Insights from a Paramedic: Navigating Conflicts in Emergency Care

Date: September 24, 2023

Location: Emergency Hall, Peking University Third Hospital

While in the emergency hall at Peking University Third Hospital, I observed a heated exchange between the family of a patient and the hospital staff. Curious about the underlying issues, I decided to speak with the 120 emergency doctor who had brought the patient in. Our conversation shed light on the challenges faced in emergency care, particularly when patient expectations clash with the realities of medical resource allocation.

The Conflict: Prioritization and Military Veterans

The patient, a car accident victim, needed surgery. However, the hospital informed the family that three other patients with similar conditions were ahead in line. This caused frustration, as the family believed the patient, a retired military veteran, should be given priority. The doctor explained, "The family insists that, as a veteran, he should get priority treatment, which is why the conflict started."

The family wasn’t just upset about waiting—they were also considering moving the patient to 301 Military Hospital, believing it would provide faster care. "They’re in contact with 301, but through our radio, we found out 301 doesn’t have any emergency beds available either," the doctor added. She emphasized the confusion that arises when families try to seek treatment at well-known hospitals, without understanding the constraints of bed availability. "Right now, they’re waiting for further coordination," she said, highlighting how these situations often get stuck in logistical bottlenecks.

Family Expectations and Emotional Strain

When I asked about her broader experiences with patient families, the doctor recounted a striking incident from her previous job in a hospital. "There was one patient who refused to follow medical advice—he smoked, didn’t eat properly, and eventually passed away. His family couldn’t accept it. They smashed our office, tried to attack us, and demanded explanations," she recalled. In this case, the patient’s second son, who had been away and had been drinking, was particularly aggressive. "He couldn’t handle it, especially since he had been away for a while, and things escalated quickly."

These conflicts, she explained, often stem from a lack of understanding or acceptance of medical realities. "Even when you explain everything clearly, some families won’t listen or can’t process the information. We told them the risks, explained the patient’s kidney issues, but they didn’t understand how that could lead to death."

The Battle Between Proximity and Prestige

Another common issue the doctor highlighted was the preference of families for prestigious hospitals, even when they’re farther away. "Just the other day, a family insisted on bringing their patient here to Peking University Third Hospital, despite my recommendation to go to a nearby hospital," she explained. "They believed this hospital was the best, but even after arriving, they couldn’t get the patient admitted right away because of the wait."

This situation, she said, often leads to frustration and delays in treatment. "They won’t even let you finish explaining that it’s better to go to the nearest hospital in these cases," she added, noting that families sometimes prioritize the hospital’s reputation over practicality, even in life-threatening situations.

Misunderstanding Costs and Ambulance Wait Times

We also discussed the confusion surrounding ambulance wait times and costs. "If we have to wait too long without handing the patient over, we start charging for the time, but we always explain this to the family first," the doctor clarified. "In this case, the family was informed, but there’s often misunderstanding about why the charges apply."

The family’s frustration in these cases isn’t just about the costs—it’s often compounded by the stress of not knowing when the patient will be admitted or transferred to another facility. "If a hospital can’t admit the patient right away, the family might feel like they’re stuck in limbo, and that’s when tensions rise," she said.

Grind of Emergency Work

When I asked about her work schedule, the doctor gave a glimpse into the exhausting nature of the job. "We work rotating shifts—day shifts from 8 a.m. to 5 p.m., and night shifts from 5 p.m. to 8 a.m. the next day," she explained. "We switch between day and night shifts regularly, and it takes a toll. It’s hard to adjust, and it’s physically exhausting." Despite the grueling nature of the work, she mentioned that the pay isn’t particularly high. "Our pay is based on kilometers traveled, like a taxi fare, but just a bit more expensive."

Technical Challenges of Emergency Procedures

We also touched on the technical aspects of emergency medical procedures. When responding to a cardiac arrest, she explained, "CPR isn’t done by just one person—there are always at least two of us alternating. It’s a team effort." In some cases, they can perform advanced procedures like intubation. However, she explained that sometimes, if they’re close to the hospital, they may opt for basic resuscitation measures. "If we’re close to the hospital, we might not do the intubation, but if the patient has no breath or pulse, we can proceed."

I was curious if they had equipment like automated CPR machines, which I’d seen in some emergency response videos. "No, we don’t have those. Only the central stations have them," she said.

Dealing with Patients Without Family

I asked how they handle situations where a patient doesn’t have family present. "If we can’t find family members on the scene, we take the patient to the nearest hospital and leave it to the hospital to contact the family. The most important thing is to get the patient treated as quickly as possible," she explained. The priority is always the patient’s life, even if it means taking on the responsibility of locating their family later.

Key Takeaways from the Doctor’s Experience

From this conversation, several important points emerged about the relationship between patients’ families and emergency medical staff:

• Prioritization Policies: The lack of clarity around policies for prioritizing military veterans and other patients can lead to misunderstandings and conflict.

• Proximity vs. Reputation: Families often prefer sending patients to renowned hospitals, even when it may not be practical or beneficial in urgent cases.

• Handling Death: Some families struggle to accept the sudden death of a loved one, leading to emotional outbursts that can escalate into violent incidents.

• Ambulance Waiting Charges: Families may not fully understand why they’re being charged for waiting times, leading to further tension in an already stressful situation.

Conclusion

The interview with the 120 emergency doctor highlighted the many challenges faced by medical professionals when dealing with families in crisis. Misunderstandings about hospital policies, proximity-based decision-making, and emotional reactions to patient outcomes all contribute to the complexity of the job. Despite these difficulties, the doctor’s commitment to patient care was clear, and her perspective emphasized the importance of clear communication and empathy when navigating these high-pressure situations.