Bernie, Erma’s Brother

We all have those addresses that get our blood boiling.  The one you know by heart.  When the address comes over the radio we can recite the person’s name, social security number and even their first 4 medications.

For me the new address, since there are folks like this in every area, is causing me more headaches than it should.

The first time I met Bernie (Bernie is Erma Fishbiscuit’s brother. Yes, I’ve added to the Glossary of Terms! Found under the Who is HM tab) he was sitting in bed, unbathed for weeks, arguing with his home health care worker about how short of breath he was and that she can’t leave him yet.  Bernie didn’t want his daily companion to leave.

Unfortunately Bernie didn’t let the care taker do anything much for him when she is there.

He won’t let her change the bedding.

He won’t let her cook him food, he’d rather snack all day.

He won’t let her clean up the room he is in for fear she will steal something.

The poor care taker sits and watches him slowly dying simply because he won’t let her help.

So here we are on a code 3 dispatch, ambulance trailing because Bernie won’t let anyone under the rank of MD help him.  But what can we as Paramedics and EMTs do?

When Bernie and I start to have an honest discussion about quitting smoking, or at least agreeing to walk the length of the apartment to get his smokes each day, he demands transport, spinning yarns about how long they will keep him there.

We all know he’ll be home tonight, if not this afternoon, right back where he started.

The care giver knows she should be doing more, but is a frail thing and if she and Bernie got into a shoving match, we’ll be here for her instead of him.

Bernie refuses to listen to reason.

“I have asthma” he tells me.

“You smoke too much” I tell him noting the stench from the nearby overflowing ashtray sitting on the oxygen machine.

“You’re no doctor, what do you know?” I’m challenged.

“No, not a Doctor, but I don’t need to be one to see what you’re doing to yourself” he hears.

The private ambulance company is more than happy to take him in since he has private insurance and I am once again reminded why my premiums keep going up.

The health care practitioners at the scene, the ones most experienced to make a determination of most appropriate resources for this person, are powerless to effect change in this situation.

We could call his insurance company and ask them to send more people.

We could ask them to send a counselor to discuss with Bernie the importance of taking their advice.

Calling Adult Protective Services might bring a case worker out in a few weeks, but we’ll have been there dozens of times by then.

Bernie doesn’t want our help, just a ride.

On our most recent visit, I moved his pack of cigarettes to the other side of the room and reminded him of the real possibility that he will kill himself AND others while smoking on oxygen.

Then I helped him to the cot and along to the ambulance for yet another treat and release at a not so local ER.

What can we do unless the system adjusts to let us assess, refer and release Bernie?  The insurance company, fire department and ambulance company could save 10s of thousands of dollars on one person each year.  And that’s just one person.

They need savings, I can offer tons.  So long as Bernie realizes that when the Paramedic arrives without an ambulance he isn’t getting an automatic taxi ride, then listens to what we have to say and becomes an active participant in his own health we all win, especially Bernie.

And Bernie is not one of the uneducated poor often blamed for EMS abuse, but one of the growing trouble spots in EMS.

Bernie is a baby boomer.

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15 thoughts on “Bernie, Erma’s Brother”

  1. Definitely a common occurrence. Seems to me that the problem here results from patients being encouraged and feeling empowered to dictate their own care without any formal training. Fear of litigation on every level means that all a patient has to do is hint at a lawsuit and we in EMS as well as those in the hospitals, clinics and private physicians offices do whatever it takes to appease these patients. That unnecessary care ranges from pain meds to expensive lab tests.

    At the end of the day, if the government and insurance companies want savings, they have to let us say “no”. Care providers across the board need to be trusted to tell patients that they don’t need every test and treatment under the sun. There are simply some times that patients can wait for a clinic appointment. Now there’s obviously training involved with that responsibility , but if we’re willing to undertake that, give us the chance to cut healthcare costs. Encourage patients to put faith back in the trained providers. Or else get out the checkbook!

  2. Definitely a common occurrence. Seems to me that the problem here results from patients being encouraged and feeling empowered to dictate their own care without any formal training. Fear of litigation on every level means that all a patient has to do is hint at a lawsuit and we in EMS as well as those in the hospitals, clinics and private physicians offices do whatever it takes to appease these patients. That unnecessary care ranges from pain meds to expensive lab tests.

    At the end of the day, if the government and insurance companies want savings, they have to let us say “no”. Care providers across the board need to be trusted to tell patients that they don't need every test and treatment under the sun. There are simply some times that patients can wait for a clinic appointment. Now there's obviously training involved with that responsibility , but if we're willing to undertake that, give us the chance to cut healthcare costs. Encourage patients to put faith back in the trained providers. Or else get out the checkbook!

  3. Being able to say “no” is a grand idea. However, it will take that one lazy Paramedic who doesn’t want to transport that last patient in before his/her shift ends that will result in something being missed, a patient dying, an agency getting sued for millions, and the system going back to the way it is now. As it stands now, even the most trusting medical director (most), aren’t willing to take that liability. How many sub par medics do you know? I agree with being able to refer patients and refuse transport, but the bottom line is, we aren’t in a position professionally to “diagnose” and refer a patient elsewhere, even if you are capable of doing so.

    We aren’t definitive care, regardless of how stupid the complain, or ignorant the patient is. It’s sad, but it’s true.

    1. But Jake, that is happening now. And it is happening because that burnt medic on his 14th job in 10 hours has not been allowed to do what their patient’s NEED, but instead what they WANT.
      Powers of refusal of service will not start at the ground level, but first with supervisors, you know, the folks already entrusted with additional training and responsibility. that burnt medic will be able to call out a supervisor who can accept responsibility.
      We are already killing people because of our laziness and inattention to patient care. Adding the ability to refuse service with a lawyer who will welcome Erma coming to court to complain we didn’t open her windows at 4 AM could change this industry forever.
      Luckily I am meeting young professionals getting into these fields who are ready to make a stand and change things for the better.

    2. I definitely agree with HM. In all honesty, there need to be consequences (educational first!) for those paramedics who misuse, whether intentionally or unintentionally, the ability to say “no”. Sadly I do know some subpar medics and they make poor treatment decisions now. I really don’t think that should decrease my ability to treat my patients in the way that is medically indicated.

      We have to take a stand against lazy paramedics. If that involves taking people aside who are staying up to speed, then so be it. At the end of the day, we have to be willing to lead by example.

  4. seems untreated mental illness plays a big part here~not letting someone change the sheets nor clean his room for fear she might “steal” something~not making the connection bwt needing oxygen to breathe and the smoking that is chocking his already damaged lungs~knowing the dangers of keeping anything aflame near an oxygen tank~sounds like a 72hold and forced assessment/treatment for mental illness would do him far more good~

  5. on facebook, i am ann noviello email im tigermom3@yahoo.com, my daughter has been a paramedic for years and my son (private pilot) just received his emt certification~i ran your happy medic column by some friends on the farm (summertown tn) who were emts & instructors in the bronx back in the 70s, this was the consensus op that mental health was the real issue here and that while you were out on that call, someone with a true breathing emergency was likely somewhere waiting for an ambulance that was otherwise engaged.

  6. Being able to say “no” is a grand idea. However, it will take that one lazy Paramedic who doesn't want to transport that last patient in before his/her shift ends that will result in something being missed, a patient dying, an agency getting sued for millions, and the system going back to the way it is now. As it stands now, even the most trusting medical director (most), aren't willing to take that liability. How many sub par medics do you know? I agree with being able to refer patients and refuse transport, but the bottom line is, we aren't in a position professionally to “diagnose” and refer a patient elsewhere, even if you are capable of doing so.

    We aren't definitive care, regardless of how stupid the complain, or ignorant the patient is. It's sad, but it's true.

  7. seems untreated mental illness plays a big part here~not letting someone change the sheets nor clean his room for fear she might “steal” something~not making the connection bwt needing oxygen to breathe and the smoking that is chocking his already damaged lungs~knowing the dangers of keeping anything aflame near an oxygen tank~sounds like a 72hold and forced assessment/treatment for mental illness would do him far more good~

  8. on facebook, i am ann noviello email im tigermom3@yahoo.com, my daughter has been a paramedic for years and my son (private pilot) just received his emt certification~i ran your happy medic column by some friends on the farm (summertown tn) who were emts & instructors in the bronx back in the 70s, this was the consensus op that mental health was the real issue here and that while you were out on that call, someone with a true breathing emergency was likely somewhere waiting for an ambulance that was otherwise engaged.

  9. But Jake, that is happening now. And it is happening because that burnt medic on his 14th job in 10 hours has not been allowed to do what their patient's NEED, but instead what they WANT.
    Powers of refusal of service will not start at the ground level, but first with supervisors, you know, the folks already entrusted with additional training and responsibility. that burnt medic will be able to call out a supervisor who can accept responsibility.
    We are already killing people because of our laziness and inattention to patient care. Adding the ability to refuse service with a lawyer who will welcome Erma coming to court to complain we didn't open her windows at 4 AM could change this industry forever.
    Luckily I am meeting young professionals getting into these fields who are ready to make a stand and change things for the better.

  10. I definitely agree with HM. In all honesty, there need to be consequences (educational first!) for those paramedics who misuse, whether intentionally or unintentionally, the ability to say “no”. Sadly I do know some subpar medics and they make poor treatment decisions now. I really don't think that should decrease my ability to treat my patients in the way that is medically indicated.

    We have to take a stand against lazy paramedics. If that involves taking people aside who are staying up to speed, then so be it. At the end of the day, we have to be willing to lead by example.

  11. Ahh… the Baby Boomers. If ever there were a demographic ready to destroy EMS they would be it. The possibilities are frightening, they mostly came of age in the sixties, expect government services, and haven’t been living exactly healthy lifestyles and grew up watching personal injury lawyers make a killing suing people for negligence.-

  12. Ahh… the Baby Boomers. If ever there were a demographic ready to destroy EMS they would be it. The possibilities are frightening, they mostly came of age in the sixties, expect government services, and haven't been living exactly healthy lifestyles and grew up watching personal injury lawyers make a killing suing people for negligence.-

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