Rouge Medic has a post up about defying conventional thinking (http://roguemedic.blogspot.com/2009/11/going-against-conventional-ignorance-i.html).
One major problem I had with my fire department was the lack of critical thinking skills. The people in charge did not encourage fire fighters to think, it was all about skills. I can teach a monkey to perform the skill set for firefighter and paramedic. The specific skill set does not make a good employee. Any Hazmat technician can suit up, walk over to a leak tree and apply the patches. Any paramedic can start and IV or intubate (I am not engaging in wether medics should intubate debate). Fighting fire is not hard. The specific skill is easy to teach, knowing when & why is the hard part.
Medicine requires critical thinking to determine what intervention is appropriate and when the intervention is appropriate.
Everyone knows of the classic “cook book” medic. The person who follows the protocols verbatim without regard to the patient’s presentation.
I keep meeting nurses with this problem. Today we picked up a patient from a nursing home complaining of difficulty breathing. The nurse told me that the patient has corse rhonchi in the lower lobes bilaterally. After placing the patient on oxygen they decided to administer lasix 40mg PO and Levaquin 500mg PO. Shotgun medicine. Rather than assessing the patient and discovering that he had a low grade fever, productive cough since the previous night and had course rhonchi, they just threw everthing in his system just in case.
That is what a cook book medic would do also.
My protocols have a very specific paragraph:
“Remember that these protocols are only a guideline and are not to be followed blindly without regard for the patient’s condition or response to therapies. Use common sense. Treat the patient, not the monitor, pulse oximeter or BP cuff. Contact medical control for consultation on unusual situations as needed.”
Luckily for me the medical director left a reminder, no an order, to use our brains. Do not follow blindly. Use common sense and for crying out loud think for yourself.