What duty of care do you have for your patients? We talk a lot about duty. It is embedded in our daily conversations. We talk about ‘off-duty’, we enquire when staff are ‘on duty’ or on a ‘duty roster’. It has become part of our everyday vocabulary, but failing to provide a duty of care is the most common reason for doctors to be sued for negligence. The law of negligence seeks to ensure that as individuals, we are responsible for both our actions and our inactions.
Our first duty of health care is that the patient remains central to all care. This is both evident and implicit in the majority of the literature, policy documents and various governmental White Papers. However, there can be a tendency to forget, or to perhaps overlook, this fact when budgeting, managing or designing services for the very people that we are all here to care for—the patients. Occasionally, we are patients ourselves and it is often this very experience that shapes our own attitudes and beliefs.
The Health Professions Council (HPC) Standard of Conduct, Performance and Ethics (2008) states that as a paramedic, you must ‘act within the limits of your knowledge, skills and experience and, if necessary, refer the matter to another practitioner’ and when accepting a patient or service, you have a duty of care (HPC, 2008).
A duty of care is an obligation on one party to take care to prevent harm being suffered by another. This duty of care, based in common law, requires the paramedic to adhere to a reasonable standard of care while performing any acts that could foreseeably harm patients. Of course, any act performed on a patient, such as inserting an intravenous cannula or administering drugs, can ‘foreseeably’ harm a patient. The intravenous infusion could extravasate, causing painful damage to surrounding tissue, and drugs have a whole range of ‘foreseeable’, sometimes unpleasant, side-effects. However, such events are fortunately relatively rare and patients do not generally sue paramedics for negligence. Patients who do take this legal step have to ensure that the following three criteria have been met:
Much has been written regarding the advancing role of paramedics and often this is outside the traditional role boundaries or perhaps public perceptions of their trauma role, and of course usually represents just a fraction of their daily work. However, caring for and assessing the capacity of patients with mental health care issues is a daily challenge for even the most experienced clinician. Such patients often have complex histories and are challenging to assess and manage.
Young children and babies can also be a difficult group for paramedics to treat. However, the common factor of both these patient groups are that they traditionally represent a very small aspect of paramedic training. The required knowledge, skills and attributes to appropriately manage a young, depressive patient who is self-harming or a 6-month-old baby with a high fever are often lacking in the basic paramedic preparation. Yet, paramedics make these clinical decisions on a daily basis with a lack of awareness of the ethical and legal aspects that underpin this practice. This is not right, but it happens daily. Some would argue that such knowledge stems from a university education, others that this is not the case. But not every paramedic wants to undertake a higher education degree.
Whatever your aspirations, I suspect that if you are reading this, you have the desire to learn, develop and do the very best for your patients. So go out, explore, read journals and books. Share knowledge with your colleagues and peers. Ensure that your duty of care for your patients is respected and delivered.