Mat

Paramedic Practitioner - ED/UTC/Events - South UK - He/him. Views = own etc.

[Mat @Mat_J_B]

@Chris_Riggers @DrEmmaNash I think it's mainly lacking the knowledge of what timescale is appropriate if not urgent, it is simpler (for me) if the patient can put the request in and the timescale then be determined by the practice

[Mat @Mat_J_B]

Paramedics of all settings, I implore you, if you were sending a patient to ED please do not tell them they *will* receive an investigation/treatment or be seen by X specialist. I encounter this often and it can lead to conflict. I suspect same is true for referring back to GP.

[Mat @Mat_J_B]

@lilylucent @AshJaySa I appreciate this may sometimes happen, but very few patients wilfully misrepresent what someone else has told them, so if this situation happens it is important for us to reflect on how we can better communicate

[Mat @Mat_J_B]

@NickyWarre80970 Yes I think key is to reframe the discussion with GP (in this example) as the intervention you're recommending rather than trying to preempt what may come from it

[Mat @Mat_J_B]

To finalise this, I think what's most important to recognise is that if you are sending a patient to an ED, their GP, a physio, mental health team etc, the value they provide to that patient lies in their knowledge and expertise, not any one investigation or treatment

[Mat @Mat_J_B]

Paramedics of all settings, I implore you, if you were sending a patient to ED please do not tell them they *will* receive an investigation/treatment or be seen by X specialist. I encounter this often and it can lead to conflict. I suspect same is true for referring back to GP.

[Mat @Mat_J_B]

@aboabisabit That may be true to an extent, but if a patient leaves a consultation with improper understanding/expectations the honus is on us as healthcare professionals to improve how we communicate to them

[Mat @Mat_J_B]

@DrEmmaNash Though I'll admit I do struggle sometimes with what to advise when saying to a patient they need to follow up with their GP but not needing urgent appointment to be told by the patient their surgery doesn't book appointments in advance, only same day 🤔

[Mat @Mat_J_B]

@DrEmmaNash And I firmly believe that all it takes is a very subtle adjustment to the language used to avoid these situations entirely

[Mat @Mat_J_B]

@lillmissd Vanishingly few patients are trying to 'fool' you, far, far more will have unrealistic expectations that have, at least in part, been set by experiences with other healthcare professionals

[Mat @Mat_J_B]

@lillmissd Ask the same person if they have been diagnosed with any medical conditions, or if they take any regular medication for anything, and you will get the answer you are expecting

[Mat @Mat_J_B]

@NatashaMDay And yes now is antiplatelets (excluding aspirin monotherapy) which has always had a similar (or worse) risk profile to DOACs that wasn't recognised by the previous guidance

[Mat @Mat_J_B]

@NatashaMDay But is perhaps suggesting that the best person to *consider* if a scan is indicated is an ED clinician? Ime a lot of people seem not to have changed practice at all, but the guidance I think allows for a degree of pragmatism e.g. 2 day old HI + asymptomatic + advanced frailty

[Mat @Mat_J_B]

@drokane I think it's reasonable when telling a patient they need to be seen by X person to give an idea what that person *may* do for them, but the emphasis should be that you are referring to them for their knowledge & expertise as a specialist (or generalist), not a specific Ix/Tx

[Mat @Mat_J_B]

@ParaPaul78 @DrLindaDykes Fair point, but often it's so specific (or bizarre) that it's obvious that they have been told this, or they arrive with a letter..

[Mat @Mat_J_B]

@AshJaySa Possibly, it depends on how you communicate it. I do think it IS reasonable for a patient to ask what to expect when you send to ED/GP etc, and it is reasonable for the paramedic to answer, but they do need to consider how they do so

[Mat @Mat_J_B]

- but I always clarify that the GP is the expert in that scenario, they may decide to do something different, or nothing at all, and if that is the case then they should trust the GP's expertise

[Mat @Mat_J_B]

If I am asking a patient to follow up with their GP, and they ask what the GP will do, I make it clear that they *may* want to investigate further and this could include (for example) blood tests, outpatient imaging or a specialty referral -