What goes through a medic’s mind?

Ginger Locke is infatuated with the minds of medics.

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She is a paramedic educator, researcher, author, blogger, and social media maven (please see awesome memes below). She has recently transformed her written word blog into a multimedia paradise featuring her new podcast, Medic Mindset, where she interviews medics delving into what makes them tick. She was inspired by her medic students questions as they became newly minted medics and wanted to help others know what to expect from their profession by interviewing working medics that share their honest perceptions and experiences. Clinical, operational, and personal topics are all present. Click above to access her blog and listen for yourself.

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The most recent episode features Fiona Thomas from The Code Green Campaign. The Code Green Campaign provides awareness of EMS provider mental health and suicide via shared stories, collects anonymous reports to track EMS suicides (in concert with Firefighter Behavioral Health Alliance), and provides education for the EMS community. Their site also has a section with mental health providers and programs that specialize in treating first responders.

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Fiona shares the origins of Code Green, personal inspirations, and her ever changing career evolution. She also shares her clinical experiences as a paramedic, what challenges her clinically, and how she personally deals with stress and mitigating the effects of work. She also has some interesting non-EMS related jobs.

She discusses the cathartic effect journaling produces for her and it’s role in helping her release stress. Fiona pulls from her non-EMS life experience, sharing that “words matter,” not just the written word, but the actions our verbiage denotes and images they inspire and communicate.

Fiona gives some sage advice to her younger self (and the rest of us) to “just stick it out.” As EMS providers, and perhaps my personal experiences, we tend to give up when things get hard (professional or personal).

She continues by advising us to “listen to your patient.” We all know patients will tell you when they are going to die, vomit, or have a baby. But, what about the patients who aren’t in the throes of an emergency- listen to their stories or what they are telling you they need, even if it’s not in your clinical arsenal

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I’m not going to spoil the ENTIRE episode for you – you’ll have to listen yourself!

If you aspire to be a student of the profession and stay abreast of current topics in EMS, make it your business to follow Ginger and Medic Mindset.

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Like No One is Watching

Sometimes you don’t even notice the people watching.

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I mean, we’re all busy right? So many tasks to complete in a certain number of hours and only a certain number of hours in a day, can leave everything in a little bit of a blur. Constant working and feeling like you never get anywhere can leave you really frustrated and focused on all the bad things going on; even like your work was worth it.

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I recently left an agency where I had a leadership role. The past year or so, I felt stagnant and voiceless; a few months ago, I decided as soon as I finished my agreed upon term, I was going to resign. I felt it was better not to “waste” any more of my time. So, for the last few weeks I have been prepping my replacements, giving them information, who to ask for what, how to avoid regular road bumps of people’s personalities. Yesterday, I turned over my keys to my replacement and punched out for the last time. Just before I did, something unexpected happened.

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People came up to me one at a time in the last few hours and said: Thank you. Thank you for doing a good job, working hard, helping out. Finally, my partner came up, I could see on his face he was about to say something mushy. He went on to wish me good luck and that we’d probably see each other at the hospitals and then…

“…thank you for teaching me.”

Wow. Just wow. I am so humbled on so many levels; mostly that someone thinks anything I had to say helped them become a better healer, to use their hands, head, and heart to take care of others. This whole time I didn’t think anyone was watching, using the work I was putting in. I thought maybe the whole thing was a waste of time.

It was me looking in the wrong place.

I was looking for acknowledgment from those who would never be moved. I was so zeroed in on their obstinance that I couldn’t see the people who did matter: the people I was leading and teaching by example.

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Some days I am so mad with EMS and all our shenanigans and tantrums and prima donna antics that I could just spit. I wonder if anything will ever change with just the minority of forward thinkers ready to depart from the ideas of yesteryear. But then, every so often, you find out someone WAS watching. What will you be teaching them?

It seems appropriate at this time to say thank you to all the people I watched when I was a new guy and watch today to learn how to be a better provider, leader, and human being. Every day I realize there are even more than I thought, when I remember an appropriate story or anecdote related to a present situation. Yes, that even includes folks I don’t care for very much because they left a sour taste in my mouth. I thank all of you, thank you for letting me watch and learn, thank you for sharing that part of yourself.

Is Too Much Starch A Bad Thing?

This blog is part of a larger “What-If-We’re-Wrong-a-Thon” by several EMS bloggers where we attempt to view the opposite point of view on a topic we have previously taken a stand on. You can find the other articles here.

This weekend I had the opportunity to attend the Connecticut State EMS Conference (more on that in another post). One of the sessions was about professionalism by Dr. David Powers. Honestly, I wasn’t sure how much more there was to say on the topic, it seems pretty straight forward. However, after attending I came away wondering is there such a thing as being too professional?

Google defines professionalism as: the competence or skill expected of a professional; the practicing of an activity, especially a sport, by professional rather than amateur players. This leaves quite a wide berth for perception of what is professional in terms of being an EMS provider. Please note it does not say “volunteer” or “paid”, but rather “professional” or “amateur”. I think we can all imagine some folks on both sides regardless of their compensation status.

Of course, there are some issues related to being “professional” that are non-negotiable:

-personal hygiene
-general cleanliness (people and equipment)
-using some sort of identifier that you are a responder and not just a bystander
-using any clothing or items related to safety (ANSI vests and the like)

Now that we have laid a foundation to be able to assess what it means at a base level to be a professional, how can individuals in various roles perceive professionalism differently? Is your Chief’s perception of what it means to be professional different from yours?  What do our patients think a professional looks like?

Cast from Nightwatch
Cast from Nightwatch

The cast from Nightwatch was one of the examples brought up in the lecture I attended, specifically about some of the cast members visible tattoos. In the past visible tattoos have been a hot button depending on your location and agency. Some providers were required to cover visible tattoos or wear long sleeves all year to keep them hidden. However, tattoos are now readily accepted in most of society and they could be used as a tool to related to certain patients.  To be sure, all patients are different, and some may take offense, particularly if the art in question is garish or overtly sexual, though that doesn’t seem to be common. Do they look professional to you? They look clean, their uniforms are neat and shirts are tucked in, pants held up with a belt, the tattoos are noticeable, but not the first thing you notice. If their community members and agency accepts it, they look like good providers to me (note we didn’t even discuss their clinical skills yet… perception is everything).

EMS Provider or Police Officer?
EMS Provider or Police Officer?

 

Could we look neat, clean, and in uniform, but be perceived by patients and family as “professionals” other than EMS providers? In the appropriate circumstance this uniform is appropriate and necessary for personal safety, but what about everyday use? If you were not involved in our service would you know if the man above was an EMT or paramedic or a police officer? Could looking militaristic be averse to excellent patient care?  Could our uniforms cause more anxiety for patients and exacerbate their already compromised health? Could a uniform like this lead to safety and security issues for crews while they are on duty due to mistaken identity or intent?

 

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Another part of the conversation in class was looking “too” professional. Funerals and special events do require an extra degree of attention to your uniform, but on a daily basis is your uniform so perfect you look like you didn’t work at work? If you are a white shirt, could your subordinates feel distanced from you because they feel you don’t relate to the “workers” and forgot what the “street” is like? Of course, this is not an excuse to roll out of bed and into the ambulance looking rumpled and bedraggled, but could looking too perfect be intimidating; like the proverbial beautiful woman who can’t get a date because men feel she is unapproachable?

While we shouldn’t throw away the idea of becoming professionals and being at the top of our game, particularly in our industry where life and safety are at the top or our responsibilities, we should take a step back and imagine the situation and perception that may be applied when we arrive on scene. Being presentable and clean are still important, but is a creased patch an absolute requirement to do the best CPR or be kind to a scared patient? Perhaps, less starch could be used in application to the topic of uniforms and appearance by staunch advocates, such as myself, when reviewing everyday EMS scenarios.

EMS Compass: The Missing Link in EMS

Hardly a week goes by without hearing about providers feeling left out in the planning of the futures of their agencies and the future of EMS in general. It’s true, some providers will never be happy, that is the nature of humans at large and it is present in any profession. Yet, not everyone is jaded, and many do have a point of not having had a voice in the coming change and development of EMS as we grow up. That is, until now.

The EMS Compass initiative is being led by The National Association of EMS Officials (NASEMSO) and financed by The National Highway Traffic Safety Administration (NHTSA) to develop EMS performance measures over the next few years. Part of their plan is to invite all stakeholders (providers, managers, agencies, government) to participate via direct suggestion during the Call for Measures this month, informational and public meetings, and transparent communication via direct access to key players.

Leaders don't necessarily need a title.
Leaders don’t necessarily need a title.

What is a performance measure?

Performance measures are common in other industries and have been used in medical practice, but not traditionally in EMS. Performance measures enable providers, management, and government agencies to track and improve performance to benefit patients and communities. Some of these measures will be clinical in nature, but operations, safety, and business/ financial aspects are also included as all of these are needed for well rounded agencies and further development of a well rounded industry.

Performance measures don’t have to be complex or convoluted. In actuality they are quite succinct. For example it is widely accepted that patients with cardiac chest pain should take an aspirin. The performance measure for that event would read: All patients who have chest pain of a cardiac nature should receive aspirin. This would then be documented via charting we already complete and reviewed later for quantification. Many things we already do such as standards for STEMI, TXA for Stroke patients, or even trauma protocols were founded in related medical professions performance measures.

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Why bother?

-We will be contributing to the development of these standards for our profession, who better to do so? Historically, government at large has not been the best at recognizing what we do and our level of importance (please see “Ambulance Extenders”)

-We already contribute data via NEMSIS for data collection in the EMS industry, this process contributes to data collection and provides information for where we currently stand so we can continue to improve and move forward

-The measures are evidence based. We are Emergency MEDICAL Services and should be practicing medicine in the way that other medical professions do, with evidence not today’s whimsical idea on how to get “cool toys”.

-Provides means of measuring long term performance in our industry so when the next generation of providers arrive, they can build on the foundation we have laid.

-Currently, if your agency bills, you are paid for service whether the patient is treated well clinically and will have an improved outcome or pleased with how they were treated, Medicare will pay for the transport. In the future, in conjunction with The Affordable Care Act (ACA or Obamacare) we will be paid for the outcome: clinically accurate care, patient satisfaction, etc. Hospitals have been preparing for this for the past few years, we should not be naive to think the government will not try to limit our payments.

-Medicare is encouraging other insurance companies to follow suit on requiring a higher standard of care for payment for EMS services.

-Can lead to better provider compensation, improved provider safety and health, and better recognition of the job we do and love.

Obviously, the above is a very simplified over view of what EMS Compass is and will achieve. I have included links below for your information. There is a great webinar you can access on demand that explains how the process works and the history of data collection in EMS. I also included links to the Call for Measures that is live until the end of May, so get your measures in. I also included links to some other blogs and podcasts that have been talking about EMS Compass recently.

Until a standard is set industry wide, EMS as an profession will flounder. EMS needs to define acceptable standards of care on an industry wide level, the lowest common denominator can no longer be our standard if we are to grow into the industry we desire. Much of what is described above are things we already do, we are just organizing and tracking it now. We must to take ownership of our profession before someone else, who has no idea what we really do, tells us how to do it. You can be a part of the future of EMS on a larger level than you ever imagined by contributing to the call for measures by May 31, 2015.

The EMS Compass Site (you can access the Call for Measures and informational webinar here)

The EMS Garage – The EMS Compass

Inside EMS Podcast – How the EMS Compass Initiative will create industry standards

Medic SBK- EMS In The New Decade – The EMS Compass

Gripes Go Up

I recently had the opportunity to attend a lecture called “Why Just Manage When You Can Lead?” by Ray Barishansky. There were many little leadership morsels and treats to delve into a little deeper in future blogs, but today I’d like to focus on one in particular that keeps rearing it’s head in my life.

Leaders complain up, not down.

I am a member of the leadership at my agency. I was having an impromptu conversation about my frustration with some of the actions of the other leaders with a peer in the leadership group. We really got going about what got us heated. At one point I suddenly remembered the three or four other employees that were in the room watching TV… and probably listening to our bitchfest. The class immediately came to mind and I felt like an idiot.

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What did our conversation do to influence the other employees’ view of our agency?

How did our conversation affect their trust in the leadership?

Who do you think they will go tell now?

The clip above from Saving Private Ryan really illustrates this idea. Complaints should go up the chain of command where they can be addressed. Otherwise, complaints just stagnate your agency and bring morale down, particularly when an agent of change is doing the complaining. That is no good for anyone.

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Whether you are already in a position of leadership or aspire to be, be aware of what you say and where you are saying it. Words are power with both good and bad outcomes. Mom’s advice still stands, “If you don’t have anything nice to say… don’t say anything at all.”

Linus Knows Best

 

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Lucy & Linus of Peanuts

Folks, I have something important to say. I’m going to keep the flowery language and gentle guiding you are used to from me to a minimum because what I have to talk about is so obvious and yet so overlooked that perhaps keeping it simple will help.

It’s winter.

It’s cold.

Put a blanket on your patient and make sure they are warm.

Yes, that obvious. Yet attendants (not providers because provision indicates you care for your patient) don’t wrap up their already ill or injured patients.

Anybody chilly?
Anybody chilly?

Earlier in the week at work I already dropped off my patient in the emergency room and I was walking out to meet my partner and help clean the truck when I saw two EMTs bundled in job shirts, hats, and winter coats standing with a patient waiting on for the charge nurse to acknowledge them. Their patient appeared moist and febrile, fresh from the nursing home. All this patient was wearing was a hospital gown, hospital socks, and a stretchy sheet wrapped around his legs. No blanket or other covering, nothing covering his head, totally exposed to the arctic chill. I bet his attendants weren’t very cold under all their layers of clothing they wore to stay warm while outside with him.

When I was a new EMT I was fortunate to have excellent providers as examples who showed me what caring for a sick person requires. That includes using what some might perceive as “creature comfort” such as a blanket or head covering. It’s not just a modesty issue or about keeping warm, there are physiological repercussions to exposing an already compromised patient to the cold. For example, heart failure patients with pulmonary edema can “flash” when they inhale the cold air making a bad situation worse. Asthmatic and other respiratory patients may also have their symptoms exacerbated from cold exposure. Nursing home and other patients used to being indoors in a high heat environment can suffer hypothermic shock and agitate any medical issues they may be having at the time.

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Blankets are great for preserving patient’s modesty.

Some simple things to remember:

  • If you are cold, so are they.
  • Prep your carrying devices and stretcher with extra blankets and towels for patient use in frigid weather.
  • Have respiratory patients cover their nose and mouth before going out into the cold, coach them if they feel they cannot breathe because of the extra layers.
  • You can also use a patient’s own hat, scarf, and coat. Most families are more than happy to find it for you to use in addition to blankets you have provided.

This is one basic thing all providers can do to make their patient feel comfortable and have an improved patient outcome in the long run. It’s not something that requires a new certification, extra training hours, or extra money in the budget, but it does reflect what kind of provider you are and the level of care you provide.

What Are You “Saying”

While getting my nails done a few weeks ago my manicurist had CNN on the television, Donald Rumsfeld was talking about the United States response to one of the many violent events occurring in the world today. It struck me how eloquent this man was under pressure. I wondered how could this translate into my own deportment and why don’t EMS providers sound like this?

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Merriam Webster’s dictionary defines eloquence as: discourse marked by force and persuasiveness; the art or power of using such discourse, or the quality of forceful or persuasive expressiveness. These are all requisite to be even moderately successful health care providers and advocates for our patients. How can we convince a truly sick patient that they NEED to be in the hospital to curtail serious or deadly consequences if we don’t have the method to communicate this to them? How do we demonstrate our professionalism and passion to other related professions, healthcare providers, and politicians that also play a hand in advancing or restraining the future of EMS if we are not able to communicate well? Presentation is as important in EMS as it is in the business or entertainment setting. Good presentation is not just about tucking your shirt in and wearing new boots if you open your mouth ruin the illusion.

 Public Speaking

It’s not as difficult as it seems to “sound smart.” There are a few ways we can all start to improve our vocabulary.

  1. Stop using profanity. Cursing does not illustrate your point, shock, make you seem important, or benefit you in any way. It really just agitates people and that doesn’t really work positively most times.
  2. Be aware of your tone and volume. How you speak may be more important than what you are actually saying. I used to work in an area with an excellent provider, but the care he gave was often missed by everyone on scene because his tone was harsh and the volume of his voice was much too loud. Many patients were disturbed and several asked for him to “stop yelling at me.” It doesn’t matter if you are the best provider in the department if your care is marred by your tongue.
  3. Use appropriate (and correct) terminology. If you want to be treated like a medical professional, you should sound like one. Honestly, you should also write your documentation like one. If you don’t remember medical terms from your days of EMT school, bust out your book and study or take a course on medical terminology. This small investment of time and money will go a long way in increasing your stature with other medical providers.
  4. Think before you speak. Many times our vocabulary faux pas is not related to the words we misuse, but because we don’t police our tongues and end up offending people. This can lead to more than disciplinary action, inciting violence on scene and placing you and your partner in danger.
  5. Listen to understand, not to respond. When you are speaking with patients or their families listen to what they have to say so you can understand what the true problem is, not just your perception. Then you can respond appropriately and sound professional. Sometimes people speak to us because we are the only ones they trust to listen without passing judgment. We in turn are often entrusted with their life experiences and they end up imparting a gift to us.
  6. Read. Reading might seem incongruous with improving your speaking abilities yet how do you learn new words and ideas without reading? Read things you wouldn’t normally read. Read from all topics, not just related to EMS although you should try to keep up with current events within our field.
  7. Look the part. I attended a seminar at a prestigious university where a speaking coach was discussing how to have your message heard. The very first thing she talked about was visual presentation. People make their decision about whether or not you are worth listening to within milliseconds. That may not seem “fair”, but it is what we have to work with when attempting to deliver our message and treat our patients.

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The list above is not exhaustive, but it’s a good place to start. It won’t be easy, but changing your vocabulary and way of speaking is possible with mindfulness and persistence. Don’t give up if it feels like the change is long in coming, it takes 3 weeks to make a habit. Changing how you speak won’t only improve your professional life, but can transform your entire life for the better.

How many A-holes work at your agency?

I was recently reading a piece by a gentleman named Olivier Blanchard called Brand Management: The Asshole Effect.  I was so excited while reading it because in a parallel life to my EMS career, I worked at a popular coffee emporium.  I was expected to and enjoyed providing awesome customer service (it’s possible that my caffeine addiction helped me fulfill that achievement).  About half way through the article, I had an “AHA!” moment. I realized that this is not just about business as we traditionally recognize it, but can also be applied to agency reputation and customer service within EMS.

 

Whether popular culture in our field regards EMS as a business or not, it is a business and we need to keep the money coming in to continue operations. We are a service provided to citizens.  Smiling at a patron while wearing my trademark green apron and handing them a paper cup filled with their caffeinated prescription is the same as smiling at a patient seated on my stretcher while wearing my clean and neat uniform bearing my agency patch.  I am representing my brand.  I am promoting my agency’s reputation.

 sbuxThe author in a parallel life

Mr. Blanchard posits that every “customer” facing agency with the least amount of a-holes wins.  Essentially, this means that people make a positive association with an agency for every positive experience they have with that agency.  Similarly, for every negative experience, people make a negative association with that agency.  Traditionally, if a customer has a great experience with a company they may tell 1 friend.  If a customer has a bad experience they will tell at least 10 friends. With the advent of the internet the 10 friends receiving bad information about your agency has increased exponentially. This theory does not only apply to customers we interact with directly, but everyone in the vicinity that might witness the event.  One glaring example involves modern technology. I am sure most of you have had some experience in the street with witnesses or family members with cell phone video cameras.  Some are just busybodies who want something cool for YouTube, but others have malicious intent and ambulance chasers on speed dial.  Civilians are not our only “customers.”  Our fellow responders such as police, fire, emergency management and hospital staff are our customers, too.  What if an asshole (I know you have one in mind) was on that scene representing your agency?

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I used to work at an agency that was regarded as “elite” by some in our area.  We had expensive uniforms, nice ambulances with cool reflective lettering, and more toys than you could count in our garage.  Our positive reputation as an agency didn’t last long because no one checked the a-hole count.  One fine afternoon, my per diem partner and I responded to a little old lady with flu like symptoms at her home.  She had difficulty walking more than a few steps and lived on the second floor so we had to carry her down the stairs.  I set up the stair chair and assisted her to a seated position and secured her to the chair.  My partner and I move toward the stairs with our equipment and patient in tow.  I positioned myself on the stairs to carry the bottom of the chair and let my partner know I was ready.  I waited about 30 seconds and stated I was ready again.  30 more seconds passed, I leaned over and looked around the chair to find him texting away at the top of the chair.  He was totally checked out of reality. The police officer and the bystanders on scene saw it, too.  Our real “customers” now viewed our agency as a joke.

 

Customer Service at its Finest

Pride. Respect. Professionalism. Honestly, those are not adjectives I conjure immediately when I think about EMS. The adjectives that come to mind when I imagine describing my chosen profession are: lazy, slovenly, and unqualified.  Let me make a disclaimer: There are some shining examples of pride, respect, and professionalism among EMS agencies and individual providers, and looking disheveled does not make you unqualified for your job, it makes you LOOK unqualified for your job.  Being an a-hole is not limited to verbal communication. Visual communication speaks volumes.  Every time you wear your shirt wrinkled or untucked, every time your boots aren’t tied, every time your truck is dirty, every time you text while you are on a call indicates that you don’t care about the “customer’s” experience.  It indicates that you, and your agency by proxy, are a-holes.

 

Resolving this issue should be important to EMS agencies, although experience shows us this is not always the case.  (This is when people start to send me hate mail.)  The reputation of an agency is of the utmost importance because it influences all aspects of the organization.  The most obvious of these is related to securing funds.  If your agency uses fundraisers to secure operational funds for continuity of operation, you must have awesome “customer” service.  Who is going to GIVE their money to an organization they regard as a bunch of jerks?  The same goes for attracting new members or employees and retaining your current staff.  People volunteer or work for and agency for a variety of reasons, one of which is to belong to a group they believe in and identify with.  Even one a-hole can cause others to find new employment or volunteer at another agency or lead to a dedicated member resigning.  Now you don’t only have to find a new “body,” you have to pay for pre-employment checks such as a background check and a physical and new uniforms and training.  If you think the politicians in your town aren’t your customers, then you need to talk to agencies that have been cast aside, not by poor clinical performance or low response statistics, but because of poor customer relations.  Some politicians will reroute 911 service to the provider of their choice and then your agency is nothing more than a social club with fancy jackets.

 1781436_10202196788858772_1855065837_nThe best agency I ever worked for, felled by politics.

Mr. Blanchard proposes the awesome service you provided 10 years ago is soon forgotten, what is important to people is what you did WRONG last week.  We must provide awesome customer service continually! 20 years ago, before the widespread use of the internet and smart phones, it was easy to contain the fallout from the a-holes that afflict your organization, but now one small misstep can tarnish your agency exponentially.  Be aware of your behavior, and if you are part of the leadership structure, be cautious of who you hire or accept for membership in the first place.

 

 

 

 

 

 

 

“Your Face Will Freeze Like That!”

It’s funny how days have themes. Usually, a series of awful things happen to us during the day and they just seem to consistently work against us. On blessed occasion it’s a stunning, temperate day with perfect clouds and not a care in the world. It seems like you could drive forever and nothing could take your bliss away. Today, is something different. Today, there is an undercurrent surging … a “vibe” if you will.
“Granny” of Warner Brother’s Fame
 
I woke up to a message from my partner asking me to come in early for my shift because someone was sick. Yes, I already sense your collective heads nodding, “Oh yeah, I’ve had those days.” Believe me, I know no good deed goes unpunished and when you do something nice, you will usually get something you wanted no part in. Despite this knowledge, I happily agreed! I then had a stimulating, intellectual conversation with a good friend. All before coffee! I got to work and shortly after I was dispatched on a job to the nicest little old lady (very similar to “Granny” who owned Tweety Bird). She even called us before she was very sick! You know, the same day the symptoms started, not a week later. We took care of her, I got back to my primary and “Murphy” allowed me to wait in the seriously long Starbucks line AND get my coffee at the end. It was while I was waiting that I noticed the surreptitious undercurrent of joy I had been floating in all morning.
 
Some days it’s necessary.
 
Let me interject dear reader, your mother was not lying, your face WILL freeze like that. I found the woman who did not listen to her mother’s warning at the Starbucks counter. She was impatiently awaiting her latte. Bundled like the rest of us in an oversized, black, wool coat with an equally oversized hat atop her head, her eyes squinted and peered out from behind retro, cat lady eyeglasses just above her mouth which was drawn together in an aggressive, tight line. This lady was angry.
 
Disclaimer: Not Actual Angry Starbucks Lady
 
She really disturbed me. I could not help but stare at this woman. If this was Star Wars she would have altered my force. That is how angry she was.  It occurred to me that sometimes in EMS we act this way. It occurred to me that in many areas this is acceptable and even venerated. It occurred to me that some days at work I wear that same face.
 
Things happen in our job, terrible things. Patients or their family members project their fear of the unknown via angry or violent voices. We work hundreds of hours and ends still don’t meet while our loved ones rail in our ear about never being there. Not every moment will be a cacophony of angels trumpeting of our ecstasy. However, not every moment is agony and angst. How many situations could we prevent if we were pleasant from the beginning? How many angry letters to your Chief or supervisor and visits to their office could be avoided with a smile and friendly voice? How much could our patient’s outcome improve without the added stress of our grumpy attitude? How much could our lives improve without the stress of our grumpy attitude?
 
Just some food for thought. Not everything is that simple, but if the above sounds like you perhaps listen to this song before your shift…
 

The True Spirit of Christmas… Every Day.

You can tell a lot about a person by how they treat the disenfranchised. My grandmother used to start collecting socks, hats, and gloves in October and would store them until Christmas. During the week before Christmas she would cook a huge feast with all the traditional dishes and make individual meals for the homeless in her city. Christmas day she would pack it all in her car and my grandparents would go FIND the homeless and celebrate Christmas with them.
 
Grandma Thomas and The Author
 
Like many of us, she understood the love of serving others. Many of us think of our jobs as pre-hospital providers as technical and high minded, but the foundation of excellent care is service. We can provide all the latest techniques and gadgets, but if the practitioner is not in tune with the patient’s emotional well being the whole patient has not been treated.
 
So what happens to our “service” and compassion when we are called for the town drunk for the fifth time today or the homeless guy in layers and layers of clothes and excrement? How do we treat them? Honestly. How do we TREAT them?
 
Sometimes our role as providers is defined by the technical skills we possess, but not the social interventions that our patients might not have access to or may not know exist because they have been ignored for so long. It is our responsibility as providers to serve EVERYONE in our community, especially the unseen. Experienced providers should also note that the “new guy” is learning what is acceptable from us. If you treat people badly, that makes it “okay” for others to continue that cycle of neglect or abuse. 
This change in attitude starts with a change in our vocabulary. Like all our other patients, call them Mr or Mrs “Smith” not “Stinky Pete” or whatever nickname your service likes to use. While we are learning to speak to patients appropriately, we should not be doing all the talking. Listen to your patient. This has obvious technical elements such as obtaining an accurate history or acquiring one if your patient is a poor historian leading to better treatment. When there are no emergent matters, simply listening to your patient’s stories from their youth, military service or about their grandchildren relaxes the patient and provides a bond of trust. In my experience, I am the one who received the greatest benefit by hearing their tales and viewing history through their eyes. Be the person they remember because you showed them the greatest kindness by doing the unexpected, being nice.
 
Mark Bezos’ TED Talk on Heroism
 
Why do people become homeless or even stay homeless? Some of the usual factors that I discovered while talking with patients that are homeless include mental health issues or addiction problems. These are usually coupled with other chronic illnesses that are not addressed due to poor self-care or lack of access to regular healthcare. This is a multifaceted problem that even the brightest minds have not been able to fix and honestly, some people choose to continue to be homeless. We are not going to change it in 20 minutes to an hour. We can however improve their existence as humans, by sharing our humanity. That means: be nice and don’t dismiss them. Listen to what they have to say about how they got to this point and what their complaint is today. If someone is inebriated, their complaint might be in addition to intoxication. Complete a full assessment. This includes vital signs and exposing affected areas that need to be assessed based on the current complaint. I know, “That’s gross!” It is also our job to take care of all our patients, not just the ones who smell good. If we don’t fully assess the patient every time, we can miss injuries or indicators of chronic illness. The nurses and doctors at the emergency department do listen to our report and preconceived notions. If we say, “Oh, he’s just a drunk.” Chances are they are going to believe that, particularly with regulars, and let them sit and wait. If a patient is having a real emergency, that can obviously be a problem on many levels and the person who bears largest burden in that situation is the patient.
 Caring for the disenfranchised and invisible members of our population should be a daily occurrence, not just a special holiday season activity. This job is not just about all the “cool” stuff we get to use or skills we get to practice, it is largely about caring for others who don’t have anyone else to call. Maybe it’s time to think about why we put our boots on every day.
 
Merry Christmas!
I would like to thank two special individuals in particular for their inspiration/ assistance with this post.  A huge Thank you to Andrew Caruso and Larry Torrey for showing and reminding me that we are all human.