Why do we spend so much time on appearance, but not spend time on the things that are important to our patients?
Sure, appearance is the first thing that people will notice, but what leaves a lasting impression is how we treat patients.
Can we intubate well?
For most of us, probably not.
How many of us keep a record of
any all of our skills and our success rates where everyone can see?
If we miss a bunch of IVs, do we view being assigned to the IV team as an opportunity to improve our skills and understanding, or do we view it as punishment?
Do we have a good understanding of the medications we use?
How many of us will read the package insert for any of the medications we give?
Few of us.
Do we read research to understand more about about what we do?
For most of us, probably not.
Who cares about what we are called?
We are insecure people who need constant validation of what we do, even though the only thing we seem to do well is complain about appearances.
Appearances are NOT reality.
Rather than insist on higher standards, we worry about what term should be used to describe us. We are the people who were just lucky enough to meet some lowest common denominator standards on the day we took a multiple choice test accompanied by a well rehearsed song and dance segment.
Is the patient in the scenario unstable?
Let me contemplate this, without being there, or having tested anyone on National Registry in about a decade. Yes, the patient is unstable.
Our test is prejudiced toward people who are skilled at taking tests, not people who are good at taking care of patients. That is why we take time away from teaching about patient care, so that we can teach test taking strategy.
We defend this. We become upset when it is pointed out that hairdressers require more time in school, but almost every medic student I have met has focused on just meeting the minimum number of ALS calls, the minimum number of IV starts, the minimum number of drug administrations, the minimum of everything.
What should we call people who are satisfied with being the lowest common denominator?
What should we call people who are satisfied with doing as little as possible to work on the skills that we expect patients’ lives to depend on?
How many of us insisted that the death of Curtis Mitchell was the fault of the medics for trying to work smarter and calling for a four wheel drive vehicle, rather than tying up one ambulance indefinitely and trying to shovel their way to Mr. Mitchell? The fault was the lack of planning by Public Safety Director Michael Huss, who only planned for mild winters. If we tie up EMS doing the work by hand that should be done by plows, how many other patients would die waiting for crews that would be delayed even longer?
When we are not smarter than the snow, are we smart enough to be providing patient care?
What kind of excuse is appropriate for a preventable bad outcome? Preventable if only the medic had some skill at the paramedic job requirements.
Don’t take our tubes, but don’t expect us to do any more than the minimum amount of practice.
Don’t take our RSI (Rapid Sequence Induction/Intubation), but don’t expect us to understand pharmacology.
Give us standing orders for all of our medications, but don’t expect us to understand pharmacology.
We have medical directors who assist us in avoiding competence.
How many of our medical directors, or any of the doctors in the hospital will take the time to assess what we have done and to provide feedback? And I am not referring to the clown who thinks that 2 mg morphine with a 2 mg repeat is aggressive pain management.
Assuming we are not immediately dispatched on another call, how many of us will stick around to listen when the doctor asks the patient questions, so that we can learn more about assessment?
How many of us will ask the doctor about the things we missed? We would be afraid of looking bad, but our ignorance already makes us look bad.
If we want to improve our appearance, we need to stop worrying about our uniforms, our titles, our fancy trucks, et cetera.
We need to pay more attention to our abilities.
The most important ability for anyone is not intubation, not IVs, not needle decompression, not ability to measure a drug dose precisely, et cetera.
Our most important skill is assessment.
How often are we correct in assessing what is going on with the patient?
Few of us know, because we don’t bother to try to find out.