The Semi-Regular Reminder on EMS Politics

Yep. It’s that time again. “EMS On The Hill Day” is just around the corner.  As we all know from EMS social media and the EMS “Powers That Be,” AKA:the usual conference speakers and the people who now provide consulting services to fix the messes that they created in the first place, merely showing up one day in Washington DC in a uniform that’s a cross between Idi Amin and the Knights of Columbus will magically fix all that is wrong with EMS.

 

I’ve worked in state government for years.  I’ve been a lawyer for years.  I’ve been involved in many political campaigns and involved in political parties.  I’m telling you — that’s not how any of this works.

 

We can fix EMS through the political process.  But it’s going to take more than one day per year in Washington DC.  Here’s what it’s going to take.

  1. MONEY.  Money fuels politics.  The reality is that politicians need money to get elected.  Money buys access to the game.  In other words, you can’t watch the game if you don’t have a ticket.
  2. All politics is local.  This famous quote from Tip O’Neill is so true. The Federal government has a limited role in the provision of EMS services, much of which relates to the role that Medicare/Medicaid funding plays. Local governments make the decisions on how to provide (and fund) the EMS system.  State governments typically are the ones who license and regulate EMS personnel and services.  And here we continue to think that the solution to EMS lies in Washington DC. State EMS associations need to step up the advocacy game.  Period.
  3. This is a year round sport.  EMS has to be engaged in the advocacy process year round.  Even in states like mine where the Legislature only meets every two years, there’s plenty going on in the “off season,” which is when interim studies happen and future legislation gets planned.
  4. It’s all about the staff.  Elected officials’ staff members are the subject matter experts and they help the officials develop their positions.  Their schedules are usually much more open than the elected official — get to know them and turn them into your ally.  In turn, they may well call upon you for input — and influence.
  5. The regulatory process matters. Getting legislation passed is great.  But oftentimes, the devil is in the proverbial details.  That’s why it’s imperative to be involved in the rulemaking process and in monitoring how the various regulatory agencies implement and interpret the law.
  6. Funding matters.  When you get funding, things happen.  If you want to fix EMS, fix the laws and regulations that reimburse EMS for being a transportation service rather than a medical service.
  7. Present the image of being professionals.  You want the elected official or their staff to consider you a professional they’d trust, not someone who looks and acts like they just got out of a clown car.

 

Of course, we all want the quick and easy answer to “fix” EMS.  We’ve been trying the quick and easy answers for years and here’s where we are.  Maybe it’s time we try what the adults have done to get their various professions a seat at the table in terms of funding and professional recognition from government.

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 upholding your constitutional rights to free speech, assembly, and petitioning the government.  That’s guaranteed by our Constitution, which is a pretty unique document and guarantee of your rights and liberties as an American citizen.

Here’s where I dissent.  There’s a lot of hashtag activism going on in the medical world on social media.  There’s a ton of people who’ve taken some very strong positions because they disagree with the current President of the United States.  That is well and good.  Again, it is your constitutional right.  I have two objections to this mindset.  First, there’s a bit of a violation of trust with the consumers of these clinicians’ social media feeds.  When your social media presence is that of a “Free and Open Access to Medicine” (aka FOAM) advocate, I rarely expect to see politics.  I expect to see medicine.  As both an attorney and a medical professional, I get that one may hold strong views and perhaps even consider them as part of your professional identity. I don’t expect to see a veiled insinuation (or in some cases, outright statement) that opposing the position of the United States government is part of one’s ethical obligation as a clinician. Further, I don’t expect to see the continued belief that being “educated” means you take a certain political worldview.  Perhaps we should recall and recollect about the collective clucking of tongues at physicians and pharmacists who refused to be involve with the “morning after” pill.

By all means, if you’re asked to do something unethical, stand up.  Stand up for your beliefs as well.  But using your megaphone to shout your beliefs in the ears of those who you’ve brought to your social media home to hear about medicine is, in this guy’s opinion, a violation of that trust. And that goes doubly so when the dissent doesn’t even involve the practice of medicine.

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 pages on Facebook in particular are dominated by the loudest voices in the forum – most often poorly educated providers who repeat dogma, dated information, and flat out incorrect information. Combine that with some who want everyone to be “supportive” and not discourage people and you have a forum where bad information drives out good information.  Many of my intelligent colleagues in EMS and medicine have tired of trying to educate the unwilling.

And then, there’s another factor at play as well.  People in many of these forums want to discuss unlikely or arcane scenarios to the detriment of mastering the basics of good medical care.  Random medical-legal scenarios involving revocation of care, bizarre EKG cases, and random trauma pictures flood EMS social media.  Yet, there’s still a significant chunk of EMS providers who think that you can reverse a cardiac arrest with dextrose or naloxone (Hint: You can’t.) or that a long spine board is mandatory for every patient (Hint: The National Association of EMS Physicians and all of the current science says no.) And let’s not even talk about the number of providers at all levels who think that all respiratory difficulty gets treated with a nebulizer full of albuterol.

Bad information from bad participants drives out good information from the people who might know something. There are too many EMS social media participants who are constantly analyzing zebras when they can’t recognize the herd of horses coming towards them.

I don’t have a solution.  As the old saying goes, you can lead a horse to water, but you can’t make them drink.  While I try to educate when and where I can, I find I’d rather work with those who want to learn and want to improve themselves and their practice of medicine.  When you find those people, it makes it all worthwhile.  Until then, don’t forget the over the counter pain medicine of your choice from banging your head against your desk.