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Patient Care

The Patient-Provider Experience: Healthcare from a Horizontal Perspective

Have you ever been a patient in an ambulance, before or after becoming an EMS provider? Have you witnessed a loved one become a patient? How did it alter your perception of patient care? EMS World’s series, “The Patient-Provider Experience,” shares the stories of both patients and providers who have been impacted by their respective experiences with EMS—on or off the cot—and how these experiences changed the way they provide care.

There’s a scene near the end of the film, The Doctor, where Jack MacKee, a tactless surgeon whose throat cancer provokes much soul-searching and self-criticism, orders the interns he’s supervising to undergo some of the same uncomfortable diagnostic procedures they routinely prescribe. Seeing first-year residents line up for barium enemas was cathartic in more than just the clinical sense.

EMS personnel suffer similar indignities when we enter our own healthcare systems not as providers, but as patients. Do we learn from those experiences? If so, how much of that knowledge can we apply to our practices? In my case, the answers were Yes and A lot.

Spinal Scrap

In December 2012, I was enduring what had become an annual holiday bout with sciatica. The timing was a mystery. A cynic might suggest it was Dickensian payback for the Bob Cratchits of the world I’d poked and palpated. All I know is Vicodin had become my favorite stocking stuffer.

If you’ve avoided chronic back torment so far, congratulations. Here’s the deal for the rest of us:

  • Children lift things we can’t.
  • Easy chairs are anything but.
  • We need an 11 on the Borg scale.
  • Dogs understand our yelping.
  • We bend over to pick something up and wonder what else we should do while we’re down there.

My discomfort, secondary to a couple of herniated discs, is usually tolerable, but when it flares up, I seriously consider felonious acts against the NYC*EMS partners who insisted we use stair chairs instead of stretchers to load patients onto ambulances. Then I embark on a routine of pills in the morning, pills at night and a cane by my side, all of which can become crutches.

Paging Nurse Ratched

One morning close to Christmas, none of the usual remedies worked, and I ended up horizontal in an ambulance. It was an act of desperation; my regular physician was gone for the holidays and I couldn’t sit long enough for my wife, Helen, to drive me to another doctor.

I was extremely reluctant to call EMS. I suppose that had something to do with all the 9-1-1 abuses we see. Also, the thought of entering the system—the one I’d been part of for so long—made me feel self-conscious and vulnerable. I didn’t want to become someone else’s patient.

After promising Helen not to micromanage my own care, I asked her to call the non-emergency number of the dispatch office where she used to work. Then I considered slipping into something less comfortable but more fashionable for transport, before yielding to the notion of underwear as outerwear. Agony has a way of rearranging priorities.

Submitting to my community’s medical services required patience and tact—two qualities I’m not exactly known for. Here’s how I’d grade the experience:

EMS: A-. They were courteous and gentle, didn’t inflict mindless back-boarding, and took me to the hospital of my choice. The only problem was they didn’t have any good drugs. Or maybe they did, but I didn’t qualify. I probably shouldn’t have offered to help them slide me from my bed to their stretcher.

ED Admission: B. There was no waiting for a bay, I was triaged on the way, and my nurse agreed a rectal exam wouldn’t be good for either of us. I was starting to hate hospitals less. Then someone from billing badgered me about a down payment (Helen had already presented our insurance). I get the part about managing receivables, but on what planet do they find people willing to pressure the infirm for a few bucks in advance?

Treatment: A. The attending physician ordered morphine and steroids right away—even before the x-ray—and two nurses made sure I got my meds promptly. The shots didn’t help much, but I appreciated the sense of urgency.

Discharge: Any letter near the end of the alphabet. While Helen went to fetch clothing more substantial than underwear for my trip home, I was banished to the waiting room. Not cool. If you’d been there, you would have seen this barefoot, scary-looking guy in a t-shirt and paper pants—the best the hospital could offer to preserve my modesty. I tried not to look like an extra from One Flew Over the Cuckoo’s Nest, but I did notice mothers shielding their children.

Medic, Heal Thyself

Helen rescued me 40 minutes later and the indignity was over. The sciatica took a few days longer. I went back to work in January with renewed empathy. Feeling helpless at the hands of other caregivers will do that to you.

Wouldn’t it be nice to summon compassion at will without a loading dose of degradation? I only had a few months to try that before my back forced me to leave the field for good. I think I did okay. My last patient had a debilitating, chronic condition we both knew was beyond treating. We sat and talked for 45 minutes. It was good for both of us.

I don’t mind sharing memories of humiliation, but if the Ghost of Christmas Past ever pays me a visit, I’m going to suggest we skip 2012. I already know what happens and wouldn’t want Tiny Tim seeing me in paper pants.

Mike Rubin is a paramedic in Nashville, Tennessee and a member of EMS World’s editorial advisory board. Contact him at mgr22@prodigy.net.

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