Professional Development-- Part 12: The Importance of Professional Behavior

   Over the past year we have undertaken an in-depth discussion of medical professionalism through the lens of Dr. Herbert Swick's 2000 article "Toward a Normative Definition of Medical Professionalism." We have also discussed how we can apply Swick's concepts to EMS practice. I believe the professional behaviors included in the following list, based upon Swick's article, should be a part of every EMS practitioner's education, consideration and practice. An EMS practitioner will:

• Subordinate their personal interests to the interests of others.
• Adhere to high moral and ethical standards.
• Respond to society's needs and recognize a social contract with the communities they serve.
• Demonstrate core humanistic values: honesty, integrity, caring, compassion, altruism, empathy, respect for others and trustworthiness.
• Exercise accountability for oneself and one's colleagues.
• Demonstrate a continuing commitment to personal excellence.
• Exhibit a commitment to scholarship and advancing our field.
• Deal with high levels of complexity and uncertainty.
• Reflect upon their actions and decisions.¹

   These behaviors should be in the forefront of our minds in the classroom and in the field. They should be guiding principles for our ongoing growth and development. When we look forward at how we can improve, these principles can give us structure. When we look back to assess and analyze our practice, these behaviors provide criteria to which we can compare our personal performance.

   Let's briefly review each of these behaviors from the perspective of our practice.

   Subordinate personal interests--Putting others' needs ahead of our own is sometimes hard to do, particularly when we feel like our own needs are not being met. It is hard to be nice when you're tired or hungry or feel unappreciated, abandoned or oppressed. Overcoming these feelings requires us to look back on why we chose this line of work in the first place, and why we choose to stay in it. I like to think people in EMS still do this work because they want to help people. It may be hard, but your patients will feel better when you put their needs first. Oddly enough, you'll feel better too.

   It's not logical, but emotions rarely are. When we are dealing with feeling and emotion, what seems to be "taking care of Number One" often turns out to do more harm than good. The statement "It is better to give than to receive" comes to mind. Think about it.

   Adhere to high moral and ethical standards--To follow this rule, we first must understand what the terms moral and ethical mean. Moral concerns principles of what is right and wrong and how we behave related to those principles. Ethical concerns behavior conforming to accepted professional standards. These ideas are closely related and subtly different.

   If we wish to judge ourselves, our practice and EMS as a profession, we must first have a clear set of standards. Consider the standards of acceptable and desirable behavior. These standards are most often articulated in a code of conduct or ethics. See Part 3 of this series for a version of an EMS code of ethics.

   Respond to society's needs--As EMS practitioners, we have an obligation to serve the needs of our communities. We have a specific duty to act that is often part of the enabling EMS legislation that authorizes us to practice. The first part of responding to society's needs is to assess just what those needs are. Once we identify the specific needs of our communities, we can take steps to meet them.

   There is also a second part of this behavior: acknowledging our contract with those we serve. The most important part of our contract is the agreement to respond. When someone calls for help, it is our responsibility and obligation to answer.

   Demonstrate core humanistic values--The core humanistic values Swick listed are honesty and integrity; caring and compassion; altruism and empathy; respect for others; and trustworthiness.¹ Values are the concepts and principles we believe are important. They provide the foundation for actions and guidance for decisions. Demonstrating core humanistic values in our practice gives us confidence, gives purpose to our work and ensures the choices we make are based upon what we believe.

   Be accountable--We need to be accountable for our choices and actions. Being accountable means taking responsibility for actions and an obligation to accept the consequences of failing to act as expected. We must be ready to pay the price for actions that violate our standards--standards of care, such as scope of practice or protocols; standards of behavior, such as those described by our values; and standards of practice, as described by our code of ethics.

   We also must hold our colleagues accountable. Holding others accountable is uncomfortable and can be difficult. It seems so much easier to just let things slide, but that's a slippery slope. There is significant exposure to risk and liability if we don't hold ourselves and our colleagues accountable. If we allow aspects of our practice to drift, we deteriorate quickly through "gray" areas, then, if we don't take steps to hold people accountable, ultimately into shadowy realms that border on malpractice, practicing outside our scope, abandonment, nastiness and meanness. We must take steps to prevent burnout and "rust"-out, and one of those steps is accountability.

   Commit to excellence--Simply, this means being the best we can be--always working to improve. Being honest with ourselves as to our personal strengths and weaknesses and recognizing that identifying a weakness is an opportunity to improve. It is hard work, but the outcome is worth the effort.

   Commit to scholarship--Scholarship relates to education and research. We all benefit when any of us improves his level of education. We need more people in EMS who are highly educated. We need EMS "scientists," or people who work in colleges and universities studying the best practices for out-of-hospital medicine, setting the foundation for evidence-based practice and education. Education--degrees from accredited postsecondary and postgraduate institutions--helps us gain access to the conversations that create policy and set the trajectory for our future. The more highly educated people we have in EMS, the more control we have over our discipline.

   Deal with complexity and uncertainty--We do this every day. We have no idea what any given day will hold for us. That is the nature of our work. We might be bored all day, or we might respond to an airplane crash with hundreds injured and killed. We might take care of an old lady who is lonely, or we may take care of a mother who crashed her car into a tree, killing her child. We may save a life or hear the last words of an elderly person who would otherwise be all alone. We never know.

   If we do our best to be prepared for everything, keep our values in mind, maintain our competence and our confidence, and avoid overconfidence and cockiness, we will be ready. If we admit when we're wrong, celebrate our successes, study our mistakes and learn from them, we can be prepared. By always striving to improve, we can equip ourselves for the daily complexity and uncertainty that is so much a part of EMS.

   Reflect on actions and decisions--Reflection is a key component of critical thinking. By looking back at what we have done and why we did it, if we are honest, we can find critical opportunities for growth and professional development. If we don't recognize and learn from our mistakes, we are doomed to repeat them.

CONCLUSION

   There is only one component in the National EMS Education Standards that addresses professional behavior. The EMR, EMT and AEMT will "Demonstrate professional behavior including but not limited to integrity, empathy, self-motivation, appearance/personal hygiene, self-confidence, communications, time management, teamwork/diplomacy, respect, patient advocacy, and careful delivery of service." The same is expected of paramedics.²

   As a person with years of experience as a front-line provider, field supervisor, quality improvement officer and EMS educator, I can say, passionately, that we must behave as professionals. The public we serve expects and deserves that from us. I bet your EMS agency expects it of you as well. Your peers should have high expectations of you, including holding you accountable for your behavior. If we ever want to be recognized as professionals, it is up to us to start behaving like we deserve such recognition. We have to earn it.

   If one person changes the way he interacts with patients, the world of EMS gets just a little bit better. If one person changes the way she deals with her partner and colleagues, our universe benefits in a small way. If one individual chooses to pursue formal education, we all gain. If we all take steps to improve, however small, EMS as a whole improves. What part will you play in creating your future and the future of our discipline?

References

1. Swick H. Toward a normative definition of medical professionalism. Acad Med 75(6): 612-616, June 2000.

2. National Highway Traffic Safety Administration. National Emergency Medical Services Education Standards, DOT HS 811 077A, Jan. 2009.

   Michael Touchstone, BS, EMT-P, is chief of EMS training for the Philadelphia Fire Department. He has been involved in EMS since 1980 as an EMT, paramedic and instructor. Contact him at m-touch@comcast.net.