Kelly Grayson writes Demystifying Diagnosis, but I decided to add a little lisp to accentuate a point.
He starts out with an almost irresistible temptation.
Want to start a fight in an EMS social media forum?[1]
I tend to avoid the EMS social media, because there are few who understand what they are doing, and no matter how wrong they are, they congratulate themselves that they are absolutely right that high-flow oxygen saves lives, or that faster is better, or that backboards save spinal cords, or that more medics means better patient care, or that . . . .
EMS is not unique in this self-deception, but I do not need to be the one correct the lowest of our lowest common denominators.
Diagnosis is a word that will draw out many of these dregs of EMS to beat their chests in defense of their failure to understand.
We don’t diagnose!
We probably should not assume a diagnosis of lupus, but we do diagnose.
Once paramedics diagnose, it’s just a slippery slope to . . .
Having paramedics decide appropriate doses of pain medicine, or appropriate doses of sedative medicine, or appropriate doses of combinations of pain medicine and sedative medicine?
Having paramedics, basic EMTs, and even first responders clear potential spinal cord injuries without an X ray? If you have moved your neck, or your back, at any time – you have a potential spinal cord injury. If you have bumped into anything at any time – you have a potential spinal cord injury. If you have sneezed, coughed, vomited, eaten, or consumed a beverage – you have a potential spinal cord injury.
Having paramedics give enough sedative to knock down the agitated delirium patient? How can we give medications without a complete history and a list of medications and allergies?
Are we really that foolish?
We need to be told what to do!
We can’t think for ourselves!
We don’t want to think!
We just want to be told what to think!
Thinking leads to responsibility and we just want to avoid responsibility, (oddly it is our responsibility to defend EMS myths)!
It appears to be true that diagnosis is the legal purview of doctors, but is it like Coke having to defend its brand name?
Sort of –
Doctors are not worried about EMS taking their jobs.
Doctors are definitely not worried about these defenders of irresponsibility taking their jobs. Doctors are worried about PAs (Physician Assistants) and NPs (Nurse Practitioners) – responsible, well educated people – taking their jobs.
Some nurses worry about EMS taking some nursing jobs, so you may see legal battles over licensure threatened by some nursing organizations. We are licensed, even if the license is called a certificate.[2]
We are not just licensed, we diagnose, even if we are taught that an EMS diagnosis is just a _________ diagnosis. Insert whatever lame excuse for why we are not really saying Voldemort diagnosis.
But diagnosis refers to definitive care!
We treat some patients with definitive enough treatment to bypass the ED (Emergency Department). STEMI is the most obvious example in the systems that do have EMS transport straight to the cath lab.
We need to be better at diagnosis and less afraid of diagnosis.
You want diagnosis? I will provide some of the most flagrant examples of EMS diagnosis in Part II.
Go read the rest of what Kelly wrote.
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Footnotes:
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[1] Demystifying Diagnosis
February 5, 2014
A Day in the Life of an Ambulance Driver
Article
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[2] The Legal Differences Between Certification and Licensure
National Registry of EMTs
Legal opinion
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But the sad thing is that as long as the EMS status quo continues as it is, the stereotypical example being private EMS, then we won’t get past this. As long as we have paramedics being churned out of these puppy mill like paramedic schools who are willing to just do it “because the protocol” says so we’re screwed. And furthermore, so long as you have medical directors willing to crucify medics for making any number of simple errors because they think because any mistake is felony worthy and if they don’t take extreme action they’ll be held responsible, we will have no changes.
So, does it matter in the end if we diagnose or not? I’d argue no, because even if you do and you do treat the patient, the system is just as bad.Until the system(s) are fixed, the argument about diagnosis is moot.
On a side note, I too try to avoid the social media for the same reasons, but strangely I’ve found a striking similarity between most EMS management and EMS social media……hmm.