Confidence, Competence and Compassion

IGEMSA Board Advisory Member John Sammons most recent blog entry

When you hear patient centered care, what comes to mind? Or being “progressive”? Being a high speed, low drag EMS system? Typically, we think of the sexy, cool skills and things we get to do. Running lights and sirens, doing all the high acuity stuff, cardiac arrests, traumas, STEMIs, giving whole blood, prehospital ultrasound, antibiotics and all the cutting-edge things. All of those things are important, and let’s be honest, pretty cool, but let’s take two steps back. Maybe three. True impact, true patient centered care, truly being progressive and high speed isn’t always the cool new thing we get to do to a patient. Because we don’t do things to patients, we do things for patients.

A few years ago (1999) when I got into fire and EMS and started working in the ER in 2000, I didn’t understand the journey that this career was going to take me on, and how it was going to shape my view of the world. I think that’s true for most of us that get into this for any period of time. We see a side of humanity that few get to experience, and I think it is a privilege and huge responsibility that some I feel don’t appreciate or understand. The weight of what we do and our impact on our patients and their families is huge, even if it feels insignificant to us at the time.

If I could give my younger self some advice and tell him just three words to carry forward in his career that would serve him well, it would be these three: confidence, competence and compassion.

Confidence ≠ Arrogance

Confidence takes time, it takes experience, and it takes support. I was 17 years old when I went on my first EMS call. It was for a stroke at a nursing home in South Jersey and man, I was nervous. I remember the adrenaline rush and the nerves jumping on old 187 in my first rescue squad, or 21-2 in my next, responding to emergencies! Like real emergencies! We were doing the thing, or I thought we were.

What does confidence look like to me? It is the ability to walk into any room, for any call, at any time and be able to manage it. Not necessarily take control, not to be the loudest, or the biggest. Needing to be the loudest, biggest, and most in control rarely has to do with confidence, it is typically insecurity manifesting itself as micromanagement and arrogance. True confidence is the ability to be the one to step up and lead when needed, to step back and support when appropriate and be the one to take ownership when things go sideways. Confidence is the ability to stand up for what is right, to mentor others and help them grow, and not be threatened by the success of others.

Confidence ≠ Competence

A few years ago we needed plumbing work done in our house. The leak was temporarily stopped, but we needed to find it to fix it. We couldn’t access it from below because of an HVAC duct, but the plumber was sure he knew where to get to it from. It was from above. Through the floor. I think you can sense where this is going. I got home and was reassured that the plumber was super confident. Supremely confident. He’d never been more confident about anything else in his life. Despite outside influence and more information, the leak was right there. Okay, I pulled up the LVP and cut a hole. The good news was I could now see where the broken pipe was, the bad news was that it was three feet away and we needed another hole. How many times have we seen clinicians, or anyone for that matter, be really confidently wrong? I’m looking at you news article and Facebook comment sections.

EMT, AEMT, and Paramedic school all give you one thing: a place to start from. It is the entry level education that says you have the minimum amount of education needed to function at your credential level. That is not a dig at educational programs, that’s the truth. Your education shouldn’t stop, you should always be learning, and there is always something to learn. I learn something new almost every day, I reflect on almost every call or debrief with coworkers on calls often to see how things went and if there was any room for improvement.

Tied into confidence, competence is also knowing when to say that you don’t know. We shouldn’t have a “fake it until you make it” mindset, because sometimes faking it can get someone killed. We should have cultures that provide a safe place for people to say that they don’t know, and we need people to step up and say that’s okay, let me teach you. That builds competence and confidence, in both the teacher and learner. This is a team sport; we should all be working to make it better.

Confidence + Competence ≠ Compassion

There’s that one person, or maybe more (hopefully not too many) that we can think of that has the bedside manner of a rattlesnake. The person that can recite the textbook, protocol book, regulation book and can do all of the skills, which sounds great until they open their mouths and they are just an asshole. They are in a business that is all about taking care of people, but they don’t have any clue how to take care of people. Do I want someone that is clinically awful but is super nice taking care of my kids? No, probably not. But there is more to being a good EMT, AEMT or paramedic than the clinical skills. It’s the soft skills, the affective domain, the willingness to see the world through someone else’s lens, the ability to sit next to another human and just care.

Our healthcare system is broken. It’s been broken, it’s still broken, and it’s going to be broken tomorrow, too. Everything is expensive, it’s almost impossible to get appointments with specialists in a timely fashion, if you even can get transportation to the appointment. Insurance, if you have it, doesn’t cover everything and some folks need to choose between healthcare and their rent or mortgage. Or food. Or taking care of their kids. Or they simply just don’t understand why managing their blood pressure or diabetes or other chronic condition is important. I get it, it’s exhausting sometimes running call after call, to what we deem “not an emergency”, but we have a choice. We can choose to focus on the good we do, the impact we have, and how important what we do is, or we can be difficult to work with, miserable all the time, and constantly clashing with people. Personally, I don’t have the energy for all that. Just be a good human.

I was in a meeting, and I guess one of the attendees has never seen my former blog, website, or podcast because he said, “patient centered care is the dumbest phrase ever, because it’s what we already should be doing.” I agree. It is what we already should be doing, but sometimes we miss the mark and need a reminder.

Confidence without arrogance.

Competence with a willingness to learn.

Compassion with resilience.

Just be a good human.

John Sammons is an Advanced Practice Paramedic with Wake County EMS in Raleigh, North Carolina. Watch for future blog posts as John presents his personal takes on being patient focused in EMS.