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Posting this as a future reminder to myself for when this job has me at my wits end and I feel like quitting. Don't. Because for the hundreds of jobs that they don't thank you for, abuse you, make you feel like crap, there will always be that pt that makes all of it worth it. 💚

@999echo_ Lots of barriers here to address. Paramedics should be empowered not to transfer. Hospitals shouldn’t dc with “GP to discuss care planning”, they should do it whilst IP. GPs need more time to adequately do RESPECT - can’t just be added on the end of a 10 min appt for other issue.

@999echo_ Can we look at RESPECT forms being filled out appropriately and pt centred firstly. So many are completed disgracefully with zero context and not helpful in the slightest.

@brionytheliony Thankyou for taking the time to explain. I hear you & agree completely. More time, less pressure, more education. Don't think it needs to be a GP to do this either? Dr. Elena Mucci (geri cons) has great views on this- follow her on IG! Says everything better than I ever could

Bane of my life is having to drag elderly, frail pts to ED in the middle of the night due to staff not writing thorough enough RESPECT forms to secure pt care in the community. We need research on this !! Accountability !! Change !!

@BendyBen999 What about "reversible" causes? E.g now needing o2/ IV abx, simply writing "avoid hospitalisation" doesn't cut it Needs to be pt centered and specific (so ideally done in advance prior to this occurring, esp if now lacking capacity)

@999echo_ Why not leave them in bed and refer ?

@NJL_Blancq Particularly when pts lack capacity, yes I need it. Because GP's (understandably) 9/10 will advise ED as "best interests" (esp o2/ abx)and argue a lot of things as reversible causes How can I go against that with no paperwork in place to state this is not what pt would've wanted?

@999echo_ Do we as autonomous paramedics NEED a RESPECT form to tell us what to do here? By all means phone a friend/senior and share the decision making burden - but can we not be the ones to make a person centred decision and do what will likely be best for the patient?

@NJL_Blancq I only need it when there's arguably a reversible cause e.g. new o2 demand/ sepsis etc. My lady was news 14, now on EOLC in ED. My point is that could have been avoided had the paperwork been in place

@jim_crawfurd @thepharmamedic That's the point. Its 3am. There aren't any. Not in my area anyway. What if pt needs o2? IV abx? All I can offer is ED, which feels wrong, esp when "avoid hospitalisation" is written but not expanded upon

@999echo_ @thepharmamedic I appreciate the frustration, but remember that ReSPECT form is only a guide. If you don’t think the patient would benefit from coming to ED, and there are suitable alternatives accessible in the community at 3am, then you are free to explore this with the patient/family.

@JoeHunter1991 And the sky is blue... but when a pt needs ongoing care and my and for example a GP differ on what those best interests are, it gets difficult. Esp when community can't/ won't accept and pt lacks capacity.

@simontutt88 No we don't, but when they're a news of 14 and requiring o2 etc there's no chance in hell of any community team accepting that. Likewise, writing "avoid hospitalisation" but not addressing for what doesn't help, esp with the majority of things now being "reversible" causes

@999echo_ It does need work, however I argue, we as paras are autonomous clincians if we don't feel the patient needs hospital or it's not appropriate, make the decision ourselves. We don't need a piece of paper to decide a nursing home, cfs 7, advanced dementia, hoisted pt doesn't need ED

@Microbedoc2 This is inspiring, thankyou for sharing. My goal for the next year is to successfully come off my SSRI that I've been on for 10+ years. Reading this makes me believe it's possible. I'm happy for you ☺️

a part of my life, and I am working really hard through exercise, therapy, trying to have healthy sleep patterns and awareness of moods to keep it at bay - quiescent I think covered it.

I am now just over one year off antidepressant medications. I think this is the longest I have been off them since I was 19 - having rotated through around 8. Even with a high pressure final exam, completing training, having an existential crisis about what I want out of life.

@davelackie Take heart, I'm on my 56th immunotherapy treatment for incurable cancer and I'm 4 years on from being given 2 months to live. If it works, it really does work!

Heartbreaking news. Another hospice closing, this one for babies. Only 25% of children's hospice care is state-funded - and that is a national scandal.

Is there anything more demoralising than having the passion and motivation to change something only for there to be 0 opportunities to get involved in the thing you want to change. Make it make sense?

Would happily spend the rest of my working life working 12 hour shifts personally writing ACP's in a way that means EVERY consideration/ need is met. These patients deserve better. I get Dr's don't have time to spend hours on them. So create a role for someone who does!! (Aka me)

@thepharmamedic It's at least one job every few shifts, and god knows how many more coming into winter. The stress, anguish and turmoil they cause is unmatched. It's a disgrace. 😢

@999echo_ Ward based care, reversible caused 😠