Professionalism

Health care providers must exude professionalism because we are dealing with a vulnerable population. You trust doctors, nurses, surgeons etc. with your life and well-being. Therefore, it is understood that these people should act in a manner concurrent with that level of privilege. It is expected, and required, that they maintain your medical privacy, act in a manner becoming of someone granted access to your person, and act with your best interest at heart. As paramedics, we have a uniquely intimate role as a health care providers, in that we are welcomed right into a persons home. This requires an extra layer of professionalism as you are not only seeing a person at their most vulnerable, you are often seeing them in the heart of their most sacred space. You have immediate access to the building that keeps them safe, stores their possessions, and houses their personal information. It is the space where they can let their guard down. And despite the uniform, we are still a strangers in their house. So for the benefit of the patient, the paramedic's career, and the profession as a whole, we must act accordingly. An important aspect of professionalism in health care is consent, specifically informed consent. This is telling the patient all aspects of the care plan, ensuring they understand the risks and benefits, and gaining permission. Professionalism for paramedics also means asking permission to enter and view areas of the house, explaining how you are going to move the patient, which hospital is the most appropriate for them, and being clear about the procedures you are doing. A small example of this is getting the health card. Most people keep them in their wallets, so when I offer to help them get it, if they give me permission to do so, I; keep their wallet in full view of the patient, have them help me locate the card, remove the card and show them both sides of it to ensure I only have the one card, and then close it in full view and hand it back to them. This transparency removes doubt about malicious intent and protects my career, so I can keep helping people.

What happens when you don't have consent? You would assume that because paramedics were called for someone, that person wants our help. This is not always the case. When a person attends a doctor's office, consent for initial assessment is implied because they made the effort to make it to the office. Often times we are called on someone's behalf, and they may not want assessment or transport, but may need it. In times like these, it is imperative that we obtain consent one step at a time. We must obtain permission to enter the house, keep our distance during initial conversations, and not breach their trust by violating their personal space without consent. Calls like this are particularly difficult because the person may need help, but refuse it for unknown reasons. It is our responsibility to try and convince them of the gravity of the situation. We must appear professional, while explaining in terms they can understand. We use these conversations to assess their aid to capacity; their ability to understand the situation and the risks associated with all decisions. Sometimes the emergency department is not always the best option for someone, and that is okay, provided the problem in questions is not life-threatening, and they have alternate plans for care. It is our job to make these judgments about their aid to capacity and obtain their consent. We must be persuasive and professional, firm and kind.

As you can see, being a professional in the field of paramedicine is more than just rushing into an emergency with flashing lights and driving fast to the hospital. It's about not breaching public trust, having effective communication skills with patients, and making clinical decisions about not just a patient's symptoms, but their understanding of the situation. It is these professional attributes that allow us to grow our profession, so we can deliver more care in the field. We have come a long way from working out of funeral home basements, to being clinicians delivering treatment in the field.