Hi, my name is Jen, and I've just taken the scary leap of moving from the ambulance environment into primary care! I'm hoping this column will shed some light on why I made the move, how it is to work in this setting, and especially the differences from emergency care.
So, why make the move? Although the puzzle-solving elements of visiting a patient in the community with acute symptoms and managing time-critical cases such as sepsis, myocardial infarction and trauma is engaging, after 3 years, I started to feel that missing puzzle piece from the patient journey. There was minimal feedback from case management, and I was also keen to learn new skills used in primary care such as ear and skin assessments.
With these elements in mind, I started to look at the advertised roles for paramedic practitioners in primary care. I landed upon a very busy clinic in South London, with a large register of patients from different demographic and socioeconomic backgrounds. I was chuffed to get an interview and thrilled post interview to be offered the position!
At the moment, I have been here for 3 weeks, and it has definitely been an education in all the new knowledge that refocusing on urgent care can bring! I am posted to the ‘duty’ team, which means that I am one of the clinicians who will contact the patients triaged as needing an on-the-day call. These can be for acute symptoms, or if the patient is vulnerable such as in the case of patients with diabetes. If after the telephone consultation, we think we need to bring the patient in for a face-to-face consultation, we have the autonomy to do so. This is a good option for patients that have conditions such as abdominal pain or ear symptoms in which a face-to-face consultation can rule out red flags and tease apart all of the potential differentials.
One of the biggest differences I am discovering with primary care is that the question we are answering is different. It is much less about ‘where is the safest place to manage this condition?’ and more focused on the tests to differentiate between several often lower-acuity conditions, and the management over time (with features such as medication compliance and appropriate reattendance schedule being more at the forefront). I love being able to chase up cases and ensure everything is followed through as discussed.
I am busy learning new skills such as ear examination, getting to grips with primary care referral pathways, new software, and of course a whole new bunch of people! But I think the most important new skill I am learning is taking patient histories without having the patient right in front of me! I am so used to seeing my patient, and with that, gaining the invaluable knowledge that an end-of-bed assessment can provide. I am also used to having basically a full set of patient observations handed to me after a few minutes, in some cases, making the decision-making much easier! On the telephone, there is no such luxury. You can bring people in, but of course you can't bring in everyone you speak to. You have to focus much more on salient aspects of the history to ensure you prioritise those that cannot be managed remotely.
As well as starting this new job, I am also attending my first level 7 module at a local university which is very exciting! I am learning more advanced tools for assessing a variety of minor injuries and illnesses. At the end, I must write a critical assessment of my assessment of a suitable case study. This is scary, but I love gaining new knowledge, and it is definitely the extra push I need to get up to speed in this environment as quickly as possible!
Next month, I will discuss what I find to be the culture in primary care. Is it collaborative? Is it friendly? Is it too busy to chat? Watch this space.