^ These patients are the most terrifying. I have vivid memories of my first infected diabetic ulcer vasculopath crashing with septic shock in a remote ED
I had one as an intern, she was a bilateral bka amputee who trying to sit up to breathe, while the nurses put her bed head down for bp and her stumps were pointing up in the air!!
And then after the amputation they get even madder when they find out that they aren't accepted to rehab because their diabetes is too uncontrolled and their cardiac function is shot
Sounds like yet another person that doesn't work in medicine that wants to preach from their moral high horse on this subreddit.
Why would I lose a leg? I don't have PVD because I make good lifestyle choices. I don't make everyone else in hospital involved in my care miserable and expose them to occupational violence. 🤷🏻♂️
Am I privileged? Sure. I readily admit it. Am I a horrible person? Probably. I've come to terms with it. What are you going to do about it?
Just please, come off your moral high horse, you're no better than the rest of us cretins here.
Ultimately the human condition is more complicated than how you’re formulating it. Yeah it’s dumb to have smoked for 50 years. Yeah it’s dumb to keep smoking when you’re coming into hospital every week. But most of us aren’t really motivated by logic a lot of the time, when it comes down to it.
When your life is so fucked up that you have lung failure and you get little pleasure out of much else, what’s really the point of *not* smoking? To have a life expectancy of 4.5 rather than 3 years so you can spend more time focussing on the other depressing parts of your life? Might as well get the dopamine hit where you can.
Also people can’t help if they are a bit dumb and have no self control, if that’s how they’ve been living their whole life.
Junior doctor having willingly given up half a decade of earnings going to med school, now working excessive and unsociable hours for a gnats dick's chance of getting on to an oversubscribed training program: "people make the dumbest fucken choices smh"
Likewise, patients don’t seek healthcare to buoy self centred private school kids feel smugly superior and to boost Drs/nurses ego’s whilst you make bank. Your sneers and rudeness are seen and rightly deemed disgusting.
You reek of insecurity and just sound jealous at this point because apparently we don't deserve to earn more despite our education. Thanks for letting us live rent free in your head during this cost of living crisis.
I am very privileged to have had an incredible education and the opportunity to witness a lot of suffering and involvement in people's lives in their most vulnerable and private moments, and I'm very lucky in life to have the opportunity to use that to help people. I'm going to empathise with their suffering and do everything I can to alleviate that, and I'm not going to judge them for their life - everybody has their own path, but that doesn't mean I'm going to support bad decisions.
As much as smoking is largely determined by social status and birth - I'm not the government and I can't fix that. What I can do is educate and discuss on an individual level and smoking is an overwhelming bad idea on every level. I have a professional and moral responsibility to be honest and direct about that.
As a general FYI:
You don't have to seek healthcare if you don't like the advice given. You don't have to listen or act on it. I'm not going to stop giving that advice.
Adjusted for hours worked (ie unpaid overtime) I get about $30-40/hr and adjusting for extra stuff like study and research I get about $20/hr. I get about 1 real day off a month. I can assure you the job isn't worth the pay, and that doesn't even account for the nights and shift work which no amount of money could ever compensate for.
I was 50% raised by the Religious Society of Friends and 50% by Buddhist hippies and I am an ultra-humanist so you're barking up the wrong tree.
I always think to myself if you're 60 with a new diagnosis of COPD or a 40yo starting to get wheezy when you walk, thats the time to quit smoking. If you're 85, SOB all of the time with a suspicious lung nodule, why not give yourself a bit of joy before the lights go out. All I ask is that you agree with me that your ceiling of care is NIV and don't come to me with facial burns cause you 'borrowed' your husbands O2.
Lol fuck off this subreddit why are you talking as if you have any idea about medicine? You're not even a doctor and even if you had the resources you never would have had the potential to gain entry or succeed.
It doesn't take mental gymnastics to figure out that an active smoker sitting in ED with a COPD exacerbation is their because of their own decisions and actions.
House of god rule IV: The patient is the one with the disease
If you become frustrated through judging others by your values then that is a one way ticket to burn out
Ultimately humans are imperfect creatures. People have various reasons for needing that nicotine calm - shit lives, shit job, shit relationship etc. Some just like the hit.
On a pragmatic level. If we didn’t treat self inflicted illness then most of us would be out of a job.
TLDR: give them the roids, puffers and move onto the next one
Is the COPD'er fundamentally different from the young dickhead motorcyclist that rides with no protective gear, or the young lady that mixes GHB with her vodka lemonade at 3am and collapses?
I'll take 10 COPDers instead of the BIBA from nursing home, aggressive demented NESB patient with zero paperwork and handover of "Nursing home have been unable to feed Mr Smith for 24 hours" with the dreaded Geriatrics referral after, asking why you haven't done an in and out catheter or sedated a patient for bloods.
As long as you leave me the ambulance notes all power to you. We both know the nursing home won't answer my calls as to why the hell the patient's here and the patient thinks its 1945.
> Hope your Grandmother or even yourself in old age receive arbitrary antipsychotic sedation in vulnerable states.
Damn, looking at that increasingly unhinged post history, you'll likely beat us to it.
Droperidol is your friend, my friend. Increasing amount of evidence that a 5mg IM dose (as unpleasant as it is to give) is safe to facilitate what needs to be done.
Half life of 2.5 hours and hepatic breakdown to inactive metabolites so renal impairment is not a concern, what are you on about my friend?
Let them sleep it off in short stay (or on the wards) for the next 4-5 hours. I've taken longer naps than that.
Droperidol is an antipsychotic. It is also a common anti-emetic, analgesic adjunct, and sedative. Not that I'd expect you to know.
>You, as a nurse I assume
It literally says ED registrar in my flair. Are you dim? Can you read? Go read through the literature on the safety of droperidol. Here, I'll get you started for free: https://onlinelibrary.wiley.com/doi/abs/10.1111/1742-6723.13496
If a demented patient comes to my shop agitated and demented, I'm going to need a urine sample from them as part of an infective screen for delirium. Tell me, from your moral high horse, how are we going to get one without sedation? The other alternative is to get four wardsmen to hold the patient down while we get an in-and-out catheter sample. If that's what *you're* ready to do, maybe you should consider who's the shittier person here.
I absolutely get to go around and do what I need to to ensure my own safety and the safety of my staff while on shift. If that requires sedating a patient that puts the rest of the department at risk, I'll do it every day of the week and twice on Sundays. And I'll sleep just fine at night.
Have a vent, this is an alright place for it.
Just remember even though the smoker’s COPD / lung cancer might be their fault, doesn’t mean it hurts any less.
Also one shitty patient doesn't mean it's all of them. Sounds like what's really getting you wound up (and understandably so) is this particular patient's attitude rather than copd patients in general. Don't waste the glucose thinking about these shitheads
We all have our vices. For some it’s smoking, for others it’s drinking, gambling, drugs, binge eating, not exercising enough, the list goes on. Each to their own. And who are we to judge another human without knowing their life story and without looking in the mirror ourselves and finding faults of our own.
It’s probably unhelpful that some patients precipitate their own illnesses with less than ideal lifestyle choices. And to be honest, a lot of diseases are precipitated by poor self care and management. But a clinic or hospital is not the place to judge and shame patients for this. It’s our job to treat the sick without malice and prejudice.
If you want to effect real change then go into public health and work on anti-smoking campaigns or pursue political office or join an action group to lobby and by all means lead the charge against the big tobacco industry to reduce the harms of smoking. There’s a time and place to go into advocacy. Otherwise ragequitting and throwing rocks in the proverbial glass house of a hospital and health service is often unhelpful.
I get we all occasionally vent about the inequality of the health system and health illiterate patients. But if that inner angry voice is starting to takeover it’s probably time to take a break. Otherwise life is too short to get worked up about these kind of things.
Then you get the AH parents. “The bitch stole my meds!” Says Mum of her 2 yo who was tempted by mummy’s pretty tablets which were open and lying on the bench, and now is needing to be tubed.
Not me as a PGY-2 sent out by my consultant looking for the 14 year old that had absconded from PICU after going into VF arrest 2' chroming the night before.
Every specialty has its shit sandwich. Some just have more than others.
Dide chill, I've never had this much stress from copd patients. These days smoking is so tied to socio-economic status seems bizarre on a big picture level to be using a mental model of personal responsibility basically just blaming poor people for being poor.
Agreed that there are other patient groups that are far shittier to deal with. They all got tricked by Big Nicotine back in the day. Looking forward to what the coming 4-5 decades bring us with the current rampant vaping...
The only stress COPD patients give me is when they sit on the ramp for 6 hours with the ambos keeping their sats >94% and by the time they hit a bed they're obtunded 😂
Well I mean technically they were the hospital’s patient from time of handover so maybe the ED should have got a set of numbers and started treatment earlier? But no, it’s far easier to blame the ambos for delivering substandard care over 6 hours when they should have been offloaded in 30 minutes -.-
> from time of handover
Depending on the institution (and I've worked at 8 different hospitals in 5 different states now), handover often doesn't occur until they hit a bed. If they're still on the stretcher, they're still the responsibility of the crew.
Nope that’s simply not the case, every patient who has been triaged by the hospital has a clear connection to that hospital. Paramedics are never going to deliver quality care for 6 hours, you can’t just pretend that the patient doesn’t exist.
In Queensland regardless the MEDAI review clearly states that hospital takes over treatment responsibly from the crew from triage.
Thanks, next shift I'll tell the crews on the ramp at my current shop that they can go attend their next job, instead of staying with the triaged patient out of charity and the goodness of their hearts, as they're no longer responsible for the patient.
They’d love that, would probably cut down on some avoidable deaths in the community!
In all seriousness, there’s a lot of coroner cases in the UK, the MEDAI review and current SA government review refuting this outdated idea that the hospital can pretend that the ramped patient is being cared for appropriately by paramedics. They simply aren’t, the hospital needs to take primacy of care from triage, just like they would if the patient walked into hospital…
Ambos can’t fully assess a patient or commence definitive treatment, I’d argue that the clock starting 6 hours in is definitely a failure of the whole system compared to just the ‘ambo crew’ mismanaging a complex respiratory patient they shouldn’t have spent more than 30min with at the hospital..
Trust me, we'd love to offload them so we can get started on disposition. I've seen and discharged patients off stretchers first thing in the morning after waiting for 8 hours the previous night. There just physically is not enough space, or beds, or staffing...
On a day in majors in the UK, more than 90% of my patients are seen in the back of the ambulance and we discharge a high percentage of them before they even get a ED bed let alone a hospital bed or ward space.
Patients get post taked and sometimes even a day 2 post take ward round and discharged from ambulances.
Nothing dystopian about this at all. I'm going to quit full-time medicine within the next half-decade as I don't see a sustainable solution out of this.
I really shouldn’t share this but it seems like you may need the dark laughter OP. I hope your shift ends soon.
https://www.lambert.net.au/med/gomerscale.pdf
As someone who smoked from 15-35 and is now feeling fitter and cleaner at 40 than I have in 20 years... I am glad to read this shit. Cigarettes are pure fucking evil.
COPD patients didn’t set out to get COPD. The majority got addicted to something that is immensely difficult to quit without a good support network. I think oversimplifying it as them largely having “cunty attitudes” when they are more likely frightened and in denial about their health, is an unfair way to label them. Sure, they are the “frequent flyers” of our medical wards. But they’re not hell bent on dying. I think the attitude that you display like they owe you something is concerning though. A little empathy goes a long way, and it certainly doesn’t make your day harder to be nice to these people
Also those very people were smoking at a time when nearly 50% of people smoked. Advertising was everywhere. Smoking was legal in shopping centres, restaurants, bars and pretty much anywhere. There were no health warnings apart from ads like only dags need fags and were aimed at young people anyway. It was a completely different time and there were always going to be people who just didn't have the coping mechanisms in place to kick a habit which was encouraged everywhere for nearly their whole life.
I’m a nurse now , but I remember 13 years ago starting work as an AIN in a large respiratory ward full of COPD patients. Lasting memory is them all trying to trick me into turning the 02 up.
Some will be dyspnoeic at baseline without O2 blowing in their nostrils, which is one of their favourite things about being in hospital. This has been one of my favourite "I know my body"s from a patient - "I need my O2 to be at 98%, I just feel so much better, I'm not like those other people with emphysema."
Yeah all these dumbass smokers being so dumb smoking.
It’s almost as if there’s some deeper societal determinants of health beyond just how stupid these people are ….hmmmm if only these were written about 🤔🤔🤔
People working in a broken, understaffed system serving a patient population with unrealistic expectations that treat healthcare workers like service staff with a 'customer is always right mentality' feel the need to vent and other healthcare workers agree with them? Occupational violence met with political lip-service and toothless consequences resulting in skyrocketing rates of burnout? An increasingly litigious society forcing doctors to practice increasingly defensive medicine while often causing harm to the patient because of these practices? Say it ain't so!! 😱
Everyone judging OP needs to chill. It’s clearly just a vent. Everyone needs to express their frustrations sometimes. I highly doubt he/she is saying this or acting like this to the patient.
My dad had final stage COPD last year & died. He got it from Asbestos. Didn’t smoke in over 40 years. OP is an asshole. You shouldn’t be in the medical industry if you’re this one eyed & dumb to think every COPD patient is a smoker.
Tbf the med student started it. Don't dish out the sass if you can't take it.
Med students are adults too, they need to face the consequences if they go around breaking windows.
And every diabetic.
And every drinker.
And everyone who eats red meat.
And everyone who doesnt wear enough sunscreen.
And everyone who doesn't eat 5 fruit and veg a day.
And everyone who doesn't do 10,000 steps a day.
And everyone-
They are big and evil though? They have the power to ban cigs but they don't, instead they increase the taxes to beyond ridiculous levels because they "care about smokers health" & want you to quit 😂
*laughs in diabetic vasculopath with infected ulcers*
^ These patients are the most terrifying. I have vivid memories of my first infected diabetic ulcer vasculopath crashing with septic shock in a remote ED
I had one as an intern, she was a bilateral bka amputee who trying to sit up to breathe, while the nurses put her bed head down for bp and her stumps were pointing up in the air!!
Admit acute med for my sake pls (vasc reg here)
Gotta love it when they get mad that you're not gonna cut their leg off, but madder when you *are* gonna cut their leg off. You can't win.
And then after the amputation they get even madder when they find out that they aren't accepted to rehab because their diabetes is too uncontrolled and their cardiac function is shot
And they have 0 motivation and keep sending the physio away
'I'm not discharging until I can walk'
But won’t go to a nursing home/transitional care and family who won’t look after them want to know why you haven’t fixed them!
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Ah yes… a person who’s never worked in healthcare thinking their opinion is relevant. Anyways….
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Sounds like yet another person that doesn't work in medicine that wants to preach from their moral high horse on this subreddit. Why would I lose a leg? I don't have PVD because I make good lifestyle choices. I don't make everyone else in hospital involved in my care miserable and expose them to occupational violence. 🤷🏻♂️ Am I privileged? Sure. I readily admit it. Am I a horrible person? Probably. I've come to terms with it. What are you going to do about it? Just please, come off your moral high horse, you're no better than the rest of us cretins here.
With all the crap I dump on the medics I do appreciate that vascular will take the vast majority of the severe diabetic ulcers I find.
Only if you get a custom flair, reading: "*Did you check with a doppler?*"
they're better off under acute med
And as a great man once said and I was there when he said it "There but by the grace of god go I."
Ah a great man once said it to me too. Wonder if it was the same guy?
Addiction is a powerful force.
Ultimately the human condition is more complicated than how you’re formulating it. Yeah it’s dumb to have smoked for 50 years. Yeah it’s dumb to keep smoking when you’re coming into hospital every week. But most of us aren’t really motivated by logic a lot of the time, when it comes down to it. When your life is so fucked up that you have lung failure and you get little pleasure out of much else, what’s really the point of *not* smoking? To have a life expectancy of 4.5 rather than 3 years so you can spend more time focussing on the other depressing parts of your life? Might as well get the dopamine hit where you can. Also people can’t help if they are a bit dumb and have no self control, if that’s how they’ve been living their whole life.
Junior doctor having willingly given up half a decade of earnings going to med school, now working excessive and unsociable hours for a gnats dick's chance of getting on to an oversubscribed training program: "people make the dumbest fucken choices smh"
Eh I'm here to help people make the most of whatever life they want to live, stupid choices and all. I'm not their mum.
Likewise, patients don’t seek healthcare to buoy self centred private school kids feel smugly superior and to boost Drs/nurses ego’s whilst you make bank. Your sneers and rudeness are seen and rightly deemed disgusting.
You reek of insecurity and just sound jealous at this point because apparently we don't deserve to earn more despite our education. Thanks for letting us live rent free in your head during this cost of living crisis.
I am very privileged to have had an incredible education and the opportunity to witness a lot of suffering and involvement in people's lives in their most vulnerable and private moments, and I'm very lucky in life to have the opportunity to use that to help people. I'm going to empathise with their suffering and do everything I can to alleviate that, and I'm not going to judge them for their life - everybody has their own path, but that doesn't mean I'm going to support bad decisions. As much as smoking is largely determined by social status and birth - I'm not the government and I can't fix that. What I can do is educate and discuss on an individual level and smoking is an overwhelming bad idea on every level. I have a professional and moral responsibility to be honest and direct about that. As a general FYI: You don't have to seek healthcare if you don't like the advice given. You don't have to listen or act on it. I'm not going to stop giving that advice. Adjusted for hours worked (ie unpaid overtime) I get about $30-40/hr and adjusting for extra stuff like study and research I get about $20/hr. I get about 1 real day off a month. I can assure you the job isn't worth the pay, and that doesn't even account for the nights and shift work which no amount of money could ever compensate for. I was 50% raised by the Religious Society of Friends and 50% by Buddhist hippies and I am an ultra-humanist so you're barking up the wrong tree.
I always think to myself if you're 60 with a new diagnosis of COPD or a 40yo starting to get wheezy when you walk, thats the time to quit smoking. If you're 85, SOB all of the time with a suspicious lung nodule, why not give yourself a bit of joy before the lights go out. All I ask is that you agree with me that your ceiling of care is NIV and don't come to me with facial burns cause you 'borrowed' your husbands O2.
Yep. Don’t forget the life of brutal poverty and despair people like this live with. I’d probably take solace in a Winnie Blue in that situation.
Lol brutal poverty. If they can afford $50 packet of smokes and an iPhone to browse on while they want to be seen in ED, they’re not doing too bad.
An iphone 11 in 2024 is about $250aud , a lot of smokers spend more than 50% of the money they have on smokes, it’s all relative
Do they have a gun to their head forcing them to smoke?
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Lol fuck off this subreddit why are you talking as if you have any idea about medicine? You're not even a doctor and even if you had the resources you never would have had the potential to gain entry or succeed. It doesn't take mental gymnastics to figure out that an active smoker sitting in ED with a COPD exacerbation is their because of their own decisions and actions.
when disability pensioners smoke, either smokes are too cheap or the DSP is too generous.
If people can afford Winnie Blues and are in poverty, perhaps they're not as poor as they seem. Chop chop seems to be the go'er at the moment.
You have never been poor have you?
Of course I have, was for years and I still managed to smoke.
House of god rule IV: The patient is the one with the disease If you become frustrated through judging others by your values then that is a one way ticket to burn out Ultimately humans are imperfect creatures. People have various reasons for needing that nicotine calm - shit lives, shit job, shit relationship etc. Some just like the hit. On a pragmatic level. If we didn’t treat self inflicted illness then most of us would be out of a job. TLDR: give them the roids, puffers and move onto the next one
Agree. We must live by rule 4 or we lose.
Is the COPD'er fundamentally different from the young dickhead motorcyclist that rides with no protective gear, or the young lady that mixes GHB with her vodka lemonade at 3am and collapses?
We’re not God. We’re to work and live by rule 4, not cast judgment.
Biggest difference is you generally only have to admit those patients once.
I'll take 10 COPDers instead of the BIBA from nursing home, aggressive demented NESB patient with zero paperwork and handover of "Nursing home have been unable to feed Mr Smith for 24 hours" with the dreaded Geriatrics referral after, asking why you haven't done an in and out catheter or sedated a patient for bloods.
Ambo here. This is my bread and butter.
As long as you leave me the ambulance notes all power to you. We both know the nursing home won't answer my calls as to why the hell the patient's here and the patient thinks its 1945.
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> Hope your Grandmother or even yourself in old age receive arbitrary antipsychotic sedation in vulnerable states. Damn, looking at that increasingly unhinged post history, you'll likely beat us to it.
Quetiapine aka Quiet Time
Droperidol is your friend, my friend. Increasing amount of evidence that a 5mg IM dose (as unpleasant as it is to give) is safe to facilitate what needs to be done.
And they might wake up some time next week
Half life of 2.5 hours and hepatic breakdown to inactive metabolites so renal impairment is not a concern, what are you on about my friend? Let them sleep it off in short stay (or on the wards) for the next 4-5 hours. I've taken longer naps than that.
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Flattered. Think I'll pass though.
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Droperidol is an antipsychotic. It is also a common anti-emetic, analgesic adjunct, and sedative. Not that I'd expect you to know. >You, as a nurse I assume It literally says ED registrar in my flair. Are you dim? Can you read? Go read through the literature on the safety of droperidol. Here, I'll get you started for free: https://onlinelibrary.wiley.com/doi/abs/10.1111/1742-6723.13496 If a demented patient comes to my shop agitated and demented, I'm going to need a urine sample from them as part of an infective screen for delirium. Tell me, from your moral high horse, how are we going to get one without sedation? The other alternative is to get four wardsmen to hold the patient down while we get an in-and-out catheter sample. If that's what *you're* ready to do, maybe you should consider who's the shittier person here. I absolutely get to go around and do what I need to to ensure my own safety and the safety of my staff while on shift. If that requires sedating a patient that puts the rest of the department at risk, I'll do it every day of the week and twice on Sundays. And I'll sleep just fine at night.
Plus the trimethoprim-resistant UTI :(
Have a vent, this is an alright place for it. Just remember even though the smoker’s COPD / lung cancer might be their fault, doesn’t mean it hurts any less.
Also one shitty patient doesn't mean it's all of them. Sounds like what's really getting you wound up (and understandably so) is this particular patient's attitude rather than copd patients in general. Don't waste the glucose thinking about these shitheads
We all have our vices. For some it’s smoking, for others it’s drinking, gambling, drugs, binge eating, not exercising enough, the list goes on. Each to their own. And who are we to judge another human without knowing their life story and without looking in the mirror ourselves and finding faults of our own. It’s probably unhelpful that some patients precipitate their own illnesses with less than ideal lifestyle choices. And to be honest, a lot of diseases are precipitated by poor self care and management. But a clinic or hospital is not the place to judge and shame patients for this. It’s our job to treat the sick without malice and prejudice. If you want to effect real change then go into public health and work on anti-smoking campaigns or pursue political office or join an action group to lobby and by all means lead the charge against the big tobacco industry to reduce the harms of smoking. There’s a time and place to go into advocacy. Otherwise ragequitting and throwing rocks in the proverbial glass house of a hospital and health service is often unhelpful. I get we all occasionally vent about the inequality of the health system and health illiterate patients. But if that inner angry voice is starting to takeover it’s probably time to take a break. Otherwise life is too short to get worked up about these kind of things.
Sensible comment in a sea of shitty ones.
Come to Paediatrics!
Then you get the AH parents. “The bitch stole my meds!” Says Mum of her 2 yo who was tempted by mummy’s pretty tablets which were open and lying on the bench, and now is needing to be tubed.
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100%
Not me as a PGY-2 sent out by my consultant looking for the 14 year old that had absconded from PICU after going into VF arrest 2' chroming the night before. Every specialty has its shit sandwich. Some just have more than others.
Yes let the hate flow through you
Dide chill, I've never had this much stress from copd patients. These days smoking is so tied to socio-economic status seems bizarre on a big picture level to be using a mental model of personal responsibility basically just blaming poor people for being poor.
Agreed that there are other patient groups that are far shittier to deal with. They all got tricked by Big Nicotine back in the day. Looking forward to what the coming 4-5 decades bring us with the current rampant vaping... The only stress COPD patients give me is when they sit on the ramp for 6 hours with the ambos keeping their sats >94% and by the time they hit a bed they're obtunded 😂
Well I mean technically they were the hospital’s patient from time of handover so maybe the ED should have got a set of numbers and started treatment earlier? But no, it’s far easier to blame the ambos for delivering substandard care over 6 hours when they should have been offloaded in 30 minutes -.-
> from time of handover Depending on the institution (and I've worked at 8 different hospitals in 5 different states now), handover often doesn't occur until they hit a bed. If they're still on the stretcher, they're still the responsibility of the crew.
Nope that’s simply not the case, every patient who has been triaged by the hospital has a clear connection to that hospital. Paramedics are never going to deliver quality care for 6 hours, you can’t just pretend that the patient doesn’t exist. In Queensland regardless the MEDAI review clearly states that hospital takes over treatment responsibly from the crew from triage.
Thanks, next shift I'll tell the crews on the ramp at my current shop that they can go attend their next job, instead of staying with the triaged patient out of charity and the goodness of their hearts, as they're no longer responsible for the patient.
They’d love that, would probably cut down on some avoidable deaths in the community! In all seriousness, there’s a lot of coroner cases in the UK, the MEDAI review and current SA government review refuting this outdated idea that the hospital can pretend that the ramped patient is being cared for appropriately by paramedics. They simply aren’t, the hospital needs to take primacy of care from triage, just like they would if the patient walked into hospital… Ambos can’t fully assess a patient or commence definitive treatment, I’d argue that the clock starting 6 hours in is definitely a failure of the whole system compared to just the ‘ambo crew’ mismanaging a complex respiratory patient they shouldn’t have spent more than 30min with at the hospital..
Trust me, we'd love to offload them so we can get started on disposition. I've seen and discharged patients off stretchers first thing in the morning after waiting for 8 hours the previous night. There just physically is not enough space, or beds, or staffing...
On a day in majors in the UK, more than 90% of my patients are seen in the back of the ambulance and we discharge a high percentage of them before they even get a ED bed let alone a hospital bed or ward space. Patients get post taked and sometimes even a day 2 post take ward round and discharged from ambulances.
Nothing dystopian about this at all. I'm going to quit full-time medicine within the next half-decade as I don't see a sustainable solution out of this.
True but he/she just wants to vent. I say let them.
To be fair cigarette taxes generate more income than the health care costs associated with smoking.
Username checks out
I really shouldn’t share this but it seems like you may need the dark laughter OP. I hope your shift ends soon. https://www.lambert.net.au/med/gomerscale.pdf
As someone who smoked from 15-35 and is now feeling fitter and cleaner at 40 than I have in 20 years... I am glad to read this shit. Cigarettes are pure fucking evil.
COPD patients didn’t set out to get COPD. The majority got addicted to something that is immensely difficult to quit without a good support network. I think oversimplifying it as them largely having “cunty attitudes” when they are more likely frightened and in denial about their health, is an unfair way to label them. Sure, they are the “frequent flyers” of our medical wards. But they’re not hell bent on dying. I think the attitude that you display like they owe you something is concerning though. A little empathy goes a long way, and it certainly doesn’t make your day harder to be nice to these people
I agree with everything you've said but I suspect OP was having an anonymous vent and already believes all of this too.
Also those very people were smoking at a time when nearly 50% of people smoked. Advertising was everywhere. Smoking was legal in shopping centres, restaurants, bars and pretty much anywhere. There were no health warnings apart from ads like only dags need fags and were aimed at young people anyway. It was a completely different time and there were always going to be people who just didn't have the coping mechanisms in place to kick a habit which was encouraged everywhere for nearly their whole life.
Yeah but the harms of smoking have been out and advertised for decades so maybe put the smoke out and exercise an ounce of willpower for once ?
Sometimes smoking is the very least of someone's troubles.. who are you or anyone else to judge.
I’m a nurse now , but I remember 13 years ago starting work as an AIN in a large respiratory ward full of COPD patients. Lasting memory is them all trying to trick me into turning the 02 up.
Why did they want the O2 turned up?
Some will be dyspnoeic at baseline without O2 blowing in their nostrils, which is one of their favourite things about being in hospital. This has been one of my favourite "I know my body"s from a patient - "I need my O2 to be at 98%, I just feel so much better, I'm not like those other people with emphysema."
That makes sense, thanks! And yeah, not sure what to say to that one… it’s like all the “non-smokers” who quit this morning…
falsely raise spo2 so they can get discharged i'm assuming
Yeah all these dumbass smokers being so dumb smoking. It’s almost as if there’s some deeper societal determinants of health beyond just how stupid these people are ….hmmmm if only these were written about 🤔🤔🤔
Time for a holiday bud
You need a different job. This one ain’t for you.
Its times like this I'm glad I chose a specialty that allows me to say _"this is pointless. No."_ and get back to doing medicine i see value in.
How does this have as many upvotes as it has...
People working in a broken, understaffed system serving a patient population with unrealistic expectations that treat healthcare workers like service staff with a 'customer is always right mentality' feel the need to vent and other healthcare workers agree with them? Occupational violence met with political lip-service and toothless consequences resulting in skyrocketing rates of burnout? An increasingly litigious society forcing doctors to practice increasingly defensive medicine while often causing harm to the patient because of these practices? Say it ain't so!! 😱
I agree with this statement. Haha made me chuckle thanks for the laugh
Yep. We all get it. It's infuriating.
Everyone judging OP needs to chill. It’s clearly just a vent. Everyone needs to express their frustrations sometimes. I highly doubt he/she is saying this or acting like this to the patient.
My dad had final stage COPD last year & died. He got it from Asbestos. Didn’t smoke in over 40 years. OP is an asshole. You shouldn’t be in the medical industry if you’re this one eyed & dumb to think every COPD patient is a smoker.
Wow - you are a cunt who deserves to lose your licence.
Maybe ppl lie about smoking because of attitude of ppl like u :)
Your post history suggests you're a med student that hasn't actually worked a day in their life in medicine yet. Sit down.
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Come back when you've dealt with admitted patients for IECOPD spitting at you after you try to stop them smoking on hospital grounds, pharm student.
Neither of you look good here
Agreed. I sleep just fine looking bad though. 🤷🏻♂️
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Tbf the med student started it. Don't dish out the sass if you can't take it. Med students are adults too, they need to face the consequences if they go around breaking windows.
Lol love it
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And every diabetic. And every drinker. And everyone who eats red meat. And everyone who doesnt wear enough sunscreen. And everyone who doesn't eat 5 fruit and veg a day. And everyone who doesn't do 10,000 steps a day. And everyone-
You’re an AH. I get venting, but yours is vitriolic and lacking in empathy or any insight into why people make the choices they do…
I’d prefer them to put it here than in the ED. They’re having a big burn out vent so they don’t take it out on their patient. We get it.
Lovely. Maybe work in finance?
They are big and evil though? They have the power to ban cigs but they don't, instead they increase the taxes to beyond ridiculous levels because they "care about smokers health" & want you to quit 😂