I recently received the following question in the comment section:
At 10:31 PM, DavisEmt said...
This is going to sound stupid:
But I don't really have anyone I trust to ask.
How do you know when you are a competent medic, because I know every call isn't going to run perfect, but I've been a medic a year (only 3 months for a busy service) and it just feels like the mistakes are never ending. I haven't hurt anyone, but I definitely don't feel I've helped anyone either.
Is there a way to know when you're just not cut out for this job, I just don't want to hang on in denial until I actually do cause damage.
Any input would be great, and well today was a bad day.....
Here's my take:
Competency comes in small steps.
I think most medics when they are first starting question their own competency. This is because no amount of schooling, ride time or precepting can prepare you for everything you will have to deal with. Also, I think beginning medics may think they need to be perfect, when the longer you do this, the more you recognize there is simply no perfection in this business. (Being perfect is different from trying to be perfect, which we should all attempt.)
I think it took me about a year before I started feeling competent. This came from starting to handle the routine calls ( the 02/NTG/ASA chest pain, the breathing treatment dyspnea, the D50 hypoglycemia) well as I developed a rhythm and system that seemed to work. But then every now and then a call (asthmatic arrest, pedi struck by car) would come along and kick my ass, and I would go through the whole "Am I fraud?" "Am I going to kill someone?" agonizing, which I think all medics go through.
As the years have gone by, I have gone through a series of plateaus. I'd pound out the calls, feeling like I was not progressing, and then all of a sudden I'd do a call(a flash pulmonary edema -- and the guy whose head was purple and who looked like he was going to die would get better), and I'd think, hey, I am actually getting good at this, and I'd find myself suddenly bumped up a level, and then I'd stay there for awhile, until the next breakthrough call. In time, many of the calls that I had thought were challenging (cardiac arrests, multisystem traumas) become more routine. And those calls that kicked my ass, well, I still had calls (admittedly fewer) that kicked my ass, but maybe my expectations were lower. I don't expect to save everyone. I am no longer a "paragod," I simply try to do the best I can with what I have to deal with.
There is a knowledge curve in EMS. You start out at knowing nothing, go to knowing something, progress to knowing alot, maybe come close to thinking you know everything, and then slowly start to slide down as you realize more and more you know less and less of what you thought you knew. And that is probably the place you want to end up. You need to have respect for the unknown. That doesn't mean I don't try to learn it, it's that I recognize that knowledge is not finite, it is infinite. I just try to learn as much as I can and do the best I can. My youthful pride has been replaced with middle-age humility.
I still always evaluate each call I do for how I could do it better. I recently had a tough multi-patient critical call that I think went very well, and I was proud of how I handled it, but if I had to do it all over, I would do it much differently.
I guess today I don't beat myself up as much for not being perfect. I do the best I can. I try to learn from the lessons each call gives me.
And when I don't know what to do, I remember the wisdom of my first EMT teacher, Judy Moore: "If you can't remember or don't know what to do, remember to at least put the patient on the stretcher and take them to the hospital."
***
In the previous comments Rogue Medic offered DavisEMT some excellent advice:
At 5:56 AM, Rogue Medic said...
DavisEmt,
Keep working at improving. Keep asking yourself what you could do better on every call. Keep asking others for advice, especially the doctors and nurses at the hospital when you bring in patients. Bug people, but learn. Think about ways you can apply what you have learned.
Review calls in your head. How could you have done things differently? Would it have made a significant difference?
Get a set of questions that you ask everyone, so you have both a starting point for questions and something to return to so you can cover the important stuff.
I ask everyone about chest discomfort, difficulty breathing, weakness, dizziness, nausea, vomiting, diarrhea, fever, head ache, visual disturbances, changes in things - medications, appetite, urination, BMs, . . . . Anything answered with a positive, even if only tangentially related, gets investigated - when did this begin, PQRST, SOAP, whatever works for you. Once you have a set of questions, and you feel that it is in an order that helps you to remember, but also helps you get to the important stuff first, just keep using it, modify it as needed for your style, keep returning to where you left off asking questions once you follow one line of questioning. You may still be asking questions when you arrive at the ED - that's OK. Stick around and listen to the questions the nurse asks, the doctor, too.
