After EMS: Truth or Consequences
This article is part of an ongoing series from Mike Rubin. In this series, he’ll reflect on his career and share practical retirement advice for emergency medical personnel. Catch up on articles you missed.
Many years ago, while working as a paramedic in the entertainment industry, I responded to a 40-something female complaining of chest pain and nausea after walking up three flights of stairs on our riverboat. My patient, a lawyer, said she hadn’t felt well during her climb and had asked one of our nonmedical contractors, a photographer, for directions to an elevator. He gave her a pep talk instead.
“You made it this far,” he reminded her. “You only have one flight to go.”
I confronted him after I transported the woman to the nearest ER. The photographer confirmed my patient’s story yet didn’t seem to understand how dangerous his suggestion had been—not surprising, given his lack of medical training. He may have been a whiz with a camera, but his employer fired him within the hour for too much flash and not enough focus.
Who(m) Do You Trust?
To me, that case was mostly about credibility, “the power to elicit belief,” as my dictionary says. The notion of symptomatic patients trusting whimsical, life-limiting guidance from shutterbugs seemed bizarre then; not so much now during widespread government-driven distrust in evidence-based medicine. Is it worse to give foolish advice or to take it? I don’t know. I’m just glad to have served my time in EMS before science got so political.
Perhaps such pathological groupthink will fade. Despite COVID-fueled debate, a 2021 Gallup poll named nurses and physicians the most trusted of 22 occupations. Politicians, including lobbyists, state officeholders, and members of Congress, were among the least reliable. Although EMS providers weren’t specified in that 2021 survey, I think we’re closer to the top of that list than the bottom. Here’s why:
- Popularity isn’t our concern. Patients don’t elect us, and we don’t make contrived promises to them in exchange for two, four, or six more years of employment.
- We report to doctors, not politicians. Learning from them is a privilege no matter whom they voted for.
- We give patients choices. We’ve taken oaths to inform and protect them. And we’re often more concerned with the accuracy of our advice than with free speech (click here to see legal consequences of riffing on the truth).
- We respect science as a tool that helps predict outcomes while tracking clinical results. We don’t try to spin failures as successes or vice versa. Most EMS workers have keen eyes and ears for opinions masquerading as facts.
To Tell the Truth
Contrary to glamorized portrayals of paramedics and EMTs, we support life but rarely save it. We don’t get many chances to be heroic. Short-term therapeutics and safe transport to definitive care are what we do best. Not too shabby when time is short and customers are potentially unstable strangers.
Next to hands-on responsibilities, I believe our most important contribution to the common good is credibility. It’s worth considering how we can best provide that essential element of public service on the job:
Whose truth are you telling?
Are you and your employer on the same page fundamentally? What about your partner? In emergent settings, there isn’t time to argue the meaning of life. Save that stuff for the ride back.
Are you drawing conclusions or sharing doubts that aren’t evidence-based?
Most paramedics with controversial views on nonemergent care lack sufficient training to back up their beliefs. Their sources should be vetted, not just loud.
Do your words distinguish opinions from facts?
It’s easy to turn authoritative statements into constructive thoughts by conceding uncertainty. “In my opinion” or “I think” moderates outrage while encouraging debate.
Imagine the plight of my patient struggling on the stairs. Like so many people in this era of alternative facts, she didn’t know what she didn’t know. She sought help and mistook flippant conjecture for expertise. She required not just a caregiver, but a truth teller. She needed EMS.
Mike’s Exit Poll #19: How does retirement affect the value of EMS education?
Those of us who’ve served as professional caregivers don’t suddenly forget all we learned in the field. As boundaries blur between patients and aged ex-providers, clinical training can be one of the most important tools medics keep after their careers. Add a calm demeanor honed by high-stakes decisions, and you may be the coolest retiree on your block.
Mike Rubin is a retired paramedic and the author of Life Support, a collection of EMS stories. Contact Mike at mgr22@prodigy.net.
