To field personnel, it seems EMS management sometimes relishes conformity, increasing the number of self-promoted rules, rewarding those who mindlessly follow them and tending to run off those who are more independent minded. Since independent thinking is necessary to function well in our profession, this seems to be counterproductive to caring for patients. An analogy can be made using the 1970s TV show “M.A.S.H,” which seems to be perpetually in reruns. Two doctors on the show, which is about emergency care of U.S. Army soldiers during the Korean War, are very different. One is a conformist and the other an independent thinker.
Hawkeye Pierce is the laid-back, wisecracking doctor on the show while Frank Burns is the up-tight, spit-polished shoe-wearing type. Hawkeye is gifted with exceptional skills as a physician and has a compassion for his patients; both of these often lead to a lack of tolerance for the Army way of doing things and for his Army superiors. Frank is less than competent as a physician, and his first priority isn’t patient care but his quest to look good for his Army superiors and to follow the rules without question.
Who would you rather have as the medic taking care of your family: Burns or Pierce?
We can all see Frank Burns, with the sweat beading on his upper lip, at the scene of a significant EMS call, trying to make a decision. He’s looking around for a superior officer to make the call for him but there’s no one there. He hasn’t had the opportunity to think for himself before, and it frustrates him when there’s no one to turn to because he has no one else to blame if the decisions made aren’t completely correct. There’s also no one to hand out accolades if everything goes smoothly. The responsibility rests squarely on his shoulders, and he hasn’t been properly groomed for the role by management. Hawkeye, however, knows what to do to take care of patients. Prehospital patient care, by the very nature of the work, is a profession in which the provider is often on their own, with no supervision, and must draw upon their ability as an independent thinker to guide their decision-making and treatment plan.
Yet, the rewards given by an organization tell volumes about what it values, and modern EMS managers often demonstrate that they value the Frank Burns-type of paramedics, ones who follow the rules without question, rather than those who possess the Hawkeye Pierce-type qualities that make a medic great. Traditionally, your best patient care has been delivered by those personnel who are independent thinkers, like Hawkeye. However, the dilemma for EMS managers is that these “Hawkeyes” who emphasize exceptional patient care and and possess the ability to make rapid judgment calls on the scene are also not going to mindlessly follow a new rule or adapt to change without good reason.
EMS management often fails to realize they might be stifling the up-and-coming medics’ ability to think independently with their “my way or the highway” management school of thought. They may be running off those with differing opinions or those who don’t completely conform to their way of thinking, i.e., they’re running off the Hawkeye Pierces. I believe patient care suffers as a result. We’ve got to embrace those whose opinions may differ from ours and be tolerant of those who don’t agree with everything we say. In other words, too many EMS managers wear their ego on their sleeve. It’s not about making the service into “my” service but rather sharing the service with the employee. The goal is excellent patient care, not a hierarchal dictatorship.
On the flip-side, do spit-polished shoes really make a good medic? Certainly there’s a sense of pride in one’s profession that can be seen in Frank Burns. However, the motivation must be pure. Don’t shine your shoes and press your shirt so you look good solely for upper management, which is Frank’s only motivation. Do it because of an inner sense of pride and because we’re in the public eye where, for so many years, our image was “Bubba EMT” arriving at the emergency department with a clump of chew in his mouth and no shirt over his generous belly. We’re a profession, and we must elevate that profession by being aware of the impression we give in public and making it a positive one of a cool-headed, in-command professional at the scene, someone who is competently taking care of the public_s family.
Once the Hawkeyes are cleaned up and respectably dressed, however, they must be allowed through the open door of the front office. In the show, Hawkeye is the one who can go to Henry or Colonel Potter’s office and express his opinion openly and without fear of repercussion. He can do this because of his reputation as an extremely competent physician. For the medic, however, this reputation is earned in the street.
EMS managers should embrace the seasoned medic’s opinion but might need to make some changes to hear it. For example, a U.S. Navy admiral once forbade the wearing of uniforms in the Navy’s nuclear program because he found that the lower-ranked workers had better ideas but the clear hierarchy of the visible uniforms prevented them from expressing those opinions. (1) Independent thinkers are typically not conventional thinkers. They tend to want an explanation of the reasons behind management’s actions and they want to be allowed to voice their opinions on change and, perhaps, be actually heard when they have a better idea than management_s for fixing a problem.
So we end up with a win-win situation if the Hawkeyes and Franks are allowed together in the EMS workplace. In this world, the Hawkeyes are allowed their place as patient advocate and competent field worker, which is for the betterment of the citizens. The service grows by allowing them to constructively voice their opinions. And the Franks are allowed to contribute by reminding the independent-thinking Hawkeyes that some conformity is necessary to have a cohesive, well-functioning EMS service. There won’t be a loss of that independent streak, but an occasional polishing of the shoes and an understanding that sometimes things need to change. They might also refrain from heckling management from the back of the room when hearing the reasons behind the latest new policy.
Robert Powers,BS, RN, EMT-P, has been a full-time paramedic with Wake County (N.C.) EMS for 24 years. He has also worked as an emergency department RN and a disaster coordinator. Contact him at”žrpowers@disasternursing.org.
Reference
- Lews EB: “Admiral Hyman Rickover: Technological Entrepreneurship in the U.S. Navy.” in Doig JW & Hargrove EC (Eds.): Leadership and Innovation: Entrepreneurs in Government. Baltimore: Johns Hopkins University Press, 1987.”ž”ž