Technically speaking, wouldn't a cookbook medic be the best medic?

ParamedicStudent

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A medical director writes all of the protocols as standing orders for ems, so for a medic to following everything to the dot, he/she is following orders to a tee, exactly how his/her medical provider wants them to. Plus, it'll have the strongest chance to winning in a malpractice lawsuit because the paramedic was doing everything that he/she was supposed to be doing.
 

zzyzx

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When people speak of cookbook medics, they don't so much mean medics who strictly follow protocols, but ones who lump patients into specific categories and then give them all the same treatment. I.e., giving nitro and aspirin to a 25 y/o complaining of chest pain with no indication that the pain is related to any cardiac issue.
 

GMCmedic

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When people speak of cookbook medics, they don't so much mean medics who strictly follow protocols, but ones who lump patients into specific categories and then give them all the same treatment. I.e., giving nitro and aspirin to a 25 y/o complaining of chest pain with no indication that the pain is related to any cardiac issue.
This.

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mgr22

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Just to build on the above comments, ParamedicStudent, even those who write protocols acknowledge the importance of judgment. Protocols can't cover all circumstances. An important step in your development as a medic will be when you assess patients and make treatment decisions based on good medicine, then figure out how to best fit those things into your protocols, rather than the other way around.
 

Underoath87

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Yesterday, one of my coworkers performed a 12-lead on a 2yM who scraped his knee and cried so hard he vomited. When his EMT asked him why, he replied "because he's ALS". Sure, he may be following protocol, but it is still completely stupid.
 

StCEMT

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There is a difference between being book smart and knowing how to apply that knowledge appropriately and being confined to the limitations of your protocol book like the given examples.
 

akflightmedic

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IV, O2, Monitor, Transport....le sigh.
 

Bullets

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Yesterday, one of my coworkers performed a 12-lead on a 2yM who scraped his knee and cried so hard he vomited. When his EMT asked him why, he replied "because he's ALS". Sure, he may be following protocol, but it is still completely stupid.
I mean , if i have time i do a 12 lead on everyone i can. I want to see as many 12 leads as possible and especially across a lot of age groups.
 

GMCmedic

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I mean , if i have time i do a 12 lead on everyone i can. I want to see as many 12 leads as possible and especially across a lot of age groups.
Hopefully not doing so on otherwise BLS patients and giving them an ALS bill for your curiosity.

That 2 year old mentioned is BLS any day of the week, regardless of what protocol says.

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Summit

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I think the best provider has good evidenced based protocols with latitude for provider judgment combined with OLMC, quality education, experience, and critical thinking.

To replace that with an equally performing "cookbook requires" a set of protocols would be so large and extensive that it would be impossible to memorize and regularly update as they would necessarily be significantly larger than your paramedic texts... well beyond the capability of the provider whose mental design puts them in the category of "cookbook medic."
 
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VentMonkey

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Bottom line: you can't teach intuition.

Some people should not be paramedics, these types would be those some.
 

Bullets

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Hopefully not doing so on otherwise BLS patients and giving them an ALS bill for your curiosity.

That 2 year old mentioned is BLS any day of the week, regardless of what protocol says.

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2 tiered state...if its BLS then i wouldnt even be there
 

RocketMedic

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Here's the difference: knowing when not to do something. For example, your protocol may state that every chest pain or possibly-cardiac patient get aspirin, barring an allergy- but it's your diagnosis and knowledge that support withholding nitro and aspirin from the dissecting aneurysm. Likewise, it's knowing when to jump to something else, utilize an alternative, or simply do what's in the patients best interests instead of the next thing on the checklist. Cookbook medics might not be technically "wrong" when graded on adherence to dogma, but they're not right on a lot of margins of care.
 

akflightmedic

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Training teaches you 1000 ways to skin a cat.
Education demonstrates the cat may never had needed to be skinned.
 

medichopeful

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Yesterday, one of my coworkers performed a 12-lead on a 2yM who scraped his knee and cried so hard he vomited. When his EMT asked him why, he replied "because he's ALS". Sure, he may be following protocol, but it is still completely stupid.

In fairness, if he was able to get a crying, vomiting 2 year old to hold still for an accurate 12-lead, he is probably a better provider than 90% of us on this forum.
 

SpecialK

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It depends on what you are talking about.

Some things you absolutely have to follow in a particular order; for example setting the defibrillator to cardiovert somebody, or using a checklist; such as the asthma non-transport checklist, or seizure non-transport checklist.

Then there are things you have to use clinical judgement on to decide what is best in terms of assessment, diagnosis and treatment.
 

mgr22

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SpecialK, the protocols you refer to -- e.g., cardioverting in a fixed sequence, or following a rigid non-transport checklist -- aren't universal. Some of us have more flexibility than that. Such regional differences are reasons it would be a mistake to treat protocols as anything other than guidelines. It's important for those of us who write protocols to understand that and not suggest written instructions are substitutes for good judgment.
 
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