The system

I am a seasoned paramedic of 12 years.  I have a different philosophy about medicine than many of our practicing physicians.  Though I am not an MD I have worked with many. I trust maybe 20% with my kids.  I would not send my dog in the local ambulance that responds to my home.  I have seen some really good doctors and medics and I have seen the worst.  There are many more bad ones than good ones.  I watched one doctor work an entire cardiac arrest and I did everything short of pushing him out of the way to defibrillate the patient.  I had paddles charges and told him to move..and he would not let go of the patient.  After the guy was pronounced dead, I asked Why did you not let me shock him...he replied, I forgot.  I screamed it and he would not listen.   I found myself as a medic basing my decision on the  facility to transport a given patient to on who was working that day.  I struggled to deliver the sickest patients to the best doctors.  Now, I am not working any more, and have children in need of a pediatrician.  I cannot find a pediatrician who offers the aggressive, assertive care I always offered my patients.  They all seem to be following a system.  There is nothing different from one office to another.  I know that every time my child is ill it is not an emergency, but I also know that there are only a few ways to determine that.  I am not seeing the typical medical doctor provide the care or orders needed to rule out the worst case scenario immediately.  If John Doe calls 911, and I respond... I will cover the most immediate base first depending on the complaint and provide the most correct treatment right then and right there.  If he has been vomiting and has not passed urine in 24 hours...and is still in a state of purging...I will immediately start a line, bolus fluid, and transport to rule out dehydration, while collecting all data needed to rule out the reason he is sick.  If I leave him at home and tell him to drink every 5 minutes, I am putting his life in his very own hands and trusting that he will remain capable of following the order.  I recently took my 20 month old to a doctor's office.  He had not passed urine in 40 hours by the 3rd visit.  He had a severe viral illness.  I had called 2 days earlier and told the MD that he was vomiting and had diarrhea.  I reported every 12 hours that he had no urine output.  I was asked, "does he still have a wet mouth and is he producing tears?"  I polled 5 pediatricians in the area and all of them would have responded the same.  Please somebody tell me why we would consider waiting until there is no spit and no tears when the patient is clearly not producing urine, is still having severe diarrhea and refusing fluids without being forced?   Why not maintain the spit and not allow the child to die before being invasive?   I told the doctor that it was wrong to not start an IV and give a fluid bolus and then treat the diarrhea with lomotil.   It had been a total of 4 days and was not getting any thicker.   I was told then...go to the ER.  Well duuuuhhh.  We can always go to the ER... that much is given.  But why is a pediatrician so afraid to offer the most basic treatment possible ...a 20/kg bolus?  Let's say there is a weird law that prevents the doctor from ordering this basic treatment... why must my child sit in a lobby 4 days after the first visit to the MD and wait for a brand new assessment?  Why not do a direct admit for 23 hours...give a bag of fluid, get the diarrhea under control and go home?  The doctor said, 'I can't start an IV in my office and we don't do direct admits."  Well, ...I as a paramedic can start an IV in your living room and do a direct bed assignment from the street...what gives!?   I don't make it a habit of telling the doctor how to do there job...I just expect that they will at least do something.  We need doctors that will treat the first time and not wait patiently for out conditions to worsen to a point that we may not make it.  We need doctors that will react like every person is an emergency until they see reason to slow down...not react like everyone will be fine and wait for them to reach a point of no return.  

[ILADVOCATE]

  Well I would say one reason (although one that should not occur) is that there has been a downsizing of the number of hospitals (in some areas) so that the average doctor sees more people on a daily basis and in emergency rooms for a person with potential cardiac arrest say time is paramount so other people are alloted less time (only a doctor could confirm specifics on this, I just know from my previous work as a consumer advocate). As well there are coverage limitations so that some forms of health care coverage (this is discussed in another forum) only cover clinics where the waiting time is long and the amount of time that a person sees the doctor limited.
  I have done consumer advocacy and when I seek help from a doctor as a consumer I believe in working with them (with the doctor having the specific medical knowledge of course) on what treatment and help I need. As to how each doctor functions and their choices it is their decision. However, some of the factors I mentioned are part of what may cause that to happen. There are of course peer review efforts and other studies to determine best practices but that information is specifically within the discretion of a doctor and would be discussed there. However if you have specific concerns you should feel free to address them, on whatever level you believe is appropriate.

[Londres70]

Totally agree.  Too much reaction and not enough PROACTION with physicians nowadays.  

I just pray I get the right combination of help when I am in need of medical attention.  

[skydnsr]

We have a bad system.

[allmymarbles]

I have a particular liking for medics and nurses because they are more practical and more tuned in to the patient. I have known nurses who could make spot-on diagnoses merely by observing the patient closely.The only doctor I truly trust is an MD with a foot in both traditional and alternative medicine, who actually listens to what his patients have to say. A rarity in today's medical practice, where you are rushed in and out without a conversation.

[munevz]

had enuff of the system.

[jandd]

It's terrible that so many doctors now-a-days are more concerned with making a mistake that might increase their malpractice insurance permuims, than they are about treating and increasing the quality of life for their patients.  So many doctors now are only in it for the $$.  Remember when you could get a house call, or actually reach your doctor other than 9-4 Mon, Tue, Thur, Fri.  I suppose that the frivolous lawsuits that have increased and increased have made them wary of actually TREATING patients.