIENTíS best interest – NEVER when itís in MY best interest. Even then, if the patient still wants to go via ambulance to an ER or is unsure that my option is the best option for them I transport them without complaint. Itís just safer for my career to do that. Ultimately, Iím not a physician and I canít make the final legal determination on whatís best. Only the patient or a physician can do that and I am usually not the patient.
However, thatís not what Ann says this new partner of hers is doing. She says that he tries to defer every transport on the grounds that heís lazy and then he writes very sloppy reports about the calls he refuses. She says that heís been in trouble for this before and that while he was working at another service, he was actually almost terminated for this behavior.
I know the type of EMT he isÖ Heís the ďSo, do you want to be transported or what?Ē kind of EMT. The kind of EMS person who feels that he or she doesnít ever respond to ďCheck someone outĒ and that only the patients that absolutely have to be transported to an ER for an ďawesomeĒ enough medical complaint are truly worth their time.
I hate those kinds of EMTs.
She is concerned for her job, her license, and her career while she works with this guy. She doesnít want his bad behavior to get her roped into a complaint, lawsuit, or worseÖ she wanted to know if there was a way she could protect herself legally from his actions while she was working with him.
I went with my stock answer on this. Being an EMS supervisor myself, I asked her if sheíd talked to her superiors about this. She said she had done just that, and it hadnít gotten anywhere.
I wasnít surprised.
Unfortunately for my friend, thereís just no reasoning with this kind of EMT. Iíve worked with their kind before and I know how painful oneís working relationship with these people can get when you force them to *gasp* do their jobs and take people places while treating them for whatever they say their medical complaint is. They tend to get growly at you when you tell them youíre having trouble hearing them over the sound of you not caring what they think. It makes lunch time a tenuous situation and totally ruins the Christmas party.
My next pearl of advice to her was to tell her to actually send a written letter to her supervisors, detailing her complaints and stating her concerns in writing. My thoughts would be that then, there would be a paper trail that shows she at least tried to do something about it. Unfortunately, I also had to warn her that it may end up branding her as a trouble-maker when the bosses realize that they now have a paper trail too, only they actually have to do something about it. They may retaliate against her instead.
Then I told her to CC a copy of the letter to the medical director, just for emphasis. Itís because Iím a devious trouble-maker myself.
Situations like this are all too common out there and they are the things that hold our profession back. Yes, I know that there are system abusers out there in patientville. Weíre not going to fix that with our current system and really need to get more options out there for appropriate treatment pathways. However, putting people at risk by encouraging RMAs because youíre a lazy provider hurts our efforts by setting a bad precedent. Please donít do this people. Take it from me. Iíd never let you get away with it on my shift.
Does anyone else have any better advice for my friend Ann?
Also, it may be helpful to read this post: a primer on the people I call “Grumblemedics”