Pt w a Dr for a wife??

[VFlutter]

Any ideas on this perspective, if the doc was a shrink?

They are still a Medical Doctor and went through medical school like all other specialties. And if I am not mistaken many of them also went through Internal Medicine residencies before specializing in Psych.

 

[Aidey]

One of the local hospital shrinks was an anesthesiologist for something like 10 years before switching to psych. I would guess that for the purposes of if someone is able to take over care that a psychiatrist would be able to if the other conditions were met.

 

[JPINFV]

As long as she accepted full responsibility for the patient, its her show now, your unit is effectively commandeered by the MD. Any ideas on this perspective, if the doc was a shrink?

A physician, including psychiatrists, have an unrestricted license to practice medicine. It's unrestricted in terms of time, location, and scope of practice. Granted, they will be held to the standard of the specialty they're practicing (i.e. if the psychiatrist decided to do a heart transplant, they'd be held to the standards of a transplant surgeon), but there's nothing legally wrong with a psychiatrist taking over patient care on an ambulance.

Also medical school and the first year of residency ("internship" year) are inherently general education. It's not like the psychiatrist wasn't educated in non-psych diseases and disorders and spent all 3 years of his/her psychiatry residency working with psychiatric patients.

 

[chaz90]

A physician, including psychiatrists, have an unrestricted license to practice medicine. It's unrestricted in terms of time, location, and scope of practice. Granted, they will be held to the standard of the specialty they're practicing (i.e. if the psychiatrist decided to do a heart transplant, they'd be held to the standards of a transplant surgeon), but there's nothing legally wrong with a psychiatrist taking over patient care on an ambulance.

Also medical school and the first year of residency ("internship" year) are inherently general education. It's not like the psychiatrist wasn't educated in non-psych diseases and disorders and spent all 3 years of his/her psychiatry residency working with psychiatric patients.

And this is why I've seen a textbook that mentions a scenario in which a "moonlighting proctology resident" is the doc at the ED. Thankfully not something I've seen, but entertaining to read.

 

[firecoins]

And this is why I've seen a textbook that mentions a scenario in which a "moonlighting proctology resident" is the doc at the ED. Thankfully not something I've seen, but entertaining to read.

hopefully he doesn't make an as of himself?

Ok someone had to go there and I did.

 

[JPINFV]

And this is why I've seen a textbook that mentions a scenario in which a "moonlighting proctology resident" is the doc at the ED. Thankfully not something I've seen, but entertaining to read.

Did the fact that the ED was staffed by a colorectal surgery resident have any effect on the outcome of the scenario?

 

[chaz90]

Did the fact that the ED was staffed by a colorectal surgery resident have any effect on the outcome of the scenario?

It was just an attempt at humor by the authors of the textbook. It was actually mentioned in the scenario that the doctor was attempting to remove the "funny looking underwear" from the patient (PASG pants). The whole book was incredibly outdated and mostly worthless.

 

[Sublime]

A physician, including psychiatrists, have an unrestricted license to practice medicine. It's unrestricted in terms of time, location, and scope of practice. Granted, they will be held to the standard of the specialty they're practicing (i.e. if the psychiatrist decided to do a heart transplant, they'd be held to the standards of a transplant surgeon), but there's nothing legally wrong with a psychiatrist taking over patient care on an ambulance.

Also medical school and the first year of residency ("internship" year) are inherently general education. It's not like the psychiatrist wasn't educated in non-psych diseases and disorders and spent all 3 years of his/her psychiatry residency working with psychiatric patients.

This may be so, but someone claiming to be a doctor on my scene most likely isn't going to get too far. Honestly I wouldn't be comfortable letting a psych or surg. doctor taking over my patient. Just because at one point years ago before they specialized they learned general medicine doesn't mean they remain competent on treatments in an acute setting. Ask any surgeon to read an EKG for example.

Thankfully my protocols state a doctor on scene can not tell me what to do, and if they want to take over care they must be in direct contact with our medical control and they must approve it first. I can't imagine it any other way. Who's to stop some crazy person or whacker from claiming they're a doctor on the streets?

 

[JPINFV]

Who's to stop some crazy person or whacker from claiming they're a doctor on the streets?

If only there was some sort of card that people can carry that can verify that the person is licensed to practice medicine.

 

[Tigger]

I do not mean to stray to far off topic..... but,
Another interesting point is that in most states if an off duty MD demands to take over patient care they can. So long as you state that they accept all responsibility and stay with the patient until patient care is handed over to another MD.
Your particular state or medical director may have specific rules or protocols for this and which MD's are allowed.
From that perspective, if she identified herself as an M.D. and this is verified somehow, shes calling the shots. As long as she accepted full responsibility for the patient, its her show now, your unit is effectively commandeered by the MD. Any ideas on this perspective, if the doc was a shrink?

I'm not so sure they can just commandeer the unit. Yes you can agree to transfer care, but I've never worked anywhere where the doctor could take over care unless the patient approves.

 

[Sublime]

If only there was some sort of card that people can carry that can verify that the person is licensed to practice medicine.

And it's probably impossible for someone who wants to pretend to be a doctor to create such a card....

Also i've never seen a physician license and wouldn't know a legit one from a fake one.

 

[JPINFV]

And it's probably impossible for someone who wants to pretend to be a doctor to create such a card....

Also i've never seen a physician license and wouldn't know a legit one from a fake one.

So why have any license card? Do you carry your EMS license while working?

 

[chaz90]

So why have any license card? Do you carry your EMS license while working?

That's a bit different. In uniform and assigned to a shift, the expectation is that your license has been checked by your employer. This would be the same as a doctor working at an ED I don't typically transport to. If he/she gives me an order to do something while there (IE give 5 mg Versed prior to a nurse being able to get it out of the Pyxis) and I do that, it was under the belief that they are properly licensed. If someone comes up to me and says they are a physician, I would absolutely check licensure before following their orders.

 

[Sublime]

So why have any license card? Do you carry your EMS license while working?

Yes I do, although I don't feel the need to explain the obvious difference between me carrying my license while on duty and a random person outside of their place of work wanting to take over my job.

 

[captinfocker]

I hope you dont work for the company that I think you do

 

[RocketMedic]

I hope you dont work for the company that I think you do

Who are you talking to?

 

[Bullets]

Agree to disagree. Patient satisfaction and patient outcomes are improved when family is allowed to be at the bedside. This is why many ICUs are revising their visitor policies and most are going towards open visitation.

They can interject all they want as long as it is not interfering with the care I am providing. I will do my best to explain why I am doing things my way.

In my experience many of the family members have legitimate concerns, as in this scenario.

For example if my grandma had to be taken to the hospital I would want to go with her. She is alert and oriented but has no clue what her medical history is, her medications, etc. If the EMT throws my grandma, who has pulmonary fibrosis, on a NRB @ 15Lpm when her SpO2 is 90% then I am going to say something. If they want to take her to a hospital that is not where her Pulmonologist is then I am going to say something. If they say "It is our protocol, GTFO" then things would get very heated.

There is a difference between assisting EMS with information, which i always welcome. I cant count how many times ive said "you know him/her better then i do, is this normal ect"

And things like the patient and family arguing with each other about course of action, should we go or not, oxygen or not, ect. Ive had family demand we transport, claiming they have a POA, while the patient adamantly refuses to go. These family members are told to get out.

My attitude with EMTs who are not on duty on scene is a very short leash. If family who are medical providers want to direct the patient care, then they should go get their own agencies ambulance or be prepared to sign some paperwork stating they have assumed care and we are simply being used as a taxi. In these cases they should also be prepared to recieve a summons to appear in court from our Police Officer for abusing the 911 system and causing a false alarm.

 

[firecoins]

I am required to to carry all credentials on me by New York State. I am also required to display my company ID which has my picture on it.

 

[captinfocker]

Who are you talking to?

I was referring to op

 

[DrParasite]

So why have any license card? Do you carry your EMS license while working?

yes, probably 98% of the time when I'm working (the other 2% I have forgotten my wallet at home). I usually carry my EMS card from the State in my wallet, and depending on what I'm doing, might even have my work ID in my pocket.

For example if my grandma had to be taken to the hospital I would want to go with her. She is alert and oriented but has no clue what her medical history is, her medications, etc. If the EMT throws my grandma, who has pulmonary fibrosis, on a NRB @ 15Lpm when her SpO2 is 90% then I am going to say something. If they want to take her to a hospital that is not where her Pulmonologist is then I am going to say something. If they say "It is our protocol, GTFO" then things would get very heated.

With all due respect, you can say whatever you want.... however, you called for the ambulance, and if I'm on the ambulance, I have my own rules to follow. I might say "It is our protocol, GTFO", and if you have a problem with that, you are more than welcome to refuse all care, and when she dies, it will fall on you. Further, if her pulmonologist is an hour away, and I am bypassing 4 other hospitals to get to the one she is at, you can say something, but it won't be changing the outcome. If she's critical, local hospital can stablize her until she gets transferred. If she's not, than sign the refusal and schedule a commercial ambulance to take her whereever you want.

Families can have a say in what goes on, but they are also emotionally involved in the situation; as the professional provider, you might have a very good reason to ignore what they say. But you better have a really really good reason, along with the backing of your superiors, before you do, because you can expect a complaint to follow your decision.