People can be pills.

That is, EMS is the business of dealing with people. Even at their best, some homo sapiens will not be your favorite; you’d have to be a saint to love every single person you’ve ever met. And unfortunately, the patients we’re handed in this job are rarely at their best. That’s why they’re in an ambulance. Expecting someone to present a winning smile while they’re dying may be unreasonable.

The trouble is that showing compassion and doing your very best for people is a lot easier when you like them. It’s just human nature; we’re always nicer to the people we identify with, get along with, and find affable and likable.

. . . a lot of ordinary people look totally uncool, especially in their BVDs. In fact, they’re pretty ugly without their clothes on, or at least a little make-up. Some of them are fairly dim bulbs, actually. And on the worst days of their lives, a lot more have BO, bad breath, wrinkles, loose skin, irregular teeth, big bellies, short penises, hair where there shouldn’t be hair, and no hair where there should be. They’re inarticulate, clumsy and, well, kind of ordinary. They don’t match any of those pictures of perfectly proportioned people you’ve seen in your textbooks or on TV.

And guess what? Their families love them dearly, just the way they are!

. . . What you are is a caregiver. What you’re not is a judge. . . . You can be one or the other, but you can’t be both — not at the same time, anyway. As a caregiver, you can’t let yourself slip into the trap of judging people you don’t know anything about, because it does bad things to you. (People Care, 16)

See, the tough thing is that although it’s very human to treat the likable people better, that’s not how this job works. You’re allowed to like whomever you want; that’s your right as a person. But your responsibility as a caregiver is to do your best for all of them, like or loathe. It’s a learned skill, because it’s not at all natural. But it helps if you remember that your standards for likability are far from the ultimate test of someone’s personal worth. Everyone’s fighting their own battles, and patients shouldn’t be expected to look pretty for you in the midst of theirs. You’re not here to add to their burdens.

We have a built-in bias that tells us that people who are smelly or fat or dumb are overall bad people. It’s hard to overcome it. And because people who are choking, or incontinent, or hospitalized tend to be especially rough around the edges, it’s very easy indeed to file them under the category of “unpleasant objects.”

Special mention should be given to patients who are, to put it simply, jerks. Even those of us who can look past physical and mental defects may have trouble treating the world’s biggest asshole like our own dear mother. Once again, we have to remember that we’re not playing this game on a personal level, and the question isn’t whether the patient will be invited to our birthday party. The question’s whether they deserve our best care — and whether or not that’s difficult, whether or not we want to give it, the answer is “yes.” That’s how this works. If they’re a patient, they get our best. Some nasty physical ailments are harder to treat than others; some personalities are likewise harder to tolerate. But we don’t get to pick and choose, so we just have to suck it up and be compassionate professionals across the board.

Try to develop the mindset that to be human carries an inherent sacredness, value, and dignity. And that even the most despicable and worn-out creature on your stretcher has the same needs and feelings, and likely the same sense of self-worth, as any CEO or socialite. To quote Antoine de Saint-Exupéry, “I have no right to say or do anything that diminishes a man in his own eyes. What matters is not what I think of him, but what he thinks of himself. Hurting a man in his dignity is a crime.” (From How to Win Friends and Influence People, 214.)

All of this isn’t easy. Striving toward it is a constant effort. But if you can take a patient who you truly loathe, and treat him just the same as you would your own child — or your partner — or yourself — then that’s something to celebrate. Because quite frankly, the patient is somebody’s child, or somebody’s partner, and odds are good that their opinions of his human worth may differ from yours.

. . . until the curtain was rung down on the last act of the drama (and it might have no last act!) he wished the intellectual cripples and the moral hunchbacks not to be jeered at; perhaps they might turn out to be the heroes of the play. (George Santayana on William James [from Linda Simon’s William James Remembered])

What does it mean to be a patient advocate?

I first learned this term from my original EMT textbook, and since then, it seems like it’s been the favorite buzzword of the medical profession. It’s a little bit like “leveraging synergies”; it sounds surely good while having no clear meaning at all.

I think this is a shame, because to me, patient advocacy is actually a very meaningful concept, and in EMS, a very important one. Perhaps this isn’t true for doctors and nurses, radiologists and cath technicians — although I’d like to think it is — but on the ambulance, it’s more than just a pretty ideal.

This was what the textbook had to say:

As an EMT-B, you are there for your patient. You are an advocate, the person who speaks up for your patient and pleads his cause. It is your responsibility to address the patient’s needs and to bring any of his concerns to the attention of the hospital staff. You will have developed a rapport with the patient during your brief but very important time together, a rapport that gives you an understanding of his condition and needs. As an advocate, you will do your best to transmit this knowledge in order to help the patient continue through the EMS and hospital system. In your role as an advocate you may perform a task as important as reporting information that will enable the hospital staff to save the patient’s life — or as simple as making sure a relative of the patient is notified. Acts that may seem minor to you may often provide major comfort to your patient. (Limmer 11)

Not half bad, really. But raise your hand if your eyes glossed over that paragraph.

You see, as a prehospital provider, you occupy a unique role in a patient’s course of care. Your time with this patient, from initial contact until transfer of care, is one of the only periods when they’ll have the one-on-one, undivided attention of a healthcare provider. Think about that for a moment. Ms. Smith may previously be, or soon will be, under the auspices of a veritable pantheon of specialists — cardiologists, endocrinologists, orthopedists, neurologists, and more. On this occasion alone, she might pass through the hands of an ED physician who stabilizes her, an internist who admits her, a surgeon who operates on her — never mind a supporting battalion of nurses, techs, CNAs, therapists, and witch doctors. It takes an army to treat a patient.

But that army has other responsibilities, too. That ED doc has two dozen other patients screaming for his attention, most of whom have already been waiting for hours. The internist is running a code in the next bed. Those nurses are overworked, underpaid, and really want to get home.

As a rule, they all have the best intentions, and they all want to look out for the patient. True bad apples or apathetic mercenaries are a rarity in this business. But everyone’s simply spread thin. Even when they have the resources to give their undivided attention to an individual patient, it’s rarely their responsibility to do so. The cardiologist is here to provide a consultation on Ms. Smith’s heart — not to champion her care like the Hospitalist Prince of North 6 and butt into everyone’s else’s work. It’s just not his job.

But what about you, the humble stretcher monkey who brings her in? For that brief period of time, you really have no business except Ms. Smith’s well being. That’s why you’re here; that’s what you were dispatched to look after; and it’s your legal, medical, and moral responsibility to do everything you can for her, until such time as you transfer that responsibility into the aforementioned healthcare cloud (or she refuses further care). Assuredly, you have a defined scope of practice, and company policies to follow, but we’re not talking about cutting out her gallbladder or taking her to a dive bar. We’re talking about — say it with me — patient advocacy. And everyone upstairs agrees that’s part of your job.

Your job is to be her champion. Not because you’re Superman. But because she’s so vulnerable right now, she doesn’t need Superman; she just needs anyone who will step up. Anybody who’ll stand there and say, you are not alone. We all need that, and we all deserve it — but many of these patients, after countless years and battles, have no one else to turn to.

Let’s steal a quote — this is from Danielle E. Sucher at Legal Agility, responding to the question of why she practices criminal defense.

I don’t like hurting people. Is that so hard to understand? When I go to bed at night, I can sleep easily, knowing that I fought for freedom, and for less suffering rather than more. That I stood by someone accused so that he would not have to stand alone.

I can’t know whether anyone is truly guilty or innocent, or what they deserve, and frankly, I don’t care. We all deserve at least one person on the damn planet willing to stand there next to us and fight on our behalf.

[Source]

Patients have problems. You can’t help with all of them. You can’t cure their cancer, or pay their bills, or make the world fair and right. But you can do an awful damned lot, because it’s astonishing how large the gap is between what the patient would do and what they can do in their current, largely powerless position.

You have resources. One’s this big ambulance, and everything in it. But you also have the resource of knowledge: you know how the system works. You know where to go for certain things, you know who to contact to get what you need, and you know what’s available for the asking. These would serve you very well if you should need to visit the emergency room or become hospitalized, or if your mother should, or your child. If Ms. Smith were your mother, you wouldn’t just shuffle through the process of putting Person A into Slot B, ignoring her needs and looking for ways to avoid going the extra mile; you’d fight like hell to keep her as happy, as comfortable, and as looked-after as possible. Because patients can’t fight for themselves, any better than defendants can argue their own cases. And because although other professionals will be involved in this process, they won’t be fighting for the patient either. I have immense respect for the docs and the nurses, but sometimes, you’re standing in a place to do things they can’t. A few of them may go above and beyond, but they all have their jobs to do, and this isn’t it.

But it is yours.