I love posting articles controversial enough to warrant a disclaimer. Today I have the pleasure of bringing you another post by guest author Sean Fontaine. Sean is a graduate of Regis University and a Firefighter / Paramedic for The South Metro Fire Rescue Authority. He lives in Denver, Colorado with his lovely wife Oz and their two sons Jonas and Axel.
Today, Sean throws down the gauntlet on an issue that must be addressed by every emergency caregiver; the delicate balance between delivering objective, impartial medical care and the urge to interject our emotions into the often emotional drama that is emergency medicine. Can you make real emotional connections in the process of administering medical care, or does the emotional aspect of the job directly impact the effectiveness of your care? Some of us may address this dilemma only in our own private thoughts. Others may wish to publicly declare their position. To that end, here’s Sean…
Let me preface this post with the explanation that this topic comes straight from my discussions with paramedic school students and co-workers and the differing/agreeing viewpoints that resulted from those discussions. These are my opinions (not Steve’s) and I know full well that there are many of you out there that will disagree and some that will think I’m an insensitive ass. So be it, we’re here to listen to different viewpoints and think through them for ourselves, deciding in the process what our own thoughts truly are on a given subject.
The Argument: Your level of objectivity effects the quality of your patient care.
I contend that when we emotionally care about our patients we become subjective caregivers and as such render subjective care, transitioning to reactive rather than proactive medicine.
This topic has come up with co-workers when discussing my history of sick and dying pediatric patients, traumatic or precipitous delivery OB calls, and violent sexual assault calls over the past 10 years. (In comparison to the rest of my calls.) In addition, this topic inevitably came up when I spoke with last year’s paramedic school class at a local teaching institution. (I was speaking on the subject of pediatric death and dying, prior to their PALS scenarios.)
During those instances, I stated with no intended malice, that a sick, dying or dead pediatric patient demands the same mental cognizance as a sick, dying or dead adult patient. As such, I see no reason to change my treatment or mindset because the pediatric patient is viewed as “innocent” or deemed “more worthy” of our efforts by some caregivers who then become emotionally involved with the patient. All patients are “worthy” of our full and complete efforts and treatment. That’s our job.
Once we take that step and become emotionally involved with our patient, I believe we cease to observe and treat to the fullest extent of our ability. Hence the previous statement regarding the rendering of subjective and reactive medicine, rather than focused, proactive medicine. I believe that we are paid to think through patient’s current signs and symptoms and consider differential diagnoses, treatment options, appropriate destinations and the most appropriate continued course of treatment. Then, through the course of these actions…we care for our patient by acting in their better interest. We act as their “advocate” if you will.
As you can tell by my verbiage the line as I see it is, “Caring for your patient equals proactive/objective care, whereas caring about your patient equals reactive/subjective care.
Don’t think that I don’t appreciate the weight of this argument. I have had numerous sick, dying and dead pediatric patients with a myriad of outcomes, some of these patients have been carried in my arms to the ambulance, as I have likely carried my own children at some point. However, in acting as our patient’s advocate, we need to operate without our emotions. It’s part of the cost of doing business for us as caregivers. That’s not to say that I don’t think about the potential gravity of the call, I just do it later.
Thinking through the call later is good for multiple reasons, such as addressing learning points, emotionally dealing with the gravity of the call, and ensuring that the crew are dealing with all associated issues in a positive manner. There is an agreement made when choosing this profession and this unspoken agreement is what defines that “mental cognizance” we are asked to bring on each call. This “mental cognizance” doesn’t recognize age, sex, color, religion, level of income, level of education or attitude. Every patient is deserving of our best and most objective efforts. The great part about this agreement though is that it’s nonbinding. We can opt out at any point and move on with our lives.
As I said earlier, I appreciate the weight of this topic. I do not intend to come across as callous in my stated opinion. I also don’t tread through unfamiliar territory. Quite the opposite, this is territory I’m quite familiar with and fully appreciate after some time running these calls. Additionally, I have come to a personal understanding about how to best work through these emotional issues, both during and after the call, to render the best possible objective patient care.
Now it’s your turn:
Thanks Sean. Now I’d love to hear what you think. Can emotions and objectivity be separated during the course of patient care or do they inevitably affect your care? Leave a comment and let us know.
Related EMS Awesomeness: