Just One Click

Spring quarter is winding down and I’m in the streets for field observations, making certain the students we’re about to graduate from the Tacoma Community College Paramedic Education Program have met the industry requirements of “entry level competency.”

The first three hours of the shift deliver no calls, so I spend some time visiting with past students who are now employed at this site, as well as going over the drug box with my student. At long last the magical music of the dispatch tones sends us out the door to see a man who is “short of breath.”

En route I’m getting the student prepped on everything this call could entail? What equipment do you want to take in? Do you perceive the need for additional manpower at this time? And so forth. With that, we pull up in front of a double wide. Foot tall grass and a bunch of pots with wilted or dead flowers say we may be seeing a patient who is short of breath more often than not. We should know for certain momentarily.

My student leads the way into the double wide, where we find our patient sitting at a kitchen table. His wife enters the room with a small tray of medications.

As my student starts the question and answer process, the patient says, “Even with my oxygen, I noticed my sats were 88%, so I thought I’d best give you folks a call.” I find an opportune moment and quietly say into the student’s ear, “You clearly have an educated patient here.” This patient is talking medicine, and even knows industry slang like “sats.” This should be interesting, I think to myself.

As the assessment continues, the patient continues to reveal more and more. He’s been fighting right heart failure for the past two years and over the last few months he thinks he’s steadily lost ground. The student periodically speaks quietly with the preceptor, and I see him open the bag with the CPAP device inside. “Hey,” the patient says, “is that a CPAP machine? I’ve been thinking that’s what I need. I’m going to talk with my doc about that.” With that comment I can’t help but ask, “Excuse me, sir, by any chance are you a medical practitioner?” “No,” he tells me, “but I’d like to think of myself as an informed consumer.” I nod as he says that; he is indeed informed.

After three or four minutes on CPAP he tells us he’s feeling markedly better, so we start to prepare him for transport. As is often the case with CHF patients treated with CPAP, his turnaround is quick and impressive. No longer short of breath, he shares with us how he became an informed consumer.

“It’s the Internet,” he tells us. “Just one click and I can access the medical knowledge of the world.” There you have it—just one click.

Prior to the advent of the Internet, unless your patient was a medical practitioner, those of us with a patch were more knowledgeable than the people we cared for. But the Internet has shifted that paradigm. Patients today are often much smarter than their predecessors. In some cases, they may even be more knowledgeable than their physician. Physicians have a very wide breadth of knowledge to maintain. In comparison, patients can focus all of their energy on studying only those maladies which afflict them.

In this particular case, the patient had been treated by the same physician for close to 40 years. Their relationship was probably rock solid, and most likely the physician had a great bedside manner. But like many practitioners he may have become complacent with the passing of time. Maybe his CME wasn’t up to date either.

Collectively, it adds up to a physician who may not be as up to date as he/she should/could be. Again, with the tremendous amount of knowledge it takes to be a good physician, it’s easy to slip behind the 8-ball. Sadly, that impacts the care provided to their patients. Informed, knowledgeable patients, who set forth to learn everything they can about their condition, can provide valuable insights about their problem.

In a nutshell, make your patient encounters a collaborative process by getting the patient involved. Instead of simply providing care to your patient, you’ll find yourself providing care with your patient as you work together to develop a care plan. You’ll be able to conduct quicker assessments and get higher quality information from your patients the better informed they are.

One caveat to keep in mind is the Internet is not a perfect source of information about anything. That being said, for anyone diligently and attentively surfing for medical content, there are many outstanding sites where a patient can find quality information. If you can ascertain your patient is an informed consumer during your initial contact, you’re starting the encounter ahead of the curve and you want to stay there. This requires a different mindset from the way we’ve provided care in the past, but it creates an opportunity to improve the care we deliver and that’s always a plus.

Until next month …

Mike Smith, BS, MICP, is program chair for the Emergency Medical Services program at Tacoma Community College in Tacoma, WA, and a member of the EMS World editorial advisory board.