It's All About the Doctor

I'm sure that some of you--particularly those who do not work in medical fields--have had enough of my whining about the lack of respect EMTs and paramedics get from the public. Sunday's newspaper contained an article that troubled me, though, and I felt compelled to write something in response. This will be my last post on the subject--for now, at least. I promise.

Doctors do great work. There can be no doubt about that. For centuries they've identified medical problems and resolved them. Thousands of times each day, all around the world, they save lives.

But you don't have to be a doctor to save a life. Nurses save lives, too. Go into a major emergency department one day, and watch as a patient is resuscitated. Most of the people in the room are nurses. Doctors make most of the treatment decisions, but nurses carry out that treatment. They are the ones who start the IVs, administer the medications, insert the catheters, draw the blood samples. Making a diagnosis is only half of the battle. To save a life, someone must actually put their hands on the patient and correct what's wrong. Often, that person is a nurse.

In the hospital, technicians save lives, too. A surgeon can't operate effectively without first looking at x-rays and CT images. Infection can't be diagnosed and treated until someone has cultured blood and tissue samples. Somebody needs to set up and monitor the ventilator that will breathe for the comatose patient.

Doctors often are hailed as heroes. And rightfully so, because they perform heroic work. Nurses, too. They get a lot of credit for what they do. In a recent survey, Americans identified nurses as the most trusted of all workers.

You don't hear nearly much about x-ray technicians, or laboratory technicians, or respiratory technicians. And that's too bad, because they save lives, just like doctors and nurses do. The difference, of course, is that they work behind the scenes. As a hematology medical technician commented recently on this site, "What I see through the microscope is just as significant as what the doctor or nurse does, but many times the patient's family pays accolades to them--especially the nurses--when it is I who tells the nurses what the real scoop is."

The same thing happens outside the hospital. EMTs and paramedics save lives. Sometimes they get appropriate credit for this. Often, though, patients and their families can't think back beyond what happened in the emergency department. Even when someone gets resuscitated in the field, it is the doctor and the nurse and the hospital who get all the praise. In the words of a longtime Calgary paramedic who commented on a previous post: "A lot of people are profuse with their thanks to the doctors and nurses who 'saved their lives,' but they forget that without the efforts of the paramedics they wouldn't have made it to emergency department in a condition that allowed the ER staff to 'save their life'!"

These thoughts have occurred to me before, but it was a newspaper editorial that caused me to think them today. In a piece entitled Gratitude for a Dear Friend Saved, Boston Globe columnist Beverly Beckham described the resuscitation and recovery of a friend who went into sudden cardiac arrest. It's clear from Beckham's account that a pair of EMTs brought her friend back to life, yet she mentions these actions only in passing:

"[The EMTs] got there within minutes and breathed air into Al's lungs, and an ambulance soon followed, bringing a defibrillator which jump-started Al's heart."

That's all she said about the resuscitation. In fact, the EMTs did a lot more than Beckham described. At a minimum, they responded to the scene, located the patient, identified the cardiac arrest, performed CPR, applied the defibrillator, and shocked the man back to life. And since the incident occurred in an area with plenty of Advanced Life Support coverage, I'm reasonably certain that they also started an IV, inserted an endotracheal tube, performed and analyzed an EKG, and administered medications. But none of this was mentioned.

Beckham goes on to ask, "[What] if the EMTs hadn't been quick to respond?" Forget about the decisions they made and the skill with which they provided treatment--in this editorial, they get credit only for driving fast.

The hero of Beckham's story is a doctor--a doctor who didn't even arrive until after the patient had been successfully resuscitated. "There was more fear than hope when Jon Olshaker appeared," Beckham writes. "Jon, who lives next door but is seldom at home, who is the chief of emergency medicine at Boston Medical Center and had just sat down to dinner with his family.

"He took charge. He signed a form. Rode in the ambulance with Al to Norwood Hospital. And arranged to have Al transferred to Boston Medical, where he was placed in a medically induced coma, his body temperature lowered in an attempt to prevent brain damage."

Beckham goes on to describe the process by which hypothermia increases post-cardiac-arrest survival rates. She concludes by writing, "It would be nice to think that God took a second look at Al and saw how much we need him here. How beloved he is. But I think God works through people, it was Jon Olshaker and Boston Medical Center that saved Al's life."

Now, don't get me wrong. I'm delighted that Beckham's friend survived. Dr. Olshaker deserves a lot of credit, too, for accompanying the patient to the hospital--something that rarely happens when a doctor or other professional offers to "help" an ambulance crew in the field. And for making use of the hypothermic treatment that may have aided the patient's recovery. I don't know Dr. Olshaker personally, but I have every reason to believe he is a well trained, highly experienced, dedicated, extremely competent professional.

I'm grateful, too, that a newspaper columnist like Beverly Beckham chose the subject of resuscitation for a Boston Globe editorial. These days, America's health care system seems to get publicity only when something goes wrong. It's nice to see someone write something positive for a change.

But to say that "Dr. Olshaker and Boston Medical center saved Al's life"--period, end of sentence, with no reference to the people who actually brought this man back from the dead and into the living--is simply not accurate. Dr. Olshaker did not resuscitate Beckham's friend. EMTs did that. But once again, the spotlight falls squarely on the doctor, as it always seems to do.

This happens all the time. Just a couple of days ago--at roughly the same time Beverly Beckham was writing her editorial--the mayor of Boston, Thomas M. Menino, held a press conference about last week's fire, the one in which a pair of firefighters perished and a dozen more were injured. He thanked a long list of people and organizations for their bravery, expertise, and dedication, including the doctors and nurses at Boston Medical Center. Conspicuously absent? EMS. The EMTs and paramedics who responded to that scene performed magnificently, treating multiple casualties, including two patients in traumatic cardiac arrest, at an incredibly chaotic scene. They did so despite a shortage of manpower and resources. And to make things worse, one paramedic suffered cardiac symptoms in the middle of it all.

The mayor never mentioned any of this. He thanked the doctors, but not the men and women who provided care outside, amid the smoke and the flames and the shouting.

That's what always seems to happen. Beverly Beckham, the mayor, families of cardiac arrest victims--everybody remembers the doctor. Even when it was somebody else who actually saved the life.

P.S. Apparently, I wasn't the only one who felt slighted by the Beckham editorial. Just as I finished this post, I received a phone call from a coworker who asked if I'd seen it. He, too, felt that Beckham, like so many other people, had praised the doctor while ignoring the people who'd really saved the man's life.

To read the entire Beverly Beckham editorial "Gratitude for a Dear Friend Saved," go here:

http://www.boston.com/news/local/articles/2007/09/02/gratitude_for_a_dear_friend_saved/