quite often (like on a daily basis) i encounter patients who paint such a bleak picture of severe pain and suffering and almost begging to be life flighted to an ed.
they answer all the "emergent" questions yes yes and yes!!! but the minute you suggest hospital.
"ya really think i need to go in?" i'm not that bad. i'm ok, no big deal just a little stomach pain and bloating and my nuts is swelled up and i can't walk, and i know allot of people that have blood in there bm. i stopped vomiting blood so why do ya think i need to go to the er?? can't i just stay home and drink a little more till my pain goes away?
Jan 18, '10
Some people need more information. Some people need to buy a little time to process what you've told them. Some people want reassurance that they really do have a legitimate reason for going in.
And some people just like to argue.
If you have provided information, time to process that information, and reassurance and the person on the other end of the line shows absolutely no evidence of change since the beginning of the phone call, say to them, "I'm sure you'll make the right choice," and let them go.
A tipoff to this kind of situation is the continuous loop conversation, in which you take them gently from point A to point B to point C and so on until you have point Z in sight, and they ask you if you're sure about point A.
Keep your cool. Just understand that your agenda and theirs are miles apart. Again, say, "You have to do whatever you think is right," and finish the call.
Jan 19, '10
We also deal with allot of manipulative patients, border line patients, Drug seakers and such who enjoy setting us up.
We are on a strict time limit and have to get this whole talk time done in 7-9 minutes.
And we cannot say "I'm sure you'll make the right choice,"and let them go. If our wonderful mindless and brain dead computer says pt. should go in and they don't want to we are stuck with an AMA situation. And if we read them the AMA it we can get written up and if there is a suite we can hang. We have to let them know we are not in agreement with their decision and the possible repurcussions of that decision
I take allot extra time for older people, non English speaking, Deaf or Blind and those that just are in crisis and aren't in a good space to input the info we give them.
And I do the best I can to clarify info I give or ask pt. and do so in laymans terms. I listen well and validate feelings, but the ******** time constrictions that are imposed on us by our "assembly line supervisors" I mean Hospital systems is ridiculous
Jan 19, '10
Seems like a Catch-22. The bottom line is that you can't make anyone do anything. If you've advised them to go in and given them the possible repercussions if they don't, what more can you do? Patient autonomy is a big deal. We're not supposed to violate a patient's choice in person. Why would this situation be any different? What are you supposed to do--reach through the phone and give them a good shake?
This kind of computer algorithm that does not allow for real human responses and makes the provider responsible for the caller's bad choices is badly designed. Even if your employer doesn't give a hoot about you, they ought to stop and consider that such a program is a set-up for THEM. The whole "nanny state" approach to health care riles me to no end. It only leads to blaming people who are doing their best when patients knowingly do stupid things and don't want to look in the mirror.
I feel for you.
Jan 20, '10
Sadly enough this computer protocol system is state of the art. IT is what is and what shall be! And I agree about not twisting the Pt.s are and we don't butttttttt we are obligated to read the AMA statement if the protocol recommends getting the pt. seen unless we are able to give a good rationale why we disagree with the all wise computer.
Especially Pt's with CP, SOB, any stroke symptoms, hypertensive crisis etc., we must be sure not to agree with their decision to stay home and not insist but be sure to convey the severity of their condition and potential for becomming allot worse.
And when you mentioned algorithms it brought to mind how liquid our protocols are. Unlike ACLS which is consistent for at least a year or so-our protocols are extensive 50-60 lines of questions or more and they are revamped on a daily basis, so you can't memorize them.
That is also as bad as the mostrous hospital system that we work in where every Urgent Cre has different hours nd different parameters for the typoes of Pt;s they will see. Plus maybe 100 hundred hospitals of so each with their own different policies.
BTW what specialties in Nursing have you worked in your career?
Jan 20, '10
I've done LTC, psych and postpartum. I was also an EMT for a long time. Had to deal with the AMA thing there, but unless someone had a head injury or was under the influence, we had to consider them competent and let them do (or not do) whatever they wanted. They signed our form and that was that. We did always tell them to call us back if they changed their minds, but anything more than that would have been considered a violation of their rights.
I still say it's insane (and asking for trouble) to have a computer model that does not allow patients to make wrong choices without blaming the operator. Are the powers that be trying to get sued?
This is something I hate about healthcare today. More and more often, people only get to be autonomous as long as they make the "right" choices. Sorry you're getting caught in the crossfire.
Jan 20, '10
You were an EMT also? That brings back memories!
I got my EMT in 1978 and Medic in 93. I started out riding in the back of a Chevy Step Van (Bread Truck). Don't know if we had AMA when we started out?
But Yeah I never forced nor coerced anyone to go if they didn't want to unless stroked out.
In the 6 or 7 years as telephone Triage Nurse we have gone thru 2 complete program changes and are enroute for a third. Who knows maybe we wont have any verbal communication just have a tape question the Pt and we over see it???
I saw 1984 last night and could see this heading that way
They tells Just trust the Program. Only ask the questions needed to find the correct Protocol
Jan 20, '10
One large local hospital just shut down their triage department. In its place they have exactly what you are describing--an online question and answer system than gives plenty of information but leaves the decision about what to do in the caller's hands. This was marketed as a cost-saving measure, but now I'm wondering if they were also hoping to avoid lawsuits.
I admire you for doing a tough (and often thankless) job.
Jan 20, '10
We do produce results though by directing Pt's to he correct facility or advising them what to do based on acuity. So instead of ER being full with sore throats nd rash and coughs at 5pm we have redirected those Pt's to Urgent Care where they belong there by alleviating unnessesary backups in ED. We also save the member allot of money by going to UC as well as reduce the wait time by 5-6 hrs probably more!
You mentioned Thank-less job. I learned a long time ago as a Medic to have realistic expectations of what you will get out of the job. After years and years of resuscitating Junkies heavy duty heroin addicts with more tracs on their arm then a railroad station, I worked The Bowery for many years in Manhattan and delt with more drunks, Bums and lice, maggots, fitlth and much much more.
I have pushed Narcan on junkies who were almost in Cardiac Arrest and been spit at, vomited on, kicked, punched and cursed for saving their miserable life because I blew their nickel bag heroin heigh.
A thank you would be nice but there are very few of them. So I base my reward on achieving my goals with the pt.
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