Administration and Leadership, Patient Care, Trauma

Egos Can Prevent Good Medicine

Issue 3 and Volume 36.

It never fails. Regardless of where my lectures take me, this cartoon always brings the most laughs and applause. The strong message here: I’m one heck of a funny guy. Sorry, that was my superego talking, which is what this article is about. I’m referring to our fragile EMS ego-system. And when it comes to egos, paramedics seem to have taken it to a height not seen since the Hubble satellite made its last transmission 100 gazillion miles away.

Freud defined ego as the center of balance within our brain, with “id” and “superego” being on either side of it. But I was never much of a psychology buff, so I always get the id and superego mixed up. For this column’s purposes the id could be defined as complete apathy toward anything involving one’s self. Superego (i.e., U.S. Congress) could be defined as being completely apathetic to anything not involving yourself.

To serve medicine altruistically and avoid being called a surgeon, we’re supposed to balance our brains. You’d think humility would serve us well in EMS, considering the lack of respect we receive from public safety and the health-care industry. Not to mention we’re also the minimum wage trade of emergency medicine.

I have some theories on what may initially drive our EMS brain matter to stretch beyond its intended capacity. I believe inflated character development begins the first time we drive an ambulance Code 3. Witnessing all those vehicles yielding as if the seas themselves were parting before you can’t help but create an overwhelming sense of clout, control and an urge to not just walk, but stroll, on water. And then there’s the uniform, which portrays authority—along with sloppy eating habits.

Our sense of power is further magnified by the mere fact that we deal with life-or-death emergencies—specifically Medicare and Medicaid reimbursement forms.

So why do paramedics tend to take their egos to an even higher level of exaggerated obnoxiousness? Well, let me first ask you this question: What’s the difference between a paramedic and a terrorist? Answer: You can negotiate with a terrorist.

We were all initially taught to take control of each situation. Becoming a paramedic pushes that idea of control to an even higher, potentially obnoxious level. Without checks and balances, the new paramedic may have no sympathy for anyone beyond themselves.

When I look back on the onset of my paramedic career, I’m sure colleagues thought I overlooked or dismissed their ideas. Maybe I was a little short-tempered or patronizing, and maybe I failed to delegate appropriately. With time and maturation, I can now look back on my self-doubting beginnings and realize that my colleagues were just moronic ignoramuses and had no clue what they were talking about.

Let’s be honest: EMS attracts a lot of insecure people who want respect and figure the uniform and sharp needles will give them that. Their calls define them, and if they don’t get enough good ones, they take it out on others. But they’re also eccentric people who need everything to go just right. Because they work in an imperfect science, they often blame others for those disappointments. They may take credit for others’ work. And if in a position of management, they rarely hire anyone who’s quicker, younger, smarter or cuter, because they always have to win. This is sad, and I blame them for making the rest of us look bad—even though we’re better than they are.

Inflamed egos are a big part of medicine. And I doubt there’s a cure, despite the accessibility of rapid IV push Manitol. I’ve found that you can rarely change people as much as you can change yourself. Try to change someone’s ego, and they’ll just tell you, “Leggo my ego!”

Humility isn’t about being better than someone else. It’s more about being better than you used to be—hard to do when you’re perfect.

It’s a lifelong endeavor, but when I find my ego on a collision course, I try to keep my sympathetic response in check by following a few self-imposed

  • Count to 10 … or 1,000. Try to eradicate the pain in the world you work, but stay at peace and let the offensive stuff roll Let the energy of your intention be your trophy, not the title of winner or loser.
  • Let go of the need to be right all the time. It’s often considered a hostile act by others when you fight to prove them wrong.
  • Ignore the patches and titles. Every person is your superior in some way.
  • Forgive yourself and others for not being perfect. Everyone is fighting some kind of battle.
  • Incorporate humor daily and nurture Steve Berry’s ego by purchasing his cartoon books.

Until next time, remember: Focusing too hard on your ego will give you blurred vision. JEMS

This article originally appeared in March 2011 JEMS as “How’s Your EMS ID?: Taking the ego out of EMS.”