By: The Musing Medic
Unique Relationship Between Paramedics And Physicians
Physicians and paramedics have a unique relationship. In the grand scheme, the physician is in charge even if they are not present in the pre-hospital setting. But the physician also trusts the paramedic to use their own clinical judgment and diagnostic skills to properly assess and treat a patient. That requires trust from the physician and humility from the paramedic. But the only way both groups can come together and form a great working relationship, perhaps even friendship, is by constantly working on communication. So here are some musings (get it, the musing medic–yeah, I know) on key communication points between physicians and pre-hospital staff.
The Top 4 Most Important Things
1. Medicine is a hierarchy whether we like it or not.
Physicians are at the top of the food chain. This is not because they possess some other-worldly quality. It is because of their training. Undergraduate, medical school, residency, and sometimes fellowship…that is a lot of time spent to honing their craft. Paramedics should realize that when a physician commends or rebukes, it is because their training has developed them into providers that attempt to collate massive amounts of data and information and form an objective stance. If they provide you with advice or criticism on a patient, take it and run. They are not trying to lead you astray.
2. Knowledge is not limited to one specific group of people.
As a paramedic, I stay in the loop with current literature–and not just the EMS trade magazines. If you could see the books on my shelf like Harrison’s and Rosen’s, both of which are well worn from reading, you would know I am serious about my field. Sometimes we are even more knowledgeable about current practices than other staff. I urge you to read up on the studies regarding supplemental oxygen use on an Acute MI or the effectiveness of Trendelenberg position. (Both are considered ineffective and outdated yet some physicians still cling to these age-old practices.) Just like anyone else, physicians can (and do) become complacent. The moral of the story is: don’t assume the paramedic you are talking with is uneducated or lacking in knowledge. Treat us as a colleague and watch your relationship evolve.
3. Medical command calls should be two professionals working together.
Rarely should the physician just say “No” without hearing the paramedic’s thought process. Help them consider alternatives or other avenues, but never shut them down immediately or without an alternate option (this does not apply to paramedic’s whose actions will likely harm the patient, that is a time for a forceful response). And to the paramedics, formulate a plan before you call in. You are on the front lines in the field, not the physician. They are counting on you. If you can provide sound, logical reasoning for a treatment, they most likely will agree. But don’t be afraid to get a second opinion, physicians are there to help.
4. And finally, be open to doing a post-run discussion or debriefing.
Physicians, you should be going over an interesting patient with the paramedics. Learning opportunities abound but are rarely capitalized on. And paramedics, seek out the physician, ask them for a moment of their time, and work through the call together. If you don’t know, ask. The only way to advance is by constantly improving yourself.
If I Had Just One Word To Sum It Up
So there you have it. Just a few tidbits that have been on my mind lately. I think if I had to highlight one single point of this whole thing it is the concept of humility. Not one person can do it all or know it all. Both sides must work together. Paramedics and physicians need to remain open to input from one another. Bill Nye once said “everyone you will ever meet knows something you don’t.”
I think this is a great way to approach medicine and life in general.
Till next time,
The Musing Medic