I have worked with several services in different states. I’ve worked with cruddy medics and with some of the very best.
The very best medics are experts in patient assessment. They almost seem psychic because they can read patients so well.
Cruddy medics want to be cool like the good medics. They see the good medics asking a few pointed questions, assessing in a few areas, and assume that what they see is all that is going on. They do not see everything the medic is thinking, doing, assessing, and comparing to experience. They don’t see the skill; they only see a supposed lack of action. So they copy the lack of action. And because they are doing that to be cool, it becomes cool to not do anything.
If it’s just one or two cruddy medics blowing things off and not doing full assessments or treatments, then it’s not a huge deal. But you get enough of them, and it becomes a culture of lackadaisical coolness. This is where patients die. All for chill. All for “I’m so good, I don’t have to do all this junk.” When the good medics were still doing it all along, the cruddy medic just didn’t have the experience to see it.
I worked at a service where medics rarely did full assessments, let alone complete secondary assessments. They didn’t reassess. They didn’t expose. They didn't give o2. All to look cool.
I then went to another service and saw the difference. Great care that followed the guidelines and protocols. I may not have always seen the assessments, the details—but they were there. Any omissions were based upon skill and experience, not an attempt to appear to have skill and experience. It was no shame to work through something—rather, it was encouraged. It was a different culture from the first service. A culture of excellence.
I don’t know how to fix a service with poor culture. I just know that I which type of provider I want to be.
