Nasty People

It’s about 10 p.m. when you’re dispatched to Hendricks, a little town just north of your service district, to the private residence of a woman complaining of bleeding. Hendricks has a population of no more than 300 souls, so they rely on your town’s paramedics, their own three-member police department and a volunteer fire district from the town north of them.
The fire district has an engine on the call, and they’re no sooner on scene than they’re asking for your ETA. But as you pull up, the whole engine company appears to be outside the residence, just standing around. They definitely seem anxious to help you get loaded and on your way.
The patient is seated in an armchair, and she interrupts your greeting. “What took you so long?” she demands to know. You’re surprised, noting no physical indication that she or anyone else has been bleeding. Nor does she tolerate so much as a few simple questions, like “Hi, what’s your name?” “What seems to be the problem?” or “Tell us about the bleeding.” When you identify her as the patient and try to ascertain her pregnancy status, that seems to irritate her even more—so you opt to load her up, put her on Os and get an IV en route. She does tell you she’s had prenatal care, and her physician has informed you she has a placenta previa. But she won’t discuss what made her call, and she insists you transport with lights and siren.
She seems to be targeting you personally, so you switch places and opt to drive. All the way to the hospital she berates your response time, your partner’s IV technique and even your driving. Then, when you get to the ED, she tells the receiving nurse she requested transport downtown to a university hospital and you’ve brought her to the wrong destination. That’s not true, but at least now she’s focused on the inadequacies of the ED staff instead of the first responders and your crew.
You write the chart and document the call as an unusual occurrence, then get back to the station. Two days later, there’s a service complaint. She says you and your partner were unprofessional, you transported her to the wrong hospital and your response time was unacceptable.
Q. This lady was just plain nasty. No matter how hard we tried, we couldn’t please her. She kicked the volunteers out of her home and told them to wait for us outside. Both of us are good, experienced medics, but she treated us like juveniles. And she simply would not listen to anything we asked her or told her. Then she lied about her choice of destination and made us look like idiots in front of the ED staff. How do you keep from telling somebody like this to pound sand?
A. I can’t think of a time when that last part would have helped. But everybody handles their stress differently; some lie, some resort to blame, and some simply do not hear you talking. Stress or no stress, some people simply are disrespectful. I think your only choice is to be the professional you are. Don’t lower yourself to match other people’s behaviors. Once you step outside that caregiver’s role, you give up every possible justification for your behaviors.
Q. I didn’t want to transport emergent, but she absolutely demanded lights and sirens. What do you do in a situation like that?
Driving is your responsibility, and the choice of warning equipment is yours—especially in the absence of a shred of information that suggests a medical emergency. Don’t let anybody take that away from you. This is precisely the kind of person who would later blame you for the occurrence of a collision when you didn’t need to be running code.
Q. You don’t know our chief. He hates complaints. This lady’s allegation about us taking her to the wrong hospital is bad mojo. He would never take our word over a patient’s.
Accusations are not indictments. Your chief needs to be your number one advocate. If he doesn’t understand that, he’s likely to document an incident like this one in a way that can jeopardize the rest of your career. In this business, we all get accused of stuff we haven’t done. If he normally presumes you’re guilty until proven innocent, I’d say he doesn’t deserve to be your chief.
I’d find myself another agency.
Thom Dick has been involved in EMS for 40 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Thom is also a member of the EMS World editorial advisory board. Reach him at boxcar_414@yahoo.com.