ACT IV: SCENE I
Indoor Doctor Office, Day.
The waiting room is full and the temperature is hot.
A nurse appears from behind a door.
NURSE: (early 20s, slightly overweight, pink scrubs)
Mr Frolin?
MR FROLIN: (early/mid 30s, fit, seems unsick)
Here.
He raises a hand and they walk back to a waiting room.
NURSE: Sorry about the wait, we're swamped lately.
MR FROLIN: I just need a referral to a
dermatologist to get this spot checked out.
Insurance says they won't let me do it unless I
get permission from you guys.
NURSE: Whatever, the Doctors will
be by in a minute.
She leaves before Mr Frolin can respond,
clearly he had something to say.
An hour passes.
Finally two men in their mid 40s and in white
coats enter the room and introduce themselves.
DR ONE: Hi, I'm Dr One, this is Dr Two. And you're...
(shuffling through papers)
MR FROLIN: I'm Steph Frolin, I hate to have to be here clogging
your office, but I have this skin spot
and want a dermatologist to check it,
my family has a history of skin
cancers.
DR TWO: Easy, buddy, we'll decide what you need.
MR FROLIN: I'm sorry, but why are there two of you in here
right now?
DR ONE: Dr Two is here for me to bounce ideas
off of and to help me if something goes
wrong. And if it gets really busy we take
turns doing patient care.
DR TWO: That's just how we do it.
MR FROLIN: But I've been in your office for over 3 hours now,
after waiting two weeks for an
appointment and now this? Aren't
you both tired from having to see the same
patients? Why not split up? You could
see twice as many patients in the same time.
DR TWO: That would leave each of us alone and
that's not safe for you. We work better as a pair.
DR ONE: Besides, the nurse was here to make sure
everything was fine before we got here, right?
MR FROLIN: Sure, an hour ago. If you guys saw
patients separately, my wait would have been cut in half.
DR ONE: Well this is how we've always done it,
so why change now?
MR FROLIN: Are there Doctor's offices that send one
Doctor to see a patient at a time? I mean, both
of you are still getting paid and doing the same
thing, so there is no additional cost...
DR TWO: Look, sometimes we have a lot of patients and
having Dr One here to check on me is in
your best interest.
MR FROLIN: But my insurance is overcharging me
to pay you to know what you're doing. Can't he go
help someone else right now, then you'll
be able to accomplish twice as much?
Better yet, if you had separate offices it would
go even smoother.
DR TWO: We just like it better this way.
DR ONE: Yeah, we're a team.
MR FROLIN: But only one of you is actually going to be
doing the work and the other is just watching. Surely
you see this is a waste of resources? Can't you?
SCENE.
Comments
Shared responsibility and a greater wealth of knowledge and experience.
In a doctor's office? Of course. On an ambulance?
Have you SEEN some of the people walking around with patches lately?
Shared responsibility and a greater wealth of knowledge and experience.
In a doctor's office? Of course. On an ambulance?
Have you SEEN some of the people walking around with patches lately?
Now, if you want to talk about dispatching two different vehicles, each with one paramedic, for the sole purpose of putting those two paramedics on the scene, then yes, THAT is a waste of resources.
Especially when one of those vehicles can't even transport the patient, and is in fact built from the ground up for a completely different purpose.
The only major concern I know of is clinical skill exposure. I've only seen one before and after study on this issue. In Houston within 6 months of switching from medics on every call to medics on some calls ETI success jumped from 90% to almost 100%. The turnover rate for medics also dropped significantly, I don't remember the numbers.
"it also allows for simultaneous ALS interventions and a medic partner to confirm differential diagnoses and treatment plans..."
Each major system I've aware of that sends medic only to some calls has two medics on an ALS unit.
At the end of the day there's very good reasons for sending medics on every call and having just one per unit.
"a higher volume of higher acuity patients as they are only responding to ALS calls."
There are two-tier systems out there such as the one that serves my area that dramatically under triage. There are many serious patients and even maybe a few critical patients that never see a medic just a bunch of people with 110 hours of basic training. Then there are the patients who get treated by medics but quickly transferred to BLS.
The only major concern I know of is clinical skill exposure. I've only seen one before and after study on this issue. In Houston within 6 months of switching from medics on every call to medics on some calls ETI success jumped from 90% to almost 100%. The turnover rate for medics also dropped significantly, I don't remember the numbers.
"it also allows for simultaneous ALS interventions and a medic partner to confirm differential diagnoses and treatment plans..."
Each major system I've aware of that sends medic only to some calls has two medics on an ALS unit.
At the end of the day there's very good reasons for sending medics on every call and having just one per unit.
"a higher volume of higher acuity patients as they are only responding to ALS calls."
There are two-tier systems out there such as the one that serves my area that dramatically under triage. There are many serious patients and even maybe a few critical patients that never see a medic just a bunch of people with 110 hours of basic training. Then there are the patients who get treated by medics but quickly transferred to BLS.
The only major concern I know of is clinical skill exposure. I've only seen one before and after study on this issue. In Houston within 6 months of switching from medics on every call to medics on some calls ETI success jumped from 90% to almost 100%. The turnover rate for medics also dropped significantly, I don't remember the numbers.
"it also allows for simultaneous ALS interventions and a medic partner to confirm differential diagnoses and treatment plans..."
Each major system I've aware of that sends medic only to some calls has two medics on an ALS unit.
At the end of the day there's very good reasons for sending medics on every call and having just one per unit.
"a higher volume of higher acuity patients as they are only responding to ALS calls."
There are two-tier systems out there such as the one that serves my area that dramatically under triage. There are many serious patients and even maybe a few critical patients that never see a medic just a bunch of people with 110 hours of basic training. Then there are the patients who get treated by medics but quickly transferred to BLS.
Dual medic staffing is effective in many other ways. For example, a new medic or recruit with experience elsewhere enters a new system - mentoring the new guy is the safest way to make sure that they will learn the city, the system and gain confidence that they will NOT get working with a lesser trained co-worker. Does Doctor 1 bounce ideas off LVN 3 ?
2 dudes on an ambulance are cheaper than 4 on a fire truck.
Dual medic staffing is effective in many other ways. For example, a new medic or recruit with experience elsewhere enters a new system - mentoring the new guy is the safest way to make sure that they will learn the city, the system and gain confidence that they will NOT get working with a lesser trained co-worker. Does Doctor 1 bounce ideas off LVN 3 ?
2 dudes on an ambulance are cheaper than 4 on a fire truck.
Dual medic staffing is effective in many other ways. For example, a new medic or recruit with experience elsewhere enters a new system - mentoring the new guy is the safest way to make sure that they will learn the city, the system and gain confidence that they will NOT get working with a lesser trained co-worker. Does Doctor 1 bounce ideas off LVN 3 ?
2 dudes on an ambulance are cheaper than 4 on a fire truck.
I've spent sixteen years working in systems (both urban and rural) that staffed every truck Medic/EMT-B. Dual medic staffing was a rarity.
In all that time, I've rarely, if ever, wished for a paramedic partner to "bounce ideas off of."
Dual medic staffing is wasteful 90% of the time. Hell, if it weren't for our out-of-control tort system and a reimbursement model heavily weighted for transport (and substandard education among many EMTs), well over half of our calls could be handled by ONE medic. Heck, maybe even one EMT-B, for that matter.
When my legion of flying monkeys completes my quest for world domination, I'll be free to implement MY version of EMS 2.0, and dual-medic staffing will probably be the first thing to go.
Every system would become a tiered response system, and I'd reverse the inequity of having major cities staffed by a glut of medics who transport nor more than five minutes to major hospitals, while small towns are stuck with a few EMT-B volunteers with transport times upwards of an hour to those same hospitals.
Gone would be the ALS intercept model. I'll replace it with community paramedics who do regular rotations in the big cities to maintain clinical competence, who'd call for a BLS intercept from the city to transport the patient.
The first thing to go would be dual-medic staffing, replaced by a tiered response system. The next thing on the chopping block would be scenes where you couldn't swing a dead cat without hitting seven medics - only one or two of which are actually doing patient care, while the other five stand around holding a pair of gloves and collectively giving the patient the Stare of Life.
No more would we have cities staffed with a glut of medics, all clamoring for their turn with the laryngoscope, all to transport a patient no more than five minutes from a major hospital.
No longer would there be little rural hamlets served by a handful of volunteer EMT-Basics, transporting their patients more than an hour to those same major hospitals.
ALS intercepts would be replaced with BLS intercepts for the vast majority of rural transports.
Happy Medic, would you like to be my EMS Minister In Charge of Eliminating the Department of Redundancy Department? Just say the word, and I'll make sure your name is entered on the protected rolls.
I've spent sixteen years working in systems (both urban and rural) that staffed every truck Medic/EMT-B. Dual medic staffing was a rarity.
In all that time, I've rarely, if ever, wished for a paramedic partner to "bounce ideas off of."
Dual medic staffing is wasteful 90% of the time. Hell, if it weren't for our out-of-control tort system and a reimbursement model heavily weighted for transport (and substandard education among many EMTs), well over half of our calls could be handled by ONE medic. Heck, maybe even one EMT-B, for that matter.
When my legion of flying monkeys completes my quest for world domination, I'll be free to implement MY version of EMS 2.0, and dual-medic staffing will probably be the first thing to go.
Every system would become a tiered response system, and I'd reverse the inequity of having major cities staffed by a glut of medics who transport nor more than five minutes to major hospitals, while small towns are stuck with a few EMT-B volunteers with transport times upwards of an hour to those same hospitals.
Gone would be the ALS intercept model. I'll replace it with community paramedics who do regular rotations in the big cities to maintain clinical competence, who'd call for a BLS intercept from the city to transport the patient.
The first thing to go would be dual-medic staffing, replaced by a tiered response system. The next thing on the chopping block would be scenes where you couldn't swing a dead cat without hitting seven medics - only one or two of which are actually doing patient care, while the other five stand around holding a pair of gloves and collectively giving the patient the Stare of Life.
No more would we have cities staffed with a glut of medics, all clamoring for their turn with the laryngoscope, all to transport a patient no more than five minutes from a major hospital.
No longer would there be little rural hamlets served by a handful of volunteer EMT-Basics, transporting their patients more than an hour to those same major hospitals.
ALS intercepts would be replaced with BLS intercepts for the vast majority of rural transports.
Happy Medic, would you like to be my EMS Minister In Charge of Eliminating the Department of Redundancy Department? Just say the word, and I'll make sure your name is entered on the protected rolls.
Mentoring a new hire or new medic DEMANDS another medic experienced in the system, but keeping them there 24/7 just because they may get along is wasteful as well.
I'm not saying take Joe out of the seat and put him in a BRT, but just get a trained set of eyes in sooner to gauge the system's response instead of relying on the most inexperienced people to do it: The caller and the call taker.
Sign my fireman ass up AD, sign it up! (redundancy at no extra additional charge.)
Mentoring a new hire or new medic DEMANDS another medic experienced in the system, but keeping them there 24/7 just because they may get along is wasteful as well.
I'm not saying take Joe out of the seat and put him in a BRT, but just get a trained set of eyes in sooner to gauge the system's response instead of relying on the most inexperienced people to do it: The caller and the call taker.
Sign my fireman ass up AD, sign it up! (redundancy at no extra additional charge.)
Mentoring a new hire or new medic DEMANDS another medic experienced in the system, but keeping them there 24/7 just because they may get along is wasteful as well.
I'm not saying take Joe out of the seat and put him in a BRT, but just get a trained set of eyes in sooner to gauge the system's response instead of relying on the most inexperienced people to do it: The caller and the call taker.
Mentoring a new hire or new medic DEMANDS another medic experienced in the system, but keeping them there 24/7 just because they may get along is wasteful as well.
I'm not saying take Joe out of the seat and put him in a BRT, but just get a trained set of eyes in sooner to gauge the system's response instead of relying on the most inexperienced people to do it: The caller and the call taker.
Sign my fireman ass up AD, sign it up! (redundancy at no extra additional charge.)
Sign my fireman ass up AD, sign it up! (redundancy at no extra additional charge.)
If the problem is a lack of quality, the solution is not more of the same low quality medics, but with even less experience.
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More people with less experience is not the same as wealth of experience..
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Dan response to “Long Beach Fire Department considers single paramedic response system” with misdirection – “I’m going to ignore the obvious arguments against single paramedic care and go right to the point.” It is embarrassing ...