Dr one and Dr Two

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

Timothy Clemans said…
YAY! Is this apart of the script for The System?
Timothy Clemans said…
YAY! Is this apart of the script for The System?
SKC Observer said…
Where are my acetaminophen? This post gave me a headache!
medic5 said…
I completely see your point, but lets take it even further and now there are the two medics on the ambulance and the four medics on the fire engine that all responded to the patient.
Timothy Clemans said…
YAY! Is this apart of the script for The System?
Matt K. said…
More medics is always better:)
Shared responsibility and a greater wealth of knowledge and experience.
CBEMT said…
Surely you see this is a waste of resources? CanĂ¢€™t you?

In a doctor's office? Of course. On an ambulance?

Have you SEEN some of the people walking around with patches lately?
the other medic said…
I have no idea which side of the fence youre on with this one but I will admit that a tiered system is less costly than a dual medic system and also provides each medic with a higher volume of higher acuity patients as they are only responding to ALS calls. However, a dual medic system ensures a quicker response time for ALS care since there are medics on every box, and it also allows for simultaneous ALS interventions and a medic partner to confirm differential diagnoses and treatment plans...
Medic 22 said…
Then Mr Frolin suddenly clutches his chest, his eyes roll up in his head and he becomes pulseless and stop breathing! Dr One does good CPR, 2 gets the defib. The nurses show up on the engine, I mean, from the staff lounge and take over BLS while Docs One and Two secure the airway, get iv access and push some epi and Ami. Working together, they find the cause of the arrest and restore Mr Frolin's pulse and get him to the cath lab for an angio. A week later Mr Frolin leaves the hospital, all neuros intact, yet he is still complaining about how two docs working together for expedient patient care is nothing but a waste of resources. Yeah? Anyone else with me on this?
Medic 22 said…
Then Mr Frolin suddenly clutches his chest, his eyes roll up in his head and he becomes pulseless and stop breathing! Dr One does good CPR, 2 gets the defib. The nurses show up on the engine, I mean, from the staff lounge and take over BLS while Docs One and Two secure the airway, get iv access and push some epi and Ami. Working together, they find the cause of the arrest and restore Mr Frolin's pulse and get him to the cath lab for an angio. A week later Mr Frolin leaves the hospital, all neuros intact, yet he is still complaining about how two docs working together for expedient patient care is nothing but a waste of resources. Yeah? Anyone else with me on this?
SKC Observer said…
Where are my acetaminophen? This post gave me a headache!
medic5 said…
I completely see your point, but lets take it even further and now there are the two medics on the ambulance and the four medics on the fire engine that all responded to the patient.
Matt K. said…
More medics is always better:)
Shared responsibility and a greater wealth of knowledge and experience.
Anonymous said…
Surely you see this is a waste of resources? CanĂ¢€™t you?

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 other medic said…
I have no idea which side of the fence youre on with this one but I will admit that a tiered system is less costly than a dual medic system and also provides each medic with a higher volume of higher acuity patients as they are only responding to ALS calls. However, a dual medic system ensures a quicker response time for ALS care since there are medics on every box, and it also allows for simultaneous ALS interventions and a medic partner to confirm differential diagnoses and treatment plans...
Medic 22 said…
Then Mr Frolin suddenly clutches his chest, his eyes roll up in his head and he becomes pulseless and stop breathing! Dr One does good CPR, 2 gets the defib. The nurses show up on the engine, I mean, from the staff lounge and take over BLS while Docs One and Two secure the airway, get iv access and push some epi and Ami. Working together, they find the cause of the arrest and restore Mr Frolin's pulse and get him to the cath lab for an angio. A week later Mr Frolin leaves the hospital, all neuros intact, yet he is still complaining about how two docs working together for expedient patient care is nothing but a waste of resources. Yeah? Anyone else with me on this?
Medic 22 said…
Then Mr Frolin suddenly clutches his chest, his eyes roll up in his head and he becomes pulseless and stop breathing! Dr One does good CPR, 2 gets the defib. The nurses show up on the engine, I mean, from the staff lounge and take over BLS while Docs One and Two secure the airway, get iv access and push some epi and Ami. Working together, they find the cause of the arrest and restore Mr Frolin's pulse and get him to the cath lab for an angio. A week later Mr Frolin leaves the hospital, all neuros intact, yet he is still complaining about how two docs working together for expedient patient care is nothing but a waste of resources. Yeah? Anyone else with me on this?
Timothy Clemans said…
Justin correct me if I'm wrong. the other medic, Justin favors an uniformed response system where a paramedic makes contact with each patient and then decides if the patient goes by BLS or ALS. If more ALS hands are needed on scene for say a cardiac arrest then an ALS single medic unit can be called in.

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.
Timothy Clemans said…
Justin correct me if I'm wrong. the other medic, Justin favors an uniformed response system where a paramedic makes contact with each patient and then decides if the patient goes by BLS or ALS. If more ALS hands are needed on scene for say a cardiac arrest then an ALS single medic unit can be called in.

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.
Timothy Clemans said…
Justin correct me if I'm wrong. the other medic, Justin favors an uniformed response system where a paramedic makes contact with each patient and then decides if the patient goes by BLS or ALS. If more ALS hands are needed on scene for say a cardiac arrest then an ALS single medic unit can be called in.

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.
medic5 said…
It doesn't take a medic to do good CPR(actually personal experience is that a lot of the time EMTs do it better). Sorry, but that's a pretty poor argument for dual medics. A medic and an EMT is a great way to staff a truck, it costs less, has less control issues, and is just as effective as dual medic(I have worked plenty of both)
medic5 said…
It doesn't take a medic to do good CPR(actually personal experience is that a lot of the time EMTs do it better). Sorry, but that's a pretty poor argument for dual medics. A medic and an EMT is a great way to staff a truck, it costs less, has less control issues, and is just as effective as dual medic(I have worked plenty of both)
3rd service, please said…
Hmmmm...is this the 'In-Basket Exercise' ? Are you agitating for fun or stating your dislike of the excess, waste and fraud of a 2 medic ambulance staffing model? I'll tell ya, my medic partner and I can run 98% of our calls all by ourselves, thank you. Fat guy? Help. CPR case? Help. Man vs. MUNI? You get the idea. The 200 calls that separate these very infrequent events, stay away. Please. Stay ready for THE BIG ONE. The cost of sending 1, 2, sometimes 3 BRT's to a simple medical event is where the waste and fraud exist.

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.
3rd service, please said…
Hmmmm...is this the 'In-Basket Exercise' ? Are you agitating for fun or stating your dislike of the excess, waste and fraud of a 2 medic ambulance staffing model? I'll tell ya, my medic partner and I can run 98% of our calls all by ourselves, thank you. Fat guy? Help. CPR case? Help. Man vs. MUNI? You get the idea. The 200 calls that separate these very infrequent events, stay away. Please. Stay ready for THE BIG ONE. The cost of sending 1, 2, sometimes 3 BRT's to a simple medical event is where the waste and fraud exist.

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.
3rd service, please said…
Hmmmm...is this the 'In-Basket Exercise' ? Are you agitating for fun or stating your dislike of the excess, waste and fraud of a 2 medic ambulance staffing model? I'll tell ya, my medic partner and I can run 98% of our calls all by ourselves, thank you. Fat guy? Help. CPR case? Help. Man vs. MUNI? You get the idea. The 200 calls that separate these very infrequent events, stay away. Please. Stay ready for THE BIG ONE. The cost of sending 1, 2, sometimes 3 BRT's to a simple medical event is where the waste and fraud exist.

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.
Ambulance_Driver said…
Heh. Nice allegory there.

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.
Ambulance_Driver said…
Heh. When my legion of flying moneys completes my quest for world domination, I shall implement my version of EMS 2.0; a leaner, more highly skilled system.

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.
Anonymous said…
Heh. Nice allegory there.

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 Happy Medic said…
What's that saying about too many cooks?
the Happy Medic said…
You mean shared liability and the same limited experience since they've all been on all the same calls.
Anonymous said…
Heh. When my legion of flying moneys completes my quest for world domination, I shall implement my version of EMS 2.0; a leaner, more highly skilled system.

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.
the Happy Medic said…
How can the dual medic system respond faster if they are in the same rig? How can they both claim more experience when only one of them was actually providing an intervention?
the Happy Medic said…
Agreed sending 2 BRTs to get one EMT and one medic indeed is a watse, almost as wasteful as paying a medic to drive.
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.
the Happy Medic said…
"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."

Sign my fireman ass up AD, sign it up! (redundancy at no extra additional charge.)
the Happy Medic said…
What's that saying about too many cooks?
the Happy Medic said…
You mean shared liability and the same limited experience since they've all been on all the same calls.
the Happy Medic said…
How can the dual medic system respond faster if they are in the same rig? How can they both claim more experience when only one of them was actually providing an intervention?
the Happy Medic said…
Agreed sending 2 BRTs to get one EMT and one medic indeed is a watse, almost as wasteful as paying a medic to drive.
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.
the Happy Medic said…
"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."

Sign my fireman ass up AD, sign it up! (redundancy at no extra additional charge.)
medic5 said…
exactly
the Happy Medic said…
What's that saying about too many cooks?
the Happy Medic said…
What's that saying about too many cooks?
the Happy Medic said…
You mean shared liability and the same limited experience since they've all been on all the same calls.
the Happy Medic said…
You mean shared liability and the same limited experience since they've all been on all the same calls.
the Happy Medic said…
How can the dual medic system respond faster if they are in the same rig? How can they both claim more experience when only one of them was actually providing an intervention?
the Happy Medic said…
How can the dual medic system respond faster if they are in the same rig? How can they both claim more experience when only one of them was actually providing an intervention?
the Happy Medic said…
Agreed sending 2 BRTs to get one EMT and one medic indeed is a watse, almost as wasteful as paying a medic to drive.
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.
the Happy Medic said…
Agreed sending 2 BRTs to get one EMT and one medic indeed is a watse, almost as wasteful as paying a medic to drive.
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.
the Happy Medic said…
"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."

Sign my fireman ass up AD, sign it up! (redundancy at no extra additional charge.)
the Happy Medic said…
"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."

Sign my fireman ass up AD, sign it up! (redundancy at no extra additional charge.)
medic5 said…
exactly
medic5 said…
exactly
Rogue Medic said…
CBEMT,
If the problem is a lack of quality, the solution is not more of the same low quality medics, but with even less experience.

.
Rogue Medic said…
Medics obviously drive faster, but when they get on scene, they can only think when in the presence of another medic.

.
Rogue Medic said…
The fewer ALS people on scene at a cardiac arrest, the better.

.
Rogue Medic said…
More people dividing the same experience is not more experience.

More people with less experience is not the same as wealth of experience..
Rogue Medic said…
Precepting new medics is the competent thing for management to do. It is not an excuse for requiring two medics on every ambulance.

.
Rogue Medic said…
I ignore it when NJ calls me a Semi-Medic, but it hurts when you point it out...

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 ...
[…] read Dr. One and Dr. Two by Happy Medic. He puts a slightly different perspective on […]