I like the word “cretin”, tracing its origin back to a French physician who described the severely retarded as “too stupid to sin.”
In yet another thread there was an EMT who was once again told that EMS persons do not diagnose in the field. This topic has been hashed out many times, but I think I can help educate people and look at it from a slightly different perspective.
To diagnose in simple terms means “to know.”
If you are not aware, there are different levels of diagnosis. For example: ACS (acute coronary syndrome), MI(myocardial infarction), and transmural infarction all describe a “heart attack.” All of them are diagnosis and all of them are accurate to a greater or lesser degree.
Despite my educated opinion on the matter, SCD (sudden cardiac death) is a diagnosis.
Now I know some instructors (who should have their patches stripped from their uniform and their cards ripped up as they stand before an EMS honor guard and are forced to face backward as their horse carries them away so they cannot turn from the jeering and insults.) Haven’t figured that out or come to terms with it yet. Mostly because they are just not that bright or recognize that if they are expected “to know” (diagnose) then they alone are responsible for their errors of insufficiency. Because it is readily apparent when they don’t know and that is how they deflect guilt, blame, and responsibility. (My heroes, people who think they actually do something but decline knowing what they are doing, and expect to be respected for it.)
EMS providers even treat the diagnosis they make. For example, most of you when faced with a patient who has an angulated extremity will apply a splint to the fracture (a diagnosis). Likewise, when faced with a patient who has pulmonary and dependent edema, a prior history of MI, and difficulty breathing, you may decide to implement your agency’s treatment for CHF (congestive heart failure) which is actually a diagnosis.
Many EMS providers seem to think that only with the magic available at the hospital, a diagnosis is possible. Actually most doctors never reach a definitive diagnosis. Usually the doctor who does is a pathologist.
So how do you go about forming a differential or working diagnosis?
The answer is simple. It is by exploring the patient’s chief compliant, medical history, and performing a physical exam.
Now some of the magical devices at the hospital like a CT scan (computer tomography) Various laboratory studies, and a plethora of other gadgets and gizmos (some of which EMS actually use, like a capillary blood sugar device) are considered “adjuncts” to the physical exam.
That is another way to say “something extra”. These adjuncts permit a more accurate diagnosis, as well as guide treatment, and measure if the patient is getting better or worse.
For those of you who don’t know, close to 90% of medical school is based around physical exam and history. There are subjects that lay the ground work like physiology and biochemistry and subjects that get into the very heart of the matter like pathophysiology and various clinical rotations.
The use of adjuncts to the physical exam are not covered in great detail usually. (Unless you have some of the psycho professors I have who felt it was important to teach me how two positrons make up a gamma ray and the wavelength at which it penetrates tissue.) We did spend a semester of biophysics learning how many of these adjuncts work. (like ultrasound crystals) But generally these adjuncts are simply referred to like “the best adjunct for detecting gall stones is the ultrasound, but if pressed you can also use a… or they may incidentally show up on a…
But, I would like to point out, that since the dawn of medicine, there has been a phrase referring to “cutting for stone.” Which is generally regarded as “renal stones” but it demonstrates nicely that renal stones, and for that matter gall stones, do not need all that magical equipment to be diagnosed. You just have to be really good at history and physical.
Now some things actually do need those fancy gadgets, like a microscope or a stethoscope. Some even require complex genetic testing. (Of various kinds) However, treatment often begins before these results are in based on signs and symptoms. For example, nobody waits for the specific gravity of urine result to treat dehydration (a diagnosis) in a patient that is lightheaded, has skin turger, and is not sweating who has been working in the sun all day drinking beer and coffee.
The real secret to diagnosis is actually knowledge. How much you remember of all that could be wrong. All of the abstract concepts of science that you can apply to helping a patient.
It is not the gadgets and gizmos that make a doctor. It is the knowledge. Just like it is not an EKG machine, an IV needle, or a drug box that differentiates a paramedic from an EMT. It is all of those dis-conjoined facts they were supposed to memorize in paramedic school that they thought were only useful in the academic environment to pass the NR or State medic exam and didn’t translate to the field.
So… Despite the rather pitiful ramblings of EMS instructors who are not fit to teach, whom you may view as an expert because you simply don’t know quality from a con artist, You hopefully now has a bit more insight on what the hell exactly you are doing and what it takes to be good at doing it.
Also , the next time one of these cretins tell you they don’t “know” (diagnose) why or what they are doing you will be wise enough to not give them as much credibility as you do because they do not deserve it; Just like it is knowledge that makes a doctor or a paramedic, it is knowledge and not title that makes an instructor or teacher.
In yet another thread there was an EMT who was once again told that EMS persons do not diagnose in the field. This topic has been hashed out many times, but I think I can help educate people and look at it from a slightly different perspective.
To diagnose in simple terms means “to know.”
If you are not aware, there are different levels of diagnosis. For example: ACS (acute coronary syndrome), MI(myocardial infarction), and transmural infarction all describe a “heart attack.” All of them are diagnosis and all of them are accurate to a greater or lesser degree.
Despite my educated opinion on the matter, SCD (sudden cardiac death) is a diagnosis.
Now I know some instructors (who should have their patches stripped from their uniform and their cards ripped up as they stand before an EMS honor guard and are forced to face backward as their horse carries them away so they cannot turn from the jeering and insults.) Haven’t figured that out or come to terms with it yet. Mostly because they are just not that bright or recognize that if they are expected “to know” (diagnose) then they alone are responsible for their errors of insufficiency. Because it is readily apparent when they don’t know and that is how they deflect guilt, blame, and responsibility. (My heroes, people who think they actually do something but decline knowing what they are doing, and expect to be respected for it.)
EMS providers even treat the diagnosis they make. For example, most of you when faced with a patient who has an angulated extremity will apply a splint to the fracture (a diagnosis). Likewise, when faced with a patient who has pulmonary and dependent edema, a prior history of MI, and difficulty breathing, you may decide to implement your agency’s treatment for CHF (congestive heart failure) which is actually a diagnosis.
Many EMS providers seem to think that only with the magic available at the hospital, a diagnosis is possible. Actually most doctors never reach a definitive diagnosis. Usually the doctor who does is a pathologist.
So how do you go about forming a differential or working diagnosis?
The answer is simple. It is by exploring the patient’s chief compliant, medical history, and performing a physical exam.
Now some of the magical devices at the hospital like a CT scan (computer tomography) Various laboratory studies, and a plethora of other gadgets and gizmos (some of which EMS actually use, like a capillary blood sugar device) are considered “adjuncts” to the physical exam.
That is another way to say “something extra”. These adjuncts permit a more accurate diagnosis, as well as guide treatment, and measure if the patient is getting better or worse.
For those of you who don’t know, close to 90% of medical school is based around physical exam and history. There are subjects that lay the ground work like physiology and biochemistry and subjects that get into the very heart of the matter like pathophysiology and various clinical rotations.
The use of adjuncts to the physical exam are not covered in great detail usually. (Unless you have some of the psycho professors I have who felt it was important to teach me how two positrons make up a gamma ray and the wavelength at which it penetrates tissue.) We did spend a semester of biophysics learning how many of these adjuncts work. (like ultrasound crystals) But generally these adjuncts are simply referred to like “the best adjunct for detecting gall stones is the ultrasound, but if pressed you can also use a… or they may incidentally show up on a…
But, I would like to point out, that since the dawn of medicine, there has been a phrase referring to “cutting for stone.” Which is generally regarded as “renal stones” but it demonstrates nicely that renal stones, and for that matter gall stones, do not need all that magical equipment to be diagnosed. You just have to be really good at history and physical.
Now some things actually do need those fancy gadgets, like a microscope or a stethoscope. Some even require complex genetic testing. (Of various kinds) However, treatment often begins before these results are in based on signs and symptoms. For example, nobody waits for the specific gravity of urine result to treat dehydration (a diagnosis) in a patient that is lightheaded, has skin turger, and is not sweating who has been working in the sun all day drinking beer and coffee.
The real secret to diagnosis is actually knowledge. How much you remember of all that could be wrong. All of the abstract concepts of science that you can apply to helping a patient.
It is not the gadgets and gizmos that make a doctor. It is the knowledge. Just like it is not an EKG machine, an IV needle, or a drug box that differentiates a paramedic from an EMT. It is all of those dis-conjoined facts they were supposed to memorize in paramedic school that they thought were only useful in the academic environment to pass the NR or State medic exam and didn’t translate to the field.
So… Despite the rather pitiful ramblings of EMS instructors who are not fit to teach, whom you may view as an expert because you simply don’t know quality from a con artist, You hopefully now has a bit more insight on what the hell exactly you are doing and what it takes to be good at doing it.
Also , the next time one of these cretins tell you they don’t “know” (diagnose) why or what they are doing you will be wise enough to not give them as much credibility as you do because they do not deserve it; Just like it is knowledge that makes a doctor or a paramedic, it is knowledge and not title that makes an instructor or teacher.
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OK, now siddown.
