Conquer the ‘Us vs. Them’ Mind-Set

Mike Smith is a featured speaker at EMS World Expo 2013, September 8–12, in Las Vegas, NV. For more information, visit EMSWorldExpo.com.

During my travels, I happened to cross paths with an old-dog EMSer I’ve known for close to 25 years, a senior medic for an urban provider that runs most all its calls in a tough inner-city environment.

In serious catch-up mode, we worked our way through family, health and work updates. Information was moving back and forth quickly to say the least. However, one comment he made put the brakes on our dialogue.

He shared with me what he felt was a startling revelation: In recent years, many of his coworkers had begun to see their patients as combatants. Though I’ve certainly had my share of encounters with patients that turned violent, I’ve never heard combatant used to describe patients as an overall term, on an everyday basis.

The simple fact of the matter is, not all of our patients appreciate the work we’re called to do. One particularly challenging group we encounter on a regular basis are those I would describe as professional substance abusers.

For the sake of clarification, I am not referring to the guy who hits the sports bar on Saturday afternoon to have a pitcher or two of beer with his buddies while watching some athletic competition. I am referring to folks who alter their perception every single day with alcohol, cocaine, narcotics, meth, cough syrup, animal tranquilizers, etc.

The folks who choose to exist in some form of chemical haze just don’t interact well with those other members of society who choose to get up every day, go to work, hold a steady job and pay taxes as productive citizens. EMS is often involved when these interactions run amok. Not so amazingly, the problem the folks who practice better living through chemistry have in interacting with society virtually guarantees they will have problems interacting with EMS.

Having worked the south side of Chicago for eight years and then the crack district of Hilltop in Tacoma for just under 10, I have seen inner-city medicine up close and personal and can confirm firsthand the challenges of remaining professional and focusing on quality medicine when your patient is belligerent, abusive or violent and huge.

That being said, I would like to share coping strategies that may help mitigate these unfortunate situations.

• Let the legal system do its job—We are not part of the legal system. We have no professional obligation to pass judgment or mete out punishment to members of society. Our job is to provide care to the citizens of and visitors to our country in the out-of-hospital setting. In addition, we are charged with delivering quality patient care consistently, while being blind to race, religion, age, socioeconomic status and anything else that might introduce bias or prejudice to our medicine.

Maintaining our perspective on what our job truly entails, and not letting it incorporate views and judgments that aren’t ours to make, lets us focus on what we are supposed to do.

• Take things professionally, not personally—In a classic Far Side cartoon, two deer are conversing in the woods. One has a unique pattern of a bull’s-eye on the fur on his chest. “Bummer of a birthmark, Hal,” is the direct-to-the-point comment from the other deer.

Sadly, we too often have the same birthmark on our chests. When people are angry that grandma can’t be resuscitated after lying on the bathroom floor in cardiac arrest for an hour, the easy recipeint of their frustration becomes us. The same is true when it’s a guy in a bar who gets stabbed in the heart and can’t be saved. We are right there in front of God and everybody else, unable to produce a miracle medical moment. We are a convenient choice to be made a target, and as a result often are.

As such, recognize the impact the severe stress of being involved in a major traumatic event or having a catastrophic medical emergency has on people. When these events involve a seriously impaired human being, the interactions are going to be difficult to say the least.

It is essential to your well-being as an EMSer that you never take these matters/interactions personally. These are professional matters that occur in the workplace that is our world. See them in that light, and it’s much easier to leave them behind when your shift is over.

• Avoid the ‘us vs. them’ mind-set—Irrespective of the intent of any given patient to turn a call into a calamity, don’t get sucked into an ‘us vs. them’ approach. Focus on providing quality medicine, let the legal system do its job, and maintain your professional perspective. We are the Department of Help coming to the rescue, like it or not.      

Until next month…

Mike Smith, BS, MICP, is director of clinical education and lead instructor for the Emergency Medical & Health Services program at Tacoma Community College in Tacoma, WA, and a member of the EMS World editorial advisory board.