Monday, May 14

What the patients don't tell us

Why are so many people programmed to lie about their health?

A brief war story is in order to explain what I am talking about. Last shift we picked up a lady who had a nasty roll-over car accident. The whole time we were cutting her out of the car she was hysterical; kicking, screaming, swearing and generally acting like someone who was hit really hard in the head. So we give her the benefit of the doubt and assume she has a bad closed head injury and treat her accordingly. As we were removing her from the car she stopped talking and moving. She failed to respond to anything we asked and didn’t even flinch during a sternal rub. Ok, I am convinced at that point. We drive fast and do all of the necessary things that has to be done for significant trauma patients. All is well except for the fact that she is in and out of consciousness. One minute she is screaming and not responding the next. About five minutes before we arrived at the hospital she becomes completely flaccid. We rolled up to the ER and wheel her in with all of the theatrics that she deserved. I gave the nurse a rushed report indicating that I really didn't want her to die on my stretcher. Of course that went over well. We transfer her to a hospital bed and by this time several spectators had congregated in the room and were helping us. With all of this going on around her she remained unresponsive until we lifted her up and set her onto the hospital bed. Miraculously she wakes up, completely lucid, and begins to explain everything that happened this evening to the doctors? The nurses begin laughing and everyone files out of the room while the patient is calmly dialing a phone to call a family member and tell them what happened. I don't get it?

This is certainly not the normal “I’ve lied to you” situation but it just portrays how inconsistent care can be. Of course once that happened everyone in the ER assumes this patient has nothing wrong with her even though her mental status had changed like Tennessee weather. Not only is this bad for this patient, it is bad for the next patient I bring in because the ER staff is going to assume I am full of shit. Unfortunately, this doesn’t just happen to me or prehospital providers in general. I think to some extent it happens every time another provider comes in contact with the same patient. Just like in grade school when the teacher would whisper a phrase to one person and ask them to pass it on until everyone heard it. The phrase always became distorted. I am not sure if there is a fix to this but in the future if someone’s report doesn’t match what I am seeing I’ll not automatically assume the report is wrong.

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