I Know Better Than You Do

Over the last week, I’ve had some interesting conversations with some smart people in EMS. Likewise, I’ve had some conversations with people who think they’re smart. During the course of these conversations, I noticed that a common trait of these people is that they believe their intellect alone qualifies them to be trusted to enact their vision. These same people also believe that they know better than you. Further, you should just accept what they say because they’re “experts.”

I’ll start by taking an example from EMS history that has received a lot of attention in the last few years. There’s been significant discussion about Freedom House and why it shut down. What Doctors Peter Safar and Nancy Caroline did in the infancy of EMS and advanced life support was nothing short of remarkable. It was even more remarkable to get these results with a pool of medics of unemployed men from a marginalized community. The current narrative from many of those who’ve read the book American Sirens is that the only reason Freedom House went away was racism. I’ll NEVER deny the factor of race in American society. But the book also takes time to explain that neither of the doctors got involved in educating the city council about Freedom House and then lobbying the council for support of Freedom House. There was a note of shock and surprise from the doctors that politicians (and presumably the public) wouldn’t listen to them about the value of Freedom House – because they’re doctors.

As we’ve seen in debates about healthcare and public health ever since, the mere appeal to authority does not persuade the public. Expertise IS important. Even more important is the ability to be able to talk to people to convince them. Shaming, belittling, condescension, arrogance, elitism, and smugness not only fail to persuade others, but often (if not always) cause others to dig into their position even harder.

Sadly, there’s a few EMS influencers out there trying to change EMS who haven’t gotten that message yet. Several of these people have good ideas. But their attitude and delivery is so off-putting to others that they don’t even get to sell the message. Yes, we need better EMS education (and there might be some advantages to an actual EMS degree), we need an EMS association that advances the profession, and we need to address maintaining currency and competency for current clinicians. But no matter how compelling or correct your idea is, it won’t go anywhere if your tone and delivery ticks people off before you even finish. Worse yet, you won’t even get the time of day from actual decision makers, whether that’s a chief, medical director, public official, or elected official. Good ideas go nowhere without support. Obtaining support requires more than an appeal to authority. Most people don’t like being talked down to, meaning you have to overcome that before you can even begin to convince them.

Years ago, I read a book from former Speaker of the House Tip O’Neill. He said, “People like to be asked for their vote.” Ask people to support your idea. Don’t tell them to support it. And definitely don’t tell them they’re not smart enough to understand why you’re right and they’re not. Even if you don’t think you’re doing it, your tone and delivery may be saying otherwise. A computer or phone screen doesn’t convey tone well — and it’s easy for the tone to be misread. (Cue the multiple stories of “so-and-so isn’t that bad in person.” Those are usually followed by someone else telling you their social media persona is EXACTLY who and what they are.)

Life, and EMS, isn’t a social media echo chamber, Med Twitter, or an amen corner in a chat group of your friends who are convinced they alone have all the answers. If it was, we’d see a lot of these supposed experts in EMS with the influence to match their ego – and the results to match.