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Fine Line, Big Difference

     EMS Reruns is an advice column designed to address dilemmas you may have experienced in EMS that you did not know how to handle. But it offers you a luxury you don't have on scene: plenty of time to think. If you think of an example like the one that follows, send it to us. If we choose to publish your dilemma, we'll pay you $50. We don't know everything, but we do know a lot of smart people. If we need to, we'll contact just the right experts and share their advice with you. E-mail ideas to

     Mary Ann's a good clinician; there's no doubt about it. But sometimes she seems just plain toasted.

     You handle a mid-night response with her to the home of Alice Chalmers, a 70-year-old frequent flyer whose complaints never seem to jibe with your dispatch information. Alice is a little dingy, but she recently lost her husband, and you've heard other crews guessing that she calls out of loneliness. Mary Ann has no patience with her tonight, and her comments leave the old woman crying. You're pretty new, and you aren't sure how you should act. Mary Ann barks at you to follow her out the door without a signed release, and you comply. Later, you're lying in your bunk, staring at the ceiling and not feeling too good about Mrs. Chalmers.

     Q. Why do experienced paramedics get so cynical?
     A. Cynicism is a balance problem that some of us mistake for an accomplishment. But it doesn't happen to all of us, and it surely doesn't have to happen to you. We think it evolves sometimes when people lose control of their professional skepticism.

     Q. Cynicism? Skepticism? What's the difference?
     A. Skepticism is a tool in your mental toolbox. It's what you use to analyze the situations you find yourself in and to filter what people tell you when they're in crisis. Unfortunately, one of the ways people handle crisis is to lie about stuff-to themselves and their caregivers. They ease their stress by breaking it down into smaller pieces, or by denying it altogether-like the patient who exhibits Levine's sign, yet says he's not having chest pain. We deal with people in crisis on almost every call. So, we all get lied to for a living. Experience teaches you not to believe everything people tell you. But your skepticism has a switch. You can turn it on and off. When you go home to someone who loves you and they say, “Honey, I love you!”, your first reaction is probably not to wonder if they're lying. That would be cynical. Cynicism is a generalized, unfocused, unbalanced tendency to see things in a negative light. But, unlike your skepticism, you can't always decide when to be cynical and when not to. Cynicism is something you allow to creep into your practice (and your life). It usually does that gradually and in subtle ways. Once it does, it eventually follows you home like a shadow and sleeps in your bed.

     Q. Sounds spooky, but it still seems kind of vague. Is there a way to feel yourself becoming cynical?
     A. We think so. Try to imagine skepticism as a question mark and cynicism as an exclamation mark. Professional skepticism is an EMT's most basic skill of noticing stuff and wondering what it means. Cynicism is a habit of assuming stuff and imposing judgments. You can't argue with a cynical person; in his mind, he's automatically right. If you're not him, you ain't diddly.

     Monitor your sense of curiosity. If you find yourself wondering about stuff, that's good. A smart caregiver asks a lot of questions, both mentally and verbally. There's nothing cynical about that; it's how you reach an accurate diagnosis, and it's how you help people who trust you. But if you find yourself consistently jumping to conclusions and acting on them, maybe your balance is slipping toward the cynical end of this little spectrum. Likewise, if other caregivers you respect tell you you're getting cynical, pay attention. Don't forget-they're professional observers, just like you.

     Q. Why do some people get cynical and others never seem to?
     A. That's a good question, and we don't know the whole answer. We think part of it is rooted in people's personal value systems. Part of it comes from the way they're educated. And part of it certainly depends on their life experience.

     We know from our own experience that the people you work with can affect you profoundly. If you're part of an angry workforce, it becomes easy to hate your job. If your system is understaffed and works you to death, you'll be tired a lot. And if your system has a cynical culture, you'll find it all too easy to become cynical. But in every one of those situations, the ultimate assessment and power of choice are yours. Those kinds of organizations tend to chew people up, and their turnover rates are usually high. As a result, they're forced to recruit constantly.

     You should never jump at the first job that comes your way, any more than you should try to diagnose a disorder in the absence of a good exam. On the other hand, if you deliberately surround yourself with people who care about each other, about you and about the public, you're much more likely to become a fine caregiver with a happy home life.

     That's another choice you can make. Every day, in fact.

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