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FMF_Doc
07-19-09, 13:37
I have a question and some thoughts-

Does emotion get in the way of providing care?


Now for my thoughts and personal experiences-

When I first got into emergency medicine 20 years ago, I actually cared and "felt" people's pain and sometimes paid the price for it after the incident (we didn't have crisis debriefing, etc in the beginning).

At some point I rose to the top 5% of my career field, was a successful and respected instructor, rock solid operator, but in order to get there I lost my sense of compassion- I was in it for the trauma and mayhem. By detaching from emotion I actually became a better practitioner, being able to make critical decisions without distractions.

And poof one day it happened- absolute burn out. I walked away from medicine altogether and switched career fields, but here lately I have been thinking of getting back into it.

.

NinjaMedic
07-19-09, 18:22
"Does emotion get in the way of providing care?"

Yes

Can detachment and a lack of empathy get in the way of providing care?

Yes

The challenge that we will always face is trying to find balance and compartmentalizing the mind sets to be available to you when needed. I find it much harder to be empathetic sometimes than I do become detached and treating an injury. The issue is that less than 6% of our patient population that activates 911 actually has a problem that we can address. The other 94% make it very easy for me to justify apathy to myself, however my attitude and interaction towards them is dictated by me and I cant blame them when I allow myself to get frustrated and burned out.

SeriousStudent
07-19-09, 18:25
.....

Does emotion get in the way of providing care?

............

Hi Doc,

I think it can. And I experienced pretty much exactly what you did, a long time ago.

It took some time for me to differentiate between "functional empathy" and "emotional attachment".

An example: You had to be able judge a child's pain level, while communicating and gathering information from parents, and then deliver care. It made you more effective to display a certain degree of concern, and understanding. That helped calm both parent and child. You were then more successful in eliciting patient history, mechanism of injury, assessing vitals, etc.

That made you a more effective caregiver. It was more efficient to display that persona.

If you wore your heart on your sleeve, so to speak, you were less effective. I learned to build a bit of a shell, as everyone in EMS longer than two weeks learns to do. The challenge for me came when something shattered that armor.

And I think that happens to just about all of us. There is a reason the turnover for field EMS personnel is so very high. You enter with admirable motives, and hopefully leave with your sanity, and your soul.

That was decades ago for me. I have thought about re-entering training, just for my personal skill set. I was in EMS so long ago, I got to watch "Emergency!" in the firehouse during prime time. ;)

I think at some point, the sense of survival sends an override to the sense of compassion, and tells both of them to beat feet to a different career. I went into the Marines as an 0331 to escape from EMS. Brilliant, huh? ;)

What are you thinking about doing? Studying for a challenge test? Or doing the classroom route and then clinical work?

FMF_Doc
07-19-09, 22:14
I am thinking about starting over and taking EMT Basic and going through the program again to EMT-P and working on a volunteer truck somewhere, a good friend of mine who was a mentor of mine and a retired FMF Corpsman as well suggested I get back into it.

Basic I can do in my sleep, I was a program director and taught EMT-B and EMT-I for several years, and used a lot of those classroom hours as CE's to maintain my EMT-P.

I just want to feel the adrenalin rush again, knowing that you have only one chance to make the right decision and limited time to do so.

My biggest burnout factor was the ops tempo and our deployment rotations, you get really good at trauma care but the price when you are treating friends as opposed to total strangers is really heavy.

As you know operational medicine and civilian EMS/911 are different animals all together.

citizensoldier16
07-19-09, 22:35
"Does emotion get in the way of providing care?"

Yes

Can detachment and a lack of empathy get in the way of providing care?

Yes



Well said. Each of us have to find that balance between caring and not caring. It's a bell curve I guess you could say.

SeriousStudent
07-19-09, 23:50
....

My biggest burnout factor was the ops tempo and our deployment rotations, you get really good at trauma care but the price when you are treating friends as opposed to total strangers is really heavy.

As you know operational medicine and civilian EMS/911 are different animals all together.

Quite true.

I hope that does work out well for you. It honestly does sounds like fun, starting over and working as a volunteer.

I wish you the best in your efforts, and may your previous experience be an inspiration to your partners.

Hell_Bent
07-27-09, 23:47
Replied. Made ZERO sense. Further attempts postponed pending sleep/introspection/psych eval.

Some great replies above, however...

MIKE G
08-04-09, 19:27
.....

benthughes
08-04-09, 19:56
To provide good patient care I believe that you need to be able empathize with a patient, conscious or not. Our company does scene calls and critical care transfers. There are countless times when you have to do a procedure that is very invasive/painful and you have to ignore the fact that and press on. It can be especially hard when dealing with kids.

I try to treat patients as I'd want to be treated. I don't hesitate with pain control or sedation where people often do. If I can do something to ease the stress of a situation or ease pain I will.

The times I have trouble are when dealing with drunk or high people. I have very little patience when dealing with the stupidity of others. I also have difficulty in dealing with people who have hurt other people and are requiring treatment. It was a regular occurance to transport people who have had a "medical condition" exacerbated by running from the cops.

Saginaw79
08-04-09, 20:32
Just keep 'em under control!

MiggyE
08-10-09, 10:43
I have a question and some thoughts-

Does emotion get in the way of providing care?


Now for my thoughts and personal experiences-

When I first got into emergency medicine 20 years ago, I actually cared and "felt" people's pain and sometimes paid the price for it after the incident (we didn't have crisis debriefing, etc in the beginning).

At some point I rose to the top 5% of my career field, was a successful and respected instructor, rock solid operator, but in order to get there I lost my sense of compassion- I was in it for the trauma and mayhem. By detaching from emotion I actually became a better practitioner, being able to make critical decisions without distractions.

And poof one day it happened- absolute burn out. I walked away from medicine altogether and switched career fields, but here lately I have been thinking of getting back into it.

.

i can very much empathize with you. like you, i went into Emergency Med with all the high hopes and ideals of a young man. now, just 20 years down the line, i feel very much of a burn out, and am in the middle of trading the ER for some industrial position, as well as a teaching load. i am even seriously contemplating the job my father-in-law dangled in front of my face. and that would take my thoughts out of medicine for most of the week.

as to your question, yes, i believe emotions do get in the way. as a resident, i had the misfortune of being the guy to break it to a college friend that his only son, not yet 6, was dying of a brain tumor. you really want to do everything for the kid, although you KNOW that there's nothing you could really do. for the past several years, i have felt that i was doing my best work, even if it came to the fact that you try to remain detached from everything.......right now, just not thinking about leaving med, i still love it, just need something else to do the rest of the week.....

Arclight
09-23-09, 17:47
This doesn't exactly answer your question, but it's a relevant story:

I've worked in EMS for ... oh, let's say just over 15 years now, but this story isn't about me. Through that whole time, one of my closest friends (NREMT-P) worked alongside me and far surpassed me in skill and dedication, working probably 60+ hours per week, every week in multiple departments.

Last month, while at a rural wedding, her little brother (26) fell on a broken drinking glass, cutting his hand very severely. He severed tendons and partially cut an artery. She provided definitive care, probably saved his hand, if not his life. She was telling me about it afterward and was really shaken up.

The noteworthy part, however, is this: She told me that she was almost glad it had caused such an emotional reaction in her. It had been so long since she had reacted emotionally to a call that she was afraid she was getting too cold and jaded to empathize with her patients anymore.

Spike59
11-07-10, 23:19
I feel that in order to be objective about an emergency situation you have to detach yourself from the pt. and/or their family. You cannot help a person if you allow yourself to be sucked into all of the emotion, pain and panic of the moment. I have been accused of not being sensitive to my pts. before. I feel I have to close myself off from the pt. to better form an idea of what the pt.'s problem is...and how best to treat that pt. I have found that people that care too much about the pt. set themselves up for emotional burnout.

ghettomedic
02-08-11, 23:34
MEDIC = My Education Doesn't Include Compassion

Just kidding, that's what I tell people when they ask, "So what's the difference between a paramedic and a nurse?"

Well, that and about $35K/year.

bp7178
02-09-11, 00:33
This thread title really caught my attention. As a LEO, as was on a double fatal shooting a while back. The first victim I found was a young guy in his 20s. He was motionless on the sidewalk, face down and unresponsive. *

EMS rolls up and two medics come over. They started cutting off his clothes, and while holding his head, I see he has a bullet entry would just below his ear. Thick goopy (medical term) blood coming out. We all see it and I remember telling the medics that there are more victims, and they should move on to someone they could help.*

There has to be a level of detatchment. You have to be able to pull yourself out of it and stay disconnected, not for yourself, put for the people you can help. This can bite you.*

The hardest part, and what I think modern law enforcement is coming to, is mainting a state of readiness. Wading through all the bullshit, until you get to someone you can actually have a positive effect on. Ever meet a cop on an accident scene that had a bad attitude? No one signs up to write accident reports, but it's a necessary componet of the job. You have to smile and be professional and stay sharp, make that positive impact where you can.*

Recently, I broke up with my girlfriend, whom I lived with. This really took a toll on me. Me and another officer got a call for a shooting victim. Male subject was shot, drove a few blocks and called 911. We were about three blocks away, and arrived in seconds. We get to the car and the driver (victim and only occupant) is slumped over the center console with his head leaned back. Unresponsive. He had a entrance wound under his left armpit, exit at his right love handle. I propped his head up, my thought being airway. I started doing sternum rubs, which is a trick my old partner showed me when he worked at a hospital. The victim started coming around, but was in and out. This went on for about 4 min, which felt like 30. EMS shows up, and we roll him in and go.

When doing these kind of jobs it's very important to maintain a balance. Balance with yourself, personal relationships and the job. Burnout isn't all about the work we do, but other factors in our life. Jobs come and go. Take care of your loved ones and have that base to fall back on.*

One of the best speakers I ever heard was Bobby Smith. Smith was shot in the face during a traffic stop and lost his vision. Bobby said don't ever bring the cop home, he will destroy it. You need to be able to separate home from work. I think of my job as an acting gig. When I'm at work, I'm the police officer, acting to fill that roll. But that isn't me, it's a part I play.

yellowfin
03-23-11, 13:43
I've been experiencing the same sort of phenomenon with the life, health, and disability insurance biz from time to time. While not exactly the same as medicine, individuals' health and certainly their well being and that of their families comes into play and the consequences can be almost as immediate. You see the tragedy and implications of people taking risks, not protecting their health, and not thinking ahead and what that does to families. You want to help as many people as possible, but they don't always think ahead and often push you away--the same attachment vs. detachment, compassion vs. business issue comes up. Everybody thinks they're invincible and know everything and will keep being lucky, it's always something that happens to someone else and never to them--but you just hate it for someone who really needed you but didn't see it that way at the time. While not the same as losing a life or limb, losing a house or kid's college funding, family business, or being burdened with debt for years or decades later is still a brutal consequence of accidents, injuries, and illnesses.

Atchcraft
03-23-11, 16:54
This thread title really caught my attention. As a LEO, as was on a double fatal shooting a while back. The first victim I found was a young guy in his 20s. He was motionless on the sidewalk, face down and unresponsive.

EMS rolls up and two medics come over. They started cutting off his clothes, and while holding his head, I see he has a bullet entry would just below his ear. Thick goopy (medical term) blood coming out. We all see it and I remember telling the medics that there are more victims, and they should move on to someone they could help.

There has to be a level of detatchment. You have to be able to pull yourself out of it and stay disconnected, not for yourself, put for the people you can help. This can bite you.

The hardest part, and what I think modern law enforcement is coming to, is mainting a state of readiness. Wading through all the bullshit, until you get to someone you can actually have a positive effect on. Ever meet a cop on an accident scene that had a bad attitude? No one signs up to write accident reports, but it's a necessary componet of the job. You have to smile and be professional and stay sharp, make that positive impact where you can.

Recently, I broke up with my girlfriend, whom I lived with. This really took a toll on me. Me and another officer got a call for a shooting victim. Male subject was shot, drove a few blocks and called 911. We were about three blocks away, and arrived in seconds. We get to the car and the driver (victim and only occupant) is slumped over the center console with his head leaned back. Unresponsive. He had a entrance wound under his left armpit, exit at his right love handle. I propped his head up, my thought being airway. I started doing sternum rubs, which is a trick my old partner showed me when he worked at a hospital. The victim started coming around, but was in and out. This went on for about 4 min, which felt like 30. EMS shows up, and we roll him in and go. I'm running code to escort the ambulance. I remember getting overwhelmed with emotion on the way in. I actually said a prayer, asking to keep this man, who I've never met, alive.

It wasn't until much later that I realized that I wasn't asking for his benefit, but for mine. Between losing my girlfriend, my home and everything that goes with it, I couldn't take any more loss in my life.

When doing these kind of jobs it's very important to maintain a balance. Balance with yourself, personal relationships and the job. Burnout isn't all about the work we do, but other factors in our life. Jobs come and go. Take care of your loved ones and have that base to fall back on.

One of the best speakers I ever heard was Bobby Smith. Smith was shot in the face during a traffic stop and lost his vision. Bobby said don't ever bring the cop home, he will destroy it. You need to be able to separate home from work. I think of my job as an acting gig. When I'm at work, I'm the police officer, acting to fill that roll. But that isn't me, it's a part I play.

Very well put, bp. I went through something very similar, relationship wise, when I became a LEO. It's not always an easy thing to "disconect" before coming home. I'm lucky to have my current wife (and I don't mean that to sound like I plan on any others) was EMS and is now an LEO also, so she's been there. It helps to have someone around that actually understands what it is that you are going through, but also is great at keeping me from dragging it into the house. I liked Kevin Gilmartin's "Emotional Survival for Law Enforcement", pretty much hit the nail on the head for me. Now I have some great, completely unwork related hobbies!

I guess my point is, x3 for disconnect! You may have to make yourself do it, but it must be done.

Be safe.

LUCKY MEDIC25
03-30-11, 14:05
I am currently in Iraq. I have learned over my year here that it is very important to detach yourself to be any good to someone needing your care. ESPECIALLY in the case of traumas. I feel that we would not be able to do what we need if we let our feelings get in the way... As most in the medical field know, you usually have to cause more pain to those at the hands of the angel of death, before we can save them.

I can relate to FMF Doc in that I LOVE trauma! Although, I don't feel we do it because we love seeing people hurt or love the craziness of it, I think we do it because we love knowing that a trauma is another chance for us to apply what we've trained so hard for! To give somebody a chance in life! To get them home to their families alive and well!

In conclusion, I would say that emotion does get in the way of us being able to effectively do our jobs. I leaned very quickly with the first soldier dieing in my hands, that you still feel compassion... I broke down after and think of this soldier every day. I will always feel compassion and care for my patients at the end of the day.

WS6
06-15-11, 22:07
I have a question and some thoughts-

Does emotion get in the way of providing care?


Now for my thoughts and personal experiences-

When I first got into emergency medicine 20 years ago, I actually cared and "felt" people's pain and sometimes paid the price for it after the incident (we didn't have crisis debriefing, etc in the beginning).

At some point I rose to the top 5% of my career field, was a successful and respected instructor, rock solid operator, but in order to get there I lost my sense of compassion- I was in it for the trauma and mayhem. By detaching from emotion I actually became a better practitioner, being able to make critical decisions without distractions.

And poof one day it happened- absolute burn out. I walked away from medicine altogether and switched career fields, but here lately I have been thinking of getting back into it.

.
Yes, extremes in emotion can. Getting "attached" DEFINITELY can. Empathy not sympathy.

*Opinion based on working 1 year in SICU and Stepdown units as an RN,BSN.

Atchcraft
06-16-11, 01:28
Yes, extremes in emotion can. Getting "attached" DEFINITELY can. Empathy not sympathy.

*Opinion based on working 1 year in SICU and Stepdown units as an RN,BSN.

It's easy to deal with emotion on-scene. But, at the end of the day and after years of build up, it's another thing not to feel something at all or let it effect you emotionally... for me anyway.

GIJew766
06-16-11, 11:13
Doc,

I got into EMS after doing something else in the Fleet, but not until after doing the whole Federal LE stuff with CBP first. The experiences I had during my time in service led me to this field, and makes me the provider I am to this day.

I was inspired to get into the field after losing my best friend in Iraq in 2005 to an IED. Corpsman managed to keep him relatively pain-free as CASEVAC was en route, and he passed shortly after arriving at the field hospital. Ever since, I've taken to EMS in the hopes that what I have learned, what skills I've honed and my actions I take will save another family from grieving the loss. I work on an 911 unit as well as with the county SRT unit, so I see all sides of it.

There is a time and place to be empathetic to a patient, but the second that empathy prevents you from being objective, you need to step back. Let your partner know you need a second. They understand. One of the worst moments in my career in this field was on scene of a fatal crash. Four occupants, parents and two children. Both parents and oldest child DOA. Surviving child was about 2 or 3, unconscious, slow but steady pulse, etc. I had to take a few steps back, told my partner to give me a second as Fire Rescue began to cut apart the vehicle, and had a 30 second shake, then refocused.

Ever since, I've seen some more things that have bothered me. Things dealing with kids are the worst. But rather than keep my shit locked up forever, I talk about it with my partner (who happens to be a friend of the family) or my better half or even call up my folks once in a while. When I can't do that, I get back to the station, resup the truck if need be, put down my paperwork, take of my boots and go somewhere private. Have a good 30 second to 2 minute "controlled breakdown," splash some water on my face and do my report. So far, seems to be working.

It helps that I see folks I work with from both the squad and the SRT guys outside of work and we can joke around with some beers or have bitch sessions while working out at the gym together. One of the SRT guys and I have been working out 6 days a week together for the past year or so. It works.

H

browningboy84
06-19-11, 21:10
I have been in EMS now for 5 years, 4 as a medic. I am currently in a Paramedic to RN bridge Program. I have seen quite a few medics and EMT's who were at opposite ends of the spectrum. Empathy to me means taking care of the pt and reassuring them when you need to. You can still do your job, and yes some of the patients elicits an emotional response for me, but I have learned to to deal with it after the call.

Call me jaded or indifferent, but the way I see it, I have a patient to deal with and take care of em. Most of the time it is definitely something that I would not even dream of calling an ambulance for. Sometimes it is a real, bona fide life threatening emergency. Then I have to step back, distance myself, take care of the patient. There is time for thinking about your emotions when you get em to the hospital. That does not always happen, but I strive for that goal.

Kids will get to me faster than anything. I have worked several children in cardiac arrest, and I still have nightmares to this day about it. I do remember the ones that I have delivered, including one with the umbilical cord wrapped around his neck, and he was not breathing when he was born. Being able to control the emotions and keep a cool head is what separates the pros from the amateurs.

Just my $.02

lethal dose
06-19-11, 21:21
I concur with ninja medic and ghetto medic.

starlight_cdn
06-26-11, 11:51
I am currently in Iraq. I have learned over my year here that it is very important to detach yourself to be any good to someone needing your care. ESPECIALLY in the case of traumas.

Agreed, with experience from multiple trips to the other sandbox, Afghanistan. Tactical medicine requires clinical and tactical judgement. Cannot be clouded by emotional responses. Combat triage in mass cas is another example....wasting time on those that cannot be saved. Also, as a medic/first responder those non-medical pers are looking to you for leadership, guidance and advice. Decisive, appropriate medical interventions saves lives.

Empathy is a skill used by medical pers in non-tactical and non-emergent roles (ie sick parade, Role 3 in KAF). It is useful there to gather Hx, increase patient compliance and promote recovery.

Before anyone throws it out there: Yes, I have treated wounded friends of many years and not all the prognosis were positive.

hwkeye1911
07-29-11, 23:57
I've spent the last decade of my life working either ICU or trauma as an Air Force medic, and my mantra has always been empathy over sympathy. I've seen exactly what war does to the human body, and in those moments those patients don't need my sympathy or pity, they need a cool, calm collected medic who can get it done when it matters most. After my last "deployment" to the ICU in landstuhl, we started to teach our medics/nurses/docs about compassion fatigue, a very real psychological problem very similar to PTSD. Unfortunately I lost some very good friends who took their own lives after that deployment, they let too much in and didn't know how to deal with it. Do your best, but don't take it home with you.

billybob19606
09-11-11, 20:06
I was hired over 10yr ago s a firefighter/EMT in a 3rd class city. Ive seen SOOO many shooting, stabbings, ODs it's unreal. The 1st few times i saw such things, i thought about them for a lil bit(next day or 2). But being 20y/o (when i was hired) helped too, cause i didnt have a child at the time, so I wasnt as "soft" as i am now :smile:
I believe that the more you see, the more jaded you become, and things effect you less and less. As much as I dont like to see as much death as i do, i say to myself "why should I let this bother me?..I didnt cause this to happen"...especially when lots of these things are gang/drug related. Things involving kids, do have greater impact on me.