It Depends

Anyone who knows me in real life or has heard me talk about the law has heard me say that the lawyer’s favorite answer to any question is always, “It depends.”

In the law, we have a lot of sayings.  “Bad facts make for bad law.”  And another favorite question of mine is “What does the contract say?”  These sayings, among many other legal maxims, recognize that answers to most legal questions are nuanced and there are many variable factors in answering the question, including the facts underlying the matter and the law of the jurisdiction.

Yet when I switch roles from lawyer to paramedic, I never cease to be amazed by the number of EMS providers who want hard and fast answers to complex medical questions.  They want an “If A, then B” approach where their ability to make decisions is binary (yes/no), as opposed to providing for nuance and judgment.  The answer in almost every scenario facing a medical provider is incredibly dependent on many subjects, including provider skill, patient presentation, access to definitive (and appropriate) care, and availability of resources. In other words, what works in rural Nevada doesn’t necessarily apply in downtown Boston.  And one rightfully expects different measures to be taken based on patient presentation.  It’s really short-sighted and dare I say, ludicrous, to expect complex questions to be answered with simple linear yes/no answers.

Part of being a professional, in any field, including EMS, is that we embrace nuance and subtlety in our practice.  By embracing the fact that uncertainty and nuance enhance what we do, we become professionals.  By demanding a liner flowchart, we remain technicians.  And ultimately, it remains my core belief that EMS providers are, even in a limited way, engaged in the practice of medicine. Practice your profession.