3 replies in one read, i think it is a record.
I must respectfully disagree.
Problem here is resources. Physicians diagnostic skills will be better than a paramedic, but the lack of diagnostic equipment (imaging equipment, blood tests) will significantly dampen their effectiveness.
This is actually a bit more complex. Many of the data collection tests are done for defensive medicine, in order to cross the T's and dot the Is to avoid a lawsuit. It is actually uite often that the physicians have rather accurate findings even before all of that stuff is done to confirm suspicions. I have never met a surgeon who required white cell counts to diagnose and remove an appendix. Prophylactic antibiotics are started well before cultures are done. (sometimes by days)
Once when I was working in an ER radiology office, I saw a physician wait for the results of an X-ray to decompress a tension pneumo. It makes you wonder about their reliance on these methods.
There is a large problem with US physician's and medical imaging technology, I would never deny that. There is even an acronym for it.
VOMIT
Victim Of Medical Imaging Technology.
Usually referring to a patient when a physician cannot treat a him without an xray or ct because of seriously lacking physical exam skills or treating the radiograph regardless of pt presentation.
However, a pneumo is not always immediately life threatening contrary to what they teach in EMT/medic class. The xray allows a physician to determine the extent, if it is progressing, and if it can be managed without decompression or a chest tube. I have seen places that do not treat a pneumo until it is >15% on xray.
True to some degree, but still a problem of resources. I can certainly think of situations in which physicians would be able to make a difference, but the things that come to mind involve emergency surgical interventions. Otherwise, they would be severely limited by the equipment held on an ambulance.
I find it to be quite the opposite. The physician can make more of a difference by redirecting non emergencies. Field surgeries, while simple on the front end, simply cutting and clamping and such, are heavy on the OR and ICU ends. It is not a save until the patient is able to leave the hospital with some level of quality function. Patients that die hours or a few days later in the ICU are not "saves."
As well, the equipment on an ambulance can be changed to better suit a physician. A portable ultrasound (like the new one that is the size of a palm) is of far more use to a properly trained physician than it is to a medic. As is the simple stethoscope or an otoscope. as LondonMedic pointed out, an increase in the doses and variety of medications is also possible.
In my county, you don't call for permission, ever. The MD is available anytime for consult, but you wouldn't call unless you needed permission to violate protocol or had an out of protocol patient. The MD interviews all of the medics and trusts that they are competent and professional enough to use their training and skill without his guidance.
A physician with an unlimited license to practice medicine never has such an issue.
They trust that the medics are professional and competent enough to use the skills and training they have, which in many places is based on epidemiology reports that show what will be beneficial to the most number of people with the least amount of risk. You said yourself you need to call to violate or step outside when a patient doesn't fit these predetermined treatments. It seems evident that the medics are not trusted to use their judgement past preset limits.