Airway & Respiratory, Operations, Patient Care, Trauma

Providers Should Treat Every Patient Like an Individual

Issue 5 and Volume 37.

I don’t think you can quantify everything that’s important in life. But in all of the science on which emergency medicine has come to depend, we never seem to give up trying.

Think for a moment. We use a numeric score to rate people’s pain. (I don’t think it tells us a dang thing.) We use endless scales to measure the concentration of ions in their body fluids, the physical pressure of the blood in their vascular systems, the color of their urine, and their heart and respiratory rates. We use scales to assess the sizes of their pupils and describe the shapes of their upper airways. We use a trauma score to predict their survival after they get hurt, and another scale to describe the severity of their burns. We imprint depth scales on the tubes we insert in their orifices. We even use numeric gradients during our runs to express the urgency of our responses to their emergencies.

We frame our lives in the same way, Life-Saver. A while back, my hometown’s pro football team (the Broncos) braced itself to take on the New England Patriots in a divisional championship game. The Broncos were no better than mediocre this year, but they had supposedly earned a shot at the Pats by beating the Steelers a week earlier, in the first few seconds of overtime. The media and the Bronco fans celebrated the win; although, few would have blamed the Steeler fans for believing they were robbed. The final score was 29–23.

In reality, there was only the barest margin of difference between the play of those two teams, and an objective observer would probably have awarded the win to Pittsburgh. In addition, the NFL’s history won’t reflect the fact that Pittsburgh’s great quarterback, Ben Roethlisberger, played the whole game on a painful, unstable ankle.

We seem obsessed with the numbers in our lives. We’ve developed maps to tell us the depths of the ocean, as well as its salinity, its temperature and how much water it contains. We assess the effects of the wastes we pour into it by guessing how many living organisms disappear afterward. (No doubt some of us believe there are acceptable numbers of those, too, even if we can’t possibly count them all.)

We’ve developed systems to help us enumerate the stars, assess their color, brightness, size and mass, and measure how far they are from us (almost as though we still believe they revolve around us). We think we know the volume of the vast space they inhabit (even if it’s so great, we can’t comprehend it). We’ve envisioned ourselves at the tippy-top of the hierarchy of all life, based on the complexity of our cognitive thought processes. Scholars have attempted since the fifth century to describe the value of nothing. (What a surprise: We’ve assigned a number to that, too.)

We even rate human intelligence using a numerical value. We call it IQ, for intelligence quotient. We discuss people in terms of their IQs, as well as their age, height, weight, body-mass index, annual income, and belt and neck sizes (as though their dimensions actually help us to understand anything about them).

The business of helping people in crisis is a lot bigger than the stuff we can measure. Measurements are simple routines, each of which typically reveals no more than a single answer to a simple question. What’s the blood pressure? What’s the blood glucose? What’s the pH?

It’s important to respect what those numbers tell us, but only as puzzle pieces. Whatever we do, we need to be much more focused instead on a prime number we call “one.”

Serving people is all about individuals. Taking care of them requires a willingness to admit that we don’t know much about them. But we have a persistent commitment to observe, question, examine and think. In emergency situations, we sometimes need to do all of those things at warp speed. (If anybody ever told you this EMS stuff would be easy, they altered the truth.)

Next time you kneel in front of somebody you don’t know or sit beside someone in that ambulance of yours, look them straight in the eye. No matter how ordinary they seem, how ugly or even unpleasant, ask for their name. And use it. And make sure there’s no doubt in their mind about one thing: While they’re with you, they’re important. What they say matters. And how they feel is essential. Not just any old person has the talent or the desire to do that. Those who do are called caregivers.

Are you one of those? If so, you really are special. This article originally appeared in May 2012 JEMS as “Numbers: Reflections on the value of one.”