What makes a "good" medic?

[usalsfyre]

I disagree slightly. A completely idiotic partner can totally take my focus off of the patient (somewhat) and onto parenting him.

I had a guy dump out the drug box a couple of weeks ago, and spike the IV through the med port on the bag, and say some stupid things to the patient.

That particular partner doesn't get to do anything anymore except carry stuff, lift his end of the stretcher and drive. That makes me a slower medic overall, since I have to stop the interview to get vitals, hang my own IV bag, etc. And I think speed and efficiency matters.

I disagree with the thought that you're only as good as your partner lets you be, though. You just need to know how much you have to control your partner's actions too.

^^^^^^
This

Your partner doesn't necessarily affect WHAT care is provided, but it sure as sunshine affects the delivery of said care, and delivery of care is part of quality care.

 

[DESERTDOC]

Good partner is not same as good Paramedic.

A good Paramedic:

Retains all of the basics they were taught.

Has common sense to apply education.

Knows what differential diagnosis is.

Does not believe in "because I can, I should" mentality.

Is an ambasador for the profession, even in the face of the ignorant.

Still learns and seeks those who can teach him more.

Is not a cowboy, yet knows how to get out of the system what will benefit his patient the most within the confines of established protocols.

Holds people around him accountable, and him or herself moreso.

Knows what they know, and does not pretend to know what they do not.



That is my short list for what it is worth.

 

[usalsfyre]

Agreed except for...

Is not a cowboy, yet knows how to get out of the system what will benefit his patient the most within the confines of established protocols.

I believe a good medic treats to his level of knowledge, whether it fits in the "protocol" or not. Patients don't read our books.

 

[shfd739]

Agreed except for...


I believe a good medic treats to his level of knowledge, whether it fits in the "protocol" or not. Patients don't read our books.

This im with. I've gone outside protocols plenty and was able to justify it and it worked. Kinda helps to be right when you do that though.


---
- Sent from my electronic overbearing life controller

 

[Chief Complaint]

Among MANY other things, the willingness to teach others what you know is very important. At least, to me it is.

Ive run with some terrible medic preceptors who didnt want me there and made zero effort to teach me anything. Ive also run with those on the opposite end of the spectrum. No reason to not make an effort to ensure that the future of EMS is in good hands.

 

[usalsfyre]

I'm really beginning to think the paramedic educational model should follow the medical educational model.

 

[Aidey]

^^^^^^
This

Your partner doesn't necessarily affect WHAT care is provided, but it sure as sunshine affects the delivery of said care, and delivery of care is part of quality care.

I also agree with this. Like ABC I've got a partner who has been demoted to carrying, lifting and driving. Nice guy, he just does not have a personality cut out for EMS. He deliberately only learns something if he is told it. The hospital could put a flashing red light outside the door to the room we are going to, and no matter how many times we go into the room with the flashing red light, he won't learn that is our room unless someone tells him "the room with the flashing red light is your room".

And if the red light were to burn out, and they were using a white light we would be back at square one.

It definitely affects how fast and efficient I am, but there is a limit to what I can teach and what as to be learned passively.

 

[DESERTDOC]

Agreed except for...


I believe a good medic treats to his level of knowledge, whether it fits in the "protocol" or not. Patients don't read our books.

There is always the option of medical control. Hence the knows how to work the system comment. The Paramedic must meet the minimum standard and not just his or her knowledge level which may be below standard.

Medical control can be used when things do not fit a treatment protocol, or we know what we want to do, and need a Physcian order to do it.

I worked in a standing order system, and would call from time to time to get a physcian order for something I knew would benefit my patient.

Deviation from established treatment protocol is where people start to get into trouble.

 

[usalsfyre]

There is always the option of medical control. Hence the knows how to work the system comment. The Paramedic must meet the minimum standard and not just his or her knowledge level which may be below standard.

Then it is the system's job to educate these medics up to standard or weed them out.

Medical control can be used when things do not fit a treatment protocol, or we know what we want to do, and need a Physcian order to do it.

Ever had a physician deny you an order because he "didn't like medics?" The problem with med control in my system is it's wildly inconsistent depending on the doc.

I worked in a standing order system, and would call from time to time to get a physcian order for something I knew would benefit my patient.

Or they'll deny the order because a medic burned them one time, or they didn't sleep well, moon's in it's 5th phase...

Deviation from established treatment protocol is where people start to get into trouble.

Yes and no. I'm not talking about radical stuff or exceeding your scope here. I'm talking about withholding or adding treatments based on your knowledge of A&P, pharm, pathophys, ect. An example would be the addition of albuterol in the suspected hyperkalemia, or choosing midaz instead of etomidate as an induction agent in a septic patient or using CPAP on a COPD'er in respiratory failure even though these may not be specifically mentioned in your protocols. These are all appropriate (excelent really) medical care that can be backed up by science.

 

[DESERTDOC]

Your post

I agree with it all.

It is up to the system to train to standard and to ensure everyone continues to meet it, if not they need to be removed. It is also incumbent upon the Paramedic to continue to learn and build upon his or her weaknesses.

I have had orders denied before, but not often. But, not for spite from the physician. Afterwords we would talk about it and he or she would explain his or her rationale and I would give mine. I would learn, but rarely, I would walk away frustrated. It happens, and I still have good relationships with them all.

Some Paramedics did burn their docs, that sucks and those Paramedics were persona non grata.

But by and large in the region I am from we have good relationships with the ED physicians.

 

[usalsfyre]

Part of my frustration/lashing out has to do with the fact we just switched med control hospitals, from one that dealt only with our system (by and large a group of well educated and forward thinking medics) to one that deals with a several different systems, a couple of which are substandard. The results been orders that have been denied because the local "big city" system doesn't have their feces together. It sucks.

 

[shfd739]

Among MANY other things, the willingness to teach others what you know is very important. At least, to me it is.

Ive run with some terrible medic preceptors who didnt want me there and made zero effort to teach me anything. Ive also run with those on the opposite end of the spectrum. No reason to not make an effort to ensure that the future of EMS is in good hands.

If someone doesn't want to precept they shouldn't. Either the company needs to pull it or they should stop themselves.

I enjoy having students and get frustrated when at the end of the shift we didn't get to cover everything, they didnt get enough skill attempts or we couldn't go over a power point about etco2(this because no one around here teaches it but everyone has the capability).




---
- Sent from my electronic overbearing life controller

 

[firetender]

Where's the AED?

Please defibrillate and restore to initial rhythm:

What makes a "good" medic?

 

[DESERTDOC]

Part of my frustration/lashing out has to do with the fact we just switched med control hospitals, from one that dealt only with our system (by and large a group of well educated and forward thinking medics) to one that deals with a several different systems, a couple of which are substandard. The results been orders that have been denied because the local "big city" system doesn't have their feces together. It sucks.

It does suck, and I do empathize. I detest mother may I systems. I was happy when, around 1995 we went to Standing Order with only a few Physican Order Only things. Our scope has gotten bigger, added CPAP and 12 leads around 10 years ago, but COULD NOT get Adenocard until 5 ago. Go figure.

ETA: It'll be a tough road, but you could band together and help educate the new hospital as to what good Paramedics are like and how they function. It is an uphill battle, but it can be done. I think, or am I just naive and overly positive?

 

[EMSBabe18]

I think a good medic is someone who can do their job well. They need to be book smart but creative too. You don't always have the exact materials to solve a problem but a good medic can problem solve and use whatever have at the time. It's robotic.
There's a difference between just being a good medic and a medic that people are drawn to and trust. A medic who can relate to patients and help them emotionally AND physically is a truly great medic.

 

[Underoath87]

"One who gives his patients the best possible care with the tools he has available, I would hope. "

What if the tools they have available are either limited or wrong? Not because of some systemic problem but because of a lack of training or CME? I have worked with plenty of other medics who really have no clue what they are doing but they still are doing what they think is best.

Then he wouldn't be a good medic. Read my post again. It wasn't some sort of lame "just try your best" answer. I never said "try" anywhere.

I just meant, for example, that he can't be expected to accurately diagnose internal injuries that require a CT scan or X-ray, or perform major surgery like in an OR. It was a pretty safe answer, and I don't think anyone could disagree with it.

 

[truetiger]

What makes a good medic cannot be taught: common sense.

 

[Chief Complaint]

If someone doesn't want to precept they shouldn't. Either the company needs to pull it or they should stop themselves.

---
- Sent from my electronic overbearing life controller

Unfortunately they don't have a choice here. Just about everyone has to be a preceptor whether they like it or not.

 

[firetender]

Sheer Inspiration!

Oh, you guys/gals get me going; so here's your firetender's take on the original question.

 

[daine.scott]

According to me it would be someone who keeps his patience with patients and the situation and is has excellent crisis management skills.