The Access To Knowledge

One of the greatest things about the Internet is that it has democratized access to information.  Most academic journals are available online, some of which are even available for free.  Wikipedia has improved, in most cases, to provide reliable information on most subjects.  There are plenty of other sites that provide scholarly level information out there.  Then there are sites like Khan Academy that make basic education in a variety of subjects available for free.  And if you can’t find the information online, you can order virtually any book online through retailers like Amazon.

In other words, you can have access to the same educational materials that train professionals in any field.  Want to learn gastroenterology?  The books used to train residents and fellows can be ordered online.  Want to learn engineering?  The materials are available online too.  Want to be an administrative lawyer?  Yep, law can be found online too.  You can find most legal codes online and with a bit of searching, you can even find the relevant cases too.

Here’s what none of these books will teach you.  They won’t teach you the mindset of how to think like a member of a profession.  The materials alone don’t teach the academic or professional discipline. Reading statutes, regulations, and cases may provide some insight on the law, but you won’t necessarily grasp the legal principles or reasoning, much less how a single law in and of itself interacts with all of the other laws out there.  Likewise, one can buy all of the cardiology texts out there and become quite knowledgeable about the heart while at the same time failing to realize that the heart is but one interdependent organ in an entire human body.

The democratization of information has done wonders for our society.  Yet, one of the biggest challenges is that mere access to information doesn’t necessarily mean understanding the information.  Nor does it mean placing said information into its proper context.  If you don’t believe me, look at the number of self-appointed experts who have “done their research” posting online. Cherry-picking from a discredited study doesn’t make you an expert on autism and vaccines. An undergraduate degree combined with a medical degree is where you learn to skeptically examine scientific claims, understand how the human body works, and put that knowledge together to treat patients. Likewise, merely cutting and pasting a statute that you found via Google doesn’t make you the next Clarence Darrow.  As much of a cliche as it is, “learning to think like a lawyer” is exactly what law school does — teaching legal research, teaching legal writing, and ultimately, teaching enough legal reasoning so that you realize that a case is rarely won by merely cutting and pasting a statute in and of itself.

Information is great.  Education is more than information.  Education is the process of learning how to process, synthesize, contextualize, and use the information outside of a vacuum. And that’s why there’s such a market for the coffee mugs that say “Don’t confuse your Google search with my professional license.”  Whether it’s an EMS certification, a professional engineer’s license, or a subspecialty in medicine, thinking that reading the books and journals on your own makes you the equivalent of a licensed professional is hubris to the point of danger.

How does this apply to my usual writing about my self-described expensive hobby of EMS?  Quite simply, our field has a fair amount of self-appointed experts in anything vaguely and tangentially connected to EMS.  While there are many in our field who worship at the altars of dogma, vaguely defined “experience,” and the even worse defined “how we do it in the field,” probably the most dangerous are so-called leaders in our field who routinely opine on subjects in which they have knowledge, but not the education to contextualize, synthesize, or harmonize the knowledge outside of what they just read and parroted.  If you don’t believe me, look at how many places immediately remove (or add) an intervention or medication based solely on one article that’s been making the rounds of the EMS community.

In conclusion, the summation of human wisdom in any field is rarely going to be found in a Facebook post or a blog post.  As the Romans would say, “caveat emptor.”  As Reagan would’ve said, “Trust, but verify.”

What Really Happened With The Proposed Sale of AMR

A friend and fellow blogger recently posted a blog where he lays the blame at the Trump Administration for the possible sale of AMR due to the possible repeal of the Affordable Care Act, AKA “ObamaCare.”  While it’s certainly trendy to blame President Trump, Republicans, and Russian hackers for everything (and I blame them for my breakfast tacos being fouled up), I offer a more reasoned analysis that lays the blame right back it should lay — at the feet of the management of Envision Healthcare, AMR’s current parent corporation.

In my opinion, Envision Healthcare and AMR engaged in two critical failures that continue to haunt EMS.

First, we in EMS like whatever is new and trendy.  If it’s on the cover of JEMS, a Facebook page, or mentioned by the right “EMS celebrity,” we jump right in.  Whatever is the newest trend, we embrace it and go all out with it. Envision/AMR jumped into community paramedicine and spent like drunken sailors on shore leave.  AMR spent significant cash on critical care classes for paramedics, partnerships with hospital networks and hiring a significant number of “celebrity” EMS physicians.  Yet nobody ever asked the simple question, “Where is the money to pay for community paramedicine coming from?”  Apparently, nobody found an answer to that.  In other words, EMS spends money like the stereotype someone who just got a tax refund check — they put new flashy rims on a car that barely runs.  In all honesty, there’s not even a commonly accepted definition of what constitutes community paramedicine – primarily because community paramedicine programs are designed to meet unmet needs in the local community.  In other words, the needs of one community aren’t going to be the same as the next town over.  And in keeping with the free market principles of the US economy, if there’s money to be made meeting a need, it’s likely that a business will expand to fill that need. The fact that nobody was in the community paramedicine market should’ve been a big, giant, huge hint — there’s not much money to be made in diverting repeat users of EMS.

Second, like I’ve mentioned before, EMS is ill-informed and poorly engaged in the political process.  From the get-go, there was no guarantee that the Affordable Care Act would provide a revenue stream for community paramedicine, much less EMS as a whole. Next, with a Republican takeover of both houses of Congress in 2010, primarily as a response to the enactment of the Affordable Care Act.  The fact that Congress controls the purse strings of the Federal government should’ve been a hint to Envision/AMR that the Affordable Care Act was in jeopardy.  Yet, aside from seeing pictures of “EMS On The Hill Day” where everyone dresses up in an EMS uniform where they do their best impersonation of Idi Amin, I rarely see EMS involved in the political or regulatory at the Federal level and virtually never at the state level.  Healthcare is one of the most regulated business fields out there and to fail to engage, especially effectively, in the political and regulatory process is professional malpractice, if not out-and-out incompetence.  Say what you want about a certain large private EMS company based in Louisiana, but those Cajuns have a government affairs team and in-house legal counsel — and those Cajuns were smart enough not to nibble on the “reinventing healthcare” bait that the Affordable Care Act dangled in front of private EMS.  They’re also profitable and return the investment to their employee owners.  Jokes aside, that’s pretty impressive in any business, much less the EMS business.

Blaming President Trump for the possible sale of AMR is like blaming the dealer at a craps table in Vegas for the bad gambling decisions you made.  In conclusion, Envision took a huge gamble based on a poor understanding of the business and regulatory environment that it plays in.  And sadly, Envision’s employees are possibly going to be the ones who have to pay for the loss.

 

Another Part of Being a Professional

Social media is the gift that keeps on giving for an EMS blogger.  It enables me to amplify my voice.  But today, it keeps pointing out something so obvious about why EMS still isn't taken as a profession. Plain and simple, part of being a … [Continue reading]

Yelping The Eagles

Anyone who knows me knows that as much as I love EMS and law, I also enjoy good food and have a tendency to write reviews of good (and occasionally bad) food on Yelp.  This weekend, I've attended the Gathering of Eagles conference in Dallas.  Seeing … [Continue reading]

McDonald’s Applied To EMS

Nope, this post has zilch to do with EMS wages, so put those pitchforks away. Rather, I'll ask a semi-rhetorical question.  Why do people stop at McDonald's when they're travelling?  It's simple.  People know what they're going to get and they like … [Continue reading]

Medicine and Politics

I get it.  Social media, outside of a few select areas, takes a fairly liberal bias.  And there's more than a few folks who believe that being liberal is consistent with being educated.  I get that.  As a lawyer, I'm one hundred percent committed to … [Continue reading]

Gresham’s Law and EMS Social Media

In economics, there's a concept called Gresham's Law.  Gresham's Law states that bad money drives out good. Sadly, the same is often true in EMS social media.  Bad discussion, particularly in some forums, drives away good discussion.  Most EMS … [Continue reading]

Be scared. Be very scared.

I saw a post in an EMS forum from a newly minted EMT expressing fear and trepidation about their knowledge base and their readiness to perform in the field. After some reflection and even a dose of cynicism and sarcasm, I hereby put these thoughts … [Continue reading]

We Aren’t Nurses. And Nurses Aren’t EMS Providers.

For the record, I'm sick and tired of the nurse bashing. Not here, but on EMS groups in general. While there's some overlap between EMS and nursing, the two are entirely different fields and both have a special place. Sometimes, though, EMS proves … [Continue reading]

Yes, We Are A Service

We keep seeing the pleas and exhortations to "pay EMS workers what they deserve."  I get it.  We're underpaid.  Or so we keep hearing. Whether we are employed by a public or private entity, we're still a business.  We get paid for our services, … [Continue reading]