This weekend there was an article by Barry Ritholtz, who is one of the smartest financial analysts out there. It seems as if he is even less fond of the word rogue than Tom Bouthillet. Maybe I should start calling myself Witch Medic. At least people are familiar with the quote – Are you a good witch, or a bad witch? Which witch?
The title of the article is There are no rogue traders, there are only rogue banks. You associated me with a bank? That hurts. Anyway, In looking at the criticisms of banks and in a variation of the spirit of turnabout is fair play, I noticed that by substituting EMS organizations for banks would put these similar oversight failures in perspective, but without the traders’ silk suits and without the traders’ pay.
Here’s a news flash: If you
issue creditissue paramedic authorization, your working assumption must be that there are unqualified people who will try toborrow moneyobtain paramedic authorization from you. It is the job of everylending facilityEMS organization each and every day to separate the qualifiedborrowerparamedic who has the capacity toservice that debtsafely treat patients from the unqualifiedborrowerswho do not.[1]
Since banks are only dealing with money, while EMS organizations are supposed to be dealing with lives, we should expect more aggressive oversight from EMS. Sadly, few seem to manage to provide the kind of oversight that benefits patients.
How many EMS organizations track outcomes?
Don’t blame HIPAA. HIPAA specifically allows for collection of information on outcomes by EMS. If someone at the hospital tells you that they are prohibited by HIPAA from providing this information about patients to EMS, they are ignorant or they are lying.
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Similarly, if your business involves the use of
leveraged capital for speculationpoisons and other dangerous treatments by your employees, then it is your job to know which, if any, of your people are not competent. It’s a simple mathematical fact that some of your traders willtake lossescause harm to patients; in some cases,enormous but manageable lossesdeath. Your job is to identify these people and move them to other professions.[1]
While I do not think that moving them to other professions is justified without some attempt at remediation, if they cannot be remediated, the exciting world of fast food order fulfillment may be a safer career path than EMS.
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There will be a small number who will try to hide their inabilities. Your job is to separate the qualified from the unqualified, to watch over the full lot of
traders and speculatorsmedics and EMTs in your employ.[1]
Constant assessment of skills is a part of aggressive oversight.
Oversight that is not aggressive is not appropriate for EMS.
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This is not easy. It is a complex set of processes that requires constant vigilance. It must be reflected in the corporate culture from the top down. And it becomes more and more complex as the size of the organization grows. The assumption must be that every employee is a potential
rogue traderdangerous medic.[1]
The slings and arrows of outrageous characterization. I am a good rogue. I am a rogue because the rules do not protect patients. However, that does not mean that breaking the rules for the sake of breaking the rules is good.
Many EMS organizations ignore the low quality of their medics and just react to errors that they pretend are unforeseeable. These errors are predictable. Errors are frequently due to low quality and inadequate oversight. Does the EMS organization look for any systemic flaws that contribute to the errors? Do they just react to errors in the way that I criticized last week?[2], [3]
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BanksEMS organizations are supposed to have expertise inpreserving capitalpatient care and managing risk. If they cannot discharge those simple duties, then perhaps they should not be in the business offinancemedicine. Most of all, they should not be engaging in behavior that puts taxpayer money patients at risk.[1]
Do our EMS organizations have expertise in patient care and managing risk?
Do they demonstrate this or do they just put on a pretense of having expertise in patient care and managing risk?
Can our EMS organizations discharge those simple duties?
Should our EMS organizations be in the business of medicine?
Should our EMS organizations be engaging in behavior that puts patients at risk?
If our EMS organizations cannot demonstrate this, then we need to change our EMS organizations.
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Footnotes:
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[1] There are no rogue traders, there are only rogue banks
Washington Post
By Barry Ritholtz
Published: September 24
Page 1 of Article Page 2 of Article
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[2] What is the Right Response to a Treatment Error – Part I through Part V
Rogue Medic
Part I
Part II
Part III
Part IV
Part V
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[3] Intubation and Errors
Rogue Medic
Article
.
Maybe Medic Gadfly would be a more proper name? For the record, I’d like to reserve EMS Heretic for when I stop being an EMT-Medical Student.
“Do our EMS organizations have expertise in patient care and managing risk?
Do they demonstrate this or do they just put on a pretense of having expertise in patient care and managing risk?”
As with many other issues in EMS, some do, some don’t, many fall in the middle. However, all should, or else it’s a ticking time bomb for everyone involved, including the patients.
“Can our EMS organizations discharge those simple duties?”
Our EMS organizations have to, and at all levels. Furthermore, these are responsibilities that cannot simply be transferred to other organizations or levels. No provider should be able to simply throw up their hands and say, “I haven’t been trained in this, so I don’t need to include it in my expertise.
Similarly, even the newest EMS provider at any level needs to view themselves as being involved in risk management. Be it expanding their knowledge, or else something as simply as unit check out. After all, confirming that all of the necessary supplies are available and organized, in contrast to assuming so, really is nothing more than appropriate risk management against the risk of missing supplies.
“Should our EMS organizations be in the business of medicine?”
Not if they aren’t meeting the above issues. I don’t think anyone outside of specifically EMS would care if EMS devolved back into a supine taxi system. However many many people would love to see EMS evolve. The problem is getting EMS as a whole to either poop or get off the pot. Be it being health care than simply public safety (and if EMS is public safety, who cares about respect from other health care providers?), or professionals rather than technicians, EMS seems to want the best of all worlds with none of the downsides.
“Should our EMS organizations be engaging in behavior that puts patients at risk?”
Depends. If the risk is appropriately offset by a benefit (such as performing research or education (i.e. like avoiding teaching hospitals in July), then most definitely. It’s it’s a behavior due to being lazy and not taking the system’s responsibility as a health care entity seriously, then definitely not.