Positive Deviance...

[funkytomtom]

Hello All. It has been awhile since I've done much posting here (mostly just been lurking), but I'd like to have a little discussion. First some background info.

I've been experiencing back pain off an on for about 6-7 months. I kept on living with it until it became too painful after a fall. Finally I went to my doc and got an MRI; found out I have two torn discs. Why does this matter to our discussion? Well, I've had to take over a month now off the rigs and really reconsider my EMS future. This has lead to a lot of thought. Where do I want to be in five years? Should I still take my medic and assume I can work out my back? Can I be happy elsewhere in medicine? The time has also been used to keep myself sharp as much as possible. I finally took the national registry (nremti) and have been teaching CPR and first aid classes. I also read a book by a doctor named Atul Gawande. It's called "Better" and if you aren't interested in medicine, you probably wouldn't like it.

If you are, however, it has some very interesting insights. The target audience is doctors, but I think (perhaps falsely) that there are a lot of parallels between the job of an MD/DO and that of an EMT/Medic. We are, at least for a few minutes, in charge of managing sick people much like a doctor (yes I know there are vast vast differences). The book goes through case studies talking about people and places in medicine that are or were exceptional and outlines why. It concludes with five suggestions I thought were relatively simple and applicable.

1. "Ask an unscripted question." This basically means form some personal rapport with your patients. At least make some effort. Our profession is all about people, and the less cold and sterile you keep your interactions the better. The tendency for both you and your patient to feel like "cogs in the machine" becomes lesser. He makes it clear that you don't need to form deep bonds, but that a simple question about your pt's family, past, or hobbies will do. Where did you grow up? Did you catch any of the playoffs? If they don't want the connection, that's ok, but some/most will appreciate it.

2. "Don't complain." You could have taken the word "doctor" and replaced it with "EMT" in this whole section of the book. I think most of us on the city get this one, but there's a lot of great reasons for it. Focusing on what you hate about the job will leave you bitter and burned out real quick. You have to accept that there's a lot you can't control in this profession and learn to live with it. So, says the Dr., every time someone starts to complain, try to change the subject to an idea, an interesting presentation you saw, a tip, trick, or even a joke. Just not whining.

3. "Count something." This one is interesting and I haven't quite figured out how to apply it. Earlier in the book he talks about the great strides made in the care of newborns after the advent of the APGAR score. Obstetricians started to look at the scores babies were getting and how their own treatment affected it. There was now a concrete way to compare performance. The point being to quantify your's or your agency's performance. It's much easier for a doctor to do this with all the patient follow-up they get, but it could be something simple; how much time am I spending on scene? Or, how often do I form enough rapport that the patient thanks me when I leave them in the ER? Start to assess your own performance concretely and you'll see ways to do better.

4. "Write something." I guess we all on the city already do this. Personally I've found a lot of things of value written by EMT's (and a handful of RN's and a couple docs) from many on this site and on various other sites (like the EMT spot)

5. "Change." I see a lot of this attitude on here, and very little in the field. WANT to be better. Hunger for it. Don't be afraid to change the way you work on scene (withing reason and protocols of course). See what works and what doesn't, change the way you do your job so you do it better.

I guess I'm asking for two things. First, what ways do you see to apply these five rules to EMS and your practice? I'm particularly curious about number 3. Secondly, and perhaps more importantly, what tips do YOU have?

I'm not satisfied to be as good as I am now, and I don't think any of you should be either. I see from this book that doctors are thinking about this stuff, we should be too. We all know how much crap there is out there that passes for EMS. Even though I think many of us represent the better half of providers, lets not rest on our laurels. Let us all be the positive deviants, the people who define what EMS should be and can be, not what it is. I remember one of my instructors used to say "the only way EMS progresses is by you knowing more than you have to." Lets all know more than we have to.

There's a lot of complaining (see #2 again please) about how we're not where we should be as a profession and we don't get paid anything, and while this is all true, I feel like it's put up or shut up time. You want the public to see us as the professionals we are? Start not just "displaying minimum competency," go farther, it might be more drug studying, more intubation practice, or it might just be as simple as #1 up there.

I tried to make this coherent and as short as possible. Thanks for reading and mostly thanks for the responses.

The book is "Better; A Surgeons Notes on Performance" by Atul Gawande.

Edited May 24, 2010 by funkytomtom