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A Blurb From Bruce

A Blurb From Bruce - I’m sick of hearing “it’s all about the patient”?

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A few weeks ago while I was in a notable healthcare facility, I overheard a provider say “I’m so sick and tired of hearing that “it’s all about the patient”.  Not trying to create a scene I casually glanced over at the individual, locked eyes with her for a hot second, and then continued on my way.  Not being one to mince my words, I have to say that I don’t completely disagree with her.  I’ve always been for analysis – and throughout my career as a critical care, transport/flight nurse and paramedic, I’ve probably coined that same statement (or something very similar) in my own head.  “Is everything we do in medicine, nursing, EMS really all about the patient?”  For years, I have been taught about teamwork, collegiality, inter-personal relations, etc. – and yet, at the core of all healthcare lies the patient – in disconnected yet peaceful repose.  Reeling in thoughtfulness and reflection, I tried to understand what I was feeling.  I did not feel conflicted; I was not mad or angry; I was not awestruck; instead, ironically, I was somewhat relieved – to hear someone else say, out loud – I’m sick of hearing that it’s always, all about the patient”.

Let me provide some background which might offer some clarity as to why that statement both intrigues and relieves me.  Having spent much of my adult career in the critical care and transport settings, I have never fully understood why there is not more emphasis on the team – patient and provider.  Let’s look at a scenario.  I am covering a flight shift for a sick colleague.  The paramedic and I don’t get the opportunity to work together very often as I am traditionally on an alternate shift.  It is 3AM and we have just been dispatched to a rural clinic for a post cardiac arrest patient with ROSC having an anterior wall STEMI.  Let’s stop there and just look at the obvious, as it relates to the comment above.  There is one patient, two medical providers and one pilot.  There are four souls on that aircraft – not only one.  Yes, for sure, there is only one patient, but doesn’t it behoove us to include the medical and operational crew here as well? Since when did everything revolve around “just the patient”.  I can remember for as long back as my original EMT-Basic class (a solid 13 years or more ago) being told – “you can’t help anybody else, if you become incapacitated”.  If that’s not the truth, I’m not sure what is…

I feel somewhat compelled to offer another perspective.  That sarcastic healthcare provider, you know, the one who made that off-the-wall comment, might NOT be that far from unearthing a huge misunderstanding in healthcare.  Healthcare should be making guidelines, regulations, policies, and rules to assure that the ENTIRE team is safe.  Solely focusing on the patient may be guiding our system way, way off course.  When an air medical evacuation mission is requested, all that the pilot and crew initially know is that there has been a request for service.  It is only in flight that the pilot and crew receive landing coordinates and patient information, respectively.  There is a reason for that – to ensure safe and objective decision making.  This same concept should be globally applied to healthcare – and in some ways it is already happening.  However, there are still some areas that are lacking significantly.

I want to assure you that my position here is NOT to forget about the patient and their ultimate and successful outcome.  Rather, it is to suggest that a more balanced approach be used when considering the needs of both the patient and team.  Assuring that health regulations, policies, guidelines, etc. are supportive of both the patient and the team, will undoubtedly add a necessary and objective safety layer, a provision of quality healthcare.

Be well and stay safe out there!!



Bruce Hoffman is a critical care nurse and paramedic.  He works as both a clinician and educator in Connecticut, Massachusetts and Maryland, with background in the division of critical care (ICU, ER, Cardiology, and Flight).  He enjoys professional gigs in clinical and distance medical education, advocacy, leadership, consultation and blogging.  He is a frequent and national lecturer for a host of Emergency Medical Services and Critical Care continuing education programs. He remains a member of his hometown ambulance service where he has served in a variety of administrative and operational roles. In his spare time, Bruce enjoys spending time with his wife Stephanie as well as traveling, hiking and biking.

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