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In EMS, Perception Is Everything (1)

In March, I found myself cruising west over the South Carolina Midlands toward the Georgia line. It was a misty day, eerie, with small patches of clear sky only at the peak of the rolling hills. From the CD player, Glen Campbell was wailing in his best Jimmy Webb mode; and as I crossed the Savannah River, I found that Gov. Sonny Perdue was glad I had "Georgia on my Mind."

I was on my way to Augusta as an invited speaker at the 2004 CHANGES Conference. Sponsored by Region 6 of the Georgia State EMS Office, this was the 14th year of the meeting. Speaking at a conference is never a tough decision if I have the time, but this one took an extra mental effort to attend. As a Floridian for almost 15 years and a resident of Gatorland for six of them, I had to pack away all of my good Georgia jokes.

(Well, almost all of them. Here's a great one they used to tell on the radio, and it's even clean. What's the best thing about leap year? There's an extra day to hate Georgia. Oh, and what does a UGA graduate say his first day on the job? "Do you want fries with that?" Needless to say, these are generic; feel free to substitute the name of your most hated collegiate rival. And if you think this is bad, you should see all the Florida State jokes I know. But I digress ... again).

I had never been to Augusta before, although I do recognize that for golf aficionados, there is a certain country club of repute that periodically proffers lime-green sport coats to tournament victors. I will admit that this means very little to me, because I am the one doctor in the planet who does not play golf. I did try once, scored about 98 billion, and decided that those odds were way to steep for my level of patience ("I've dropped my handicap from 400 to 398. What a great game!!).

The Radisson Riverwalk was a wonderful facility, and after arriving and getting cleaned up (I thought using soap would be a nice gesture), I gave my first of two talks. For me, the work was merely a prelude to food, and this conference does dinner right. The evening meal was a candlelight affair with regional dishes, such as pecan-encrusted pork. It made me wonder what we would serve in Daytona for local cuisine. There actually was a columnist in the January 2004 issue of Glamour magazine who identified the Daytona Beach diet as, "Bud from a beer cozy and bologna sandwiches with sand in them." As a public health official, it bothers me that he may be right.

Dinner with EMS people is always interesting, and stories were told as they often are. There were the tales of the nursing home patient who got CPR sitting up, the other nursing home resident who got CPR and was actually alive, and the woman in labor who identified EMS as her primary care provider with the words, "Y'all is." The best story was how one of our dinner companions acquired a crab louse in the ED for a college entomology course. This then prompted a review of the use of Kwell vs. lighter fluid to kill the parasites (Health Tip #1: Only light the parasites on fire when they are off the pubic area) and a discussion of how we all began to involuntarily scratch as the conversation ensued.

After dinner, it was time for a presentation by Edward Racht, MD, EMS medical director for Austin/Travis County, Texas. As you may know, I am an unabashed Ed Racht groupie. Not only that, but since I had bought him lunch earlier that day, I figured if I stayed awake there was a free beer in it for me. (Turns out I was right. Twice.)

Dr. Racht's talk focused on the concept of perception. Perception itself is a tricky word. Webster defines perception as "The act or faculty of apprehending by means of the sense or the mind." Stedman's Medical Dictionary is more specific, noting, "The process is primarily cognition rather than affective or conative, although all three aspects are manifested." Which is to say that when you perceive a person or a thing, you do so by not only recognizing and interpreting the sensory input, but also by the production of an emotional response and by conscious acknowledgment of the sensory input. When we see someone we "love," we recognize the vision, link it to an emotional peg and place that bit of data foremost in our awareness. In contrast, we don't often take those steps with our own heartbeats or respirations.

(Just to make it fun, we should also note that the English philosopher David Hume concluded that all we know is derived from our sensory experiences, and that the true objects generating these experiences ... their "ultimate reality" ... can never be known. So although I know I see a stalk of celery, it smells like what I think is celery and tastes like what I think is celery, I don't actually know what the thing that generates these experiences actually is. Think Lola by The Kinks or the Crying Game. Who would have guessed at those ultimate realities? This concept, known as Phenomenalism, is also consistent with the Country Music Vision Principle, which describes the effect of malt beverages upon the interpretation of visual data. This tenet, known in the vernacular as "beer goggles," has been immortalized in the song, "Don't the Girls All Get Prettier at Closing Time.")

What kinds of things contribute to these perceptions? Raw sensory data is certainly the starting place. The unrefined input we receive from our eyes, ears, skin and the organs of smell and taste is probably similar for all of us. But I think what makes us perceive a similar thing in radically different ways is the contribution of culture. Culture, in turn, is a function of such forces as race, religion, nationality, education and socioeconomics.

Gender influences culture as well. This is why, during the Great Napkin Color War of 1996, my intended bride saw multiple hues requiring coordination while all I saw was something to wipe up my spills. (My observation that I really didn't care what color napkin it was because it was going to get dirty later on brought the immediate response that I didn't care about the wedding and wasn't truly committed to the relationship. I've resolved to exhibit a true devotion to napkin color the next time around.)

Your view of the world drives all that you do, and that which you do is how you seem to the world. And this is nowhere more true than in personal services like EMS. To the patient, perception is everything. They don't really know if you're any good at what you do. They simply know how you make them feel.

For me, Dr. Racht's key point was that to be considered as prehospital care professionals, we must be perceived as professionals by the public. The difference may seem semantic, but I think there's a crucial root issue here.

The process of evaluating a person, thing or situation really has three phases. ... Tune in next week for details.


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