When You Care About Excellence in Life

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When You Care About Excellence in Life-Saving Works

So, you’ve made it out of orientation.  You’ve completed your third rider testing in the air medical world. You’ve received the National Registry “pass” for which you studied and prepared. Med school is in the rear-view.  The NCLEX is over. You’re a seasoned clinician out there in the real world with real lives and real consequences— consequences both desired and undesired, within your control and well beyond your control. And you realize, that in many ways, your chosen vocation is an ongoing, decidedly bold quest for the mastery of controlled chaos.

Imagine you were a webcam watching your resusc assessments, evaluating your differentials, examining your decision-making models and the actuation of your interventions…are you satisfied?  Could you ever be satisfied?  For many of us, the answer is no.  We will push, we will analyze, we will dialogue, we will question. Because, with our tribe, there burns within each one of us a fire to decode the physiology of illness and injury, intertwined with the insatiable, competitive hunger for victory over the spectre of morbidity and mortality.

Have we?

The hardest thing to measure, and the very thing that would point to the impact of excellence in our practice, is the revelation of the functional outcomes the patients we encounter ultimately experience.  It is much, much easier to study morbidity and mortality in the shorter term, where the impact of our work is often murkier, less compelling.  Longitudinal studies of these shorter-term outcomes have been done, and these studies have been widely disseminated.  The golden hour in trauma, for example, has not held up well under the magnifying glass of researchers who defined this particular segment of time as the endpoint of whether what we do and how we do it really matters.

While the media rips into us, political entanglements and financial motivators seek to disempower, if not destroy, the good organizations and agencies whose mission it is to save lives, understand that we are in a battle.  This vocation that you have chosen and that you love—it is under attack.  It matters not if you manifest your work in the prehospital setting or in the acute care setting.  Everyone is feeling it.

Give up you say?  It’s bigger than we are you say?  Our tribe says no. Don’t ever forget or underestimate the ripple effect. You do you.  Disentangle from the clutter. With each patient, we have opportunity.  We have knowledge, we have experience, we have tools, we have clinical decision-making tactics and strategies, we have grit, and we often have a choice to bring excellence to the table.

Bring it.  Bring excellence.  Meet those standards of care.  Respond safely and with purpose to those time-sensitive emergencies.  Initiate evidence-based components of tertiary-care at the bedside of a critical access hospital or on a remote highway to fight the merciless progression of clinical course. Master your craft. To quote the words of Mother Teresa, “Do. It. Anyway.”

When they who are the studiers are ready and willing to take on the much harder task to collect and evaluate long-term functional outcomes, both in terms of quality of life and the enormous financial costs—both publicly and privately– from all degrees of morbidity, excellence vs mediocrity will be the new conversation. And excellence will win.


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