Sunday, November 9 evaluate the pneumonia...

Another case of a physician on scene correctly identifying a condition or another citizen up late, bored and feeling bad? For the last 15 years.

A fellow has waited until the wee hours of the morning to decide his last few years of poor health is as a result of "pneumonia" and can't seem to get a doctor on the phone to confirm it so he reaches out to the only section of American health care that is legally REQUIRED to help, EMS.

More and more journals are talking about EMS being the first line of offense in an attempt to bring a public health message out of the office and into the homes of the public, changing the role of the rescuer to that of the social worker. I'm a big supporter of this idea if only medical directors would have the spine to let us tell folks who don't need us that they don't need us and leave it at that. But for now we have to do whatever they say or we get sued, the Department gets sued and the Medical Director gets sued. What a system!

Answering the door in the upscale building, the unit is in a state of disrepair. He answers, clearly winded, and the stink of alcohol and cigarettes flow at us like an airlock opening. He goes into broken sentences about how he can't get a doctor to talk to him on the phone about his self diagnosed pneumonia and we gather our information and a thorough assessment. He is on dialysis, as evidenced by the shunt, and heroin, as evidenced by the spoons, lighter and needles. He is also heavily medicated by the tobacco industry, clearly causing most if not all of his health concerns. He doesn't want an ambulance to take him to the hospital, he wants a doctor to give him something for his pneumonia. I hold the overflowing ash tray before him and say, in my monotoned Night Medic voice, "This is your pneumonia. Every puff on this is another 5 minutes off your life. You will not get better until you quit smoking. That is what the doctors will tell you and that is what the doctors have already told you, I'm sure." "But you're not... a doctor how... would you know?" The '...' are for the pauses he takes. This man clearly needed routine care about 15 years ago and now, whithering away at home, smoking himself literally to death he refuses to listen to our message that a change in habit can be the beginning of a better life ahead.
As the ambulance arrives to take over I give my report and the EMT smiles. "We were here yesterday," he tells me pokes his head inside the door. "Still pneumonia today John (Not his real name) or did you quit smoking like we told you to?" I patted our friend on the back and reminded myself to tell the Engine boss he needs to quit smoking too.

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