Why Can t We All Just Think Like Health-Care Providers? Part 2

Last week, in the first half of this two-part column, I talked about the importance of having reasons for your actions, a maxim I learned from my father many years ago. I offered my opinion that examining the issues of terrorism and homeland security from the perspective of health-care providers, rather than out of a sheer sense of needing to “do something,” warrants consideration.

So why have the things I talked about not occurred? It should be relatively easy to pass a law. Making failure to use seatbelts a primary offense costs nothing. But given that our political system is driven not by thought but by money, it s not surprising that we direct the focus to airport security. Nobody has a financial stake in the outcome). Besides, who can argue with the idea of “safer skies”? Still, one of the mandates of being an effective health-care provider is having the courage to tell patients what they need to know, whether they want to hear it or not.

(Critics might argue that much of EMS care is actually reflexive. In a sense, all EMS care is reactionary, a response to a situation. But I d counter that this claim is a bit of a smoke screen. A reactionary action is undertaken without thought. In EMS, we take a developed thought process and inculcate it so it becomes habit.)

I ve couched the initial part of my argument in terms of logic. However, human beings are not necessarily rational. Health-care providers must also consider the emotional and moral dimensions of the scenario at hand. One needs to balance the sense of security experienced by some travelers with the feelings of inconvenience experienced by others.

But just as a patient s chief complaint can indicate a problem on many levels, there are other moral issues here as well. Think in terms of screening for a disease: Let s imagine there s a contagious disease that only affects people with blue eyes. Logic would dictate that the best way to find the diseased population would be to screen everyone with blue eyes as we encounter them in the community. This raises issues of prejudice: Are people with blue eyes being singled out and stigmatized? They probably are, so to make up for this we target everyone. The human cost of screening the entire population is far too high, so we randomly screen a percentage of everyone. In doing so, we miss most of the high-risk group. This approach allows us to claim the moral high ground, but it also compromises our efforts to screen for the disease which was our goal in the first place.

If we think like health-care providers, we may find that the better (and more cost-effective) approach is to screen the high-risk population. As with any screening test, we know there will be false positives and false negatives. But it is a way to gain control over what is otherwise a purely chaotic situation.

Profiling is by no means a fine art, and I don t like the idea that anyone can be singled out simply by an accident of birth or residence. It s a very small step from mandated screenings of one group for terrorist potential to investigating other groups for “threatening” views, opinions or actions. Just as in a health-care screening procedure, any form of profiling has to be instituted with an awareness of the consequences of the action and a plan for what to do with the results. At least if one thinks like a health-care professional, one knows enough to ask the question.

Living in an open society involves risk. If America is to stay an open society, we need to accept that risk. I d contend that despite the increasing segregation in our multicultural nation, it s the baseline value of openness and interchange that continues to hold us together. Where control is paramount, cultural conflict reigns (look at Yugoslavia, Rwanda, Zimbabwe, Indonesia, etc). Again, try maintaining a health-care perspective: How bad is the disease, and how much can we do to achieve a cure without irreversibly damaging the patient?

I want to stress that my argument in no way minimizes the terrible deeds of terrorists of any stripe, anywhere in the world. Terrorist actions are those of cowards whose goals are so tenuous that they re afraid of conversation, but are perfectly willing to sacrifice others in their defense. Nor is this piece to say that we should not be watchful and aware. But one has to look at the entire issue before taking action. As EMS providers, we do ourselves no favors to blindly jump on any bandwagon. We need to use our backgrounds as health-care providers and as community leaders to explain the opinions we hold and the actions we take.

EMS professionals owe it to themselves to use the same logic and compassion in decision-making regarding issues of policy and politics as they do in issues of patient care. There are no easy answers. And while I ve certainly espoused one view in this column, someone might certainly take the same set of facts and derive a different interpretation. That s OK with me; it s the process of thinking, or, more accurately, the avoidance of it, that worries me.

Let me pose one final question: If we cannot be trusted to think in matters of public policy, how can we trust ourselves to think in our daily encounters with life and death?

Author s note: A week after I completed this piece, I was traveling to Atlanta. I was asked to show my ID twice within a 10-yard span. The three Transportation Security Agency officers who had gathered specifically to check my ID (I was the only one in line) must have thought I had changed between one officer and the next. At the X-ray machine, I took off my jacket, got out my computer, emptied my pockets it gives me a warm feeling to leave my wallet lying on a moving conveyer belt and waited while a covey of other officers patted down an elderly woman. As I was allowed to go through the detector, the officer asked if my shoes were likely to activate the alarm. I suppose it s another thing to ask about at the shoe store: “Do you have these in black? Do you have it in size 8? Will this pair set off the alarms at the airport?” And all this was without being pulled aside to be searched by hand.

I understand the desire for safety, I really do. I have no particular desire to end my time on this earth in a fireball plunging from the skies. But I also know that with any screening test, you ll only find what you expect. A drug screen in the ED only picks up what the drug screen is geared to find. Unless the system is absolutely foolproof, unless each agent has been trained in every possible way an individual might disrupt a flight and has a way to specifically identify the person in question, this random nonsense will continue unabated. Granted, it s good for the public sector unions. But for many of us, it s a source of lost time, increased frustration and an unnecessary invasion of our persons, our possessions and our privacy. The latest initiative, a proposed passenger color code based on demographic data, police records and economic data, such as your credit history, simply exacerbates the madness.

At some point, reason must prevail, or we will all go downhill together. As EMS providers, we ve been taught the tools of reason for use in clinical care. We need to apply these same tools to the larger issues of life).

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