Doing things right

     Having been born in the Deep South, I guess it was inevitable that I would grow up with a real love for barbecue. Add to that the almost three million air miles I've flown, and it adds up to a whole lot of coast-to-coast opportunities to eat this uniquely American food. From the sweet, thick Kansas City-style sauce and the more vinegary sauce of Kentucky to the more robust sauces in Chicago, I have had more BBQ adventures than I can count.

     I added to my BBQ adventure list during a recent vacation on the Hawaiian Island of Kauai, when my wife and I found ourselves bogged down in a serious mid-afternoon traffic jam, courtesy of whatever less-than-brilliant urban planner thought that putting one two-lane highway around the perimeter of the island was a great idea.

     After moving less than a half-mile in nearly 45 minutes, we decided that a change of plans was in order. As luck would have it, we were in front of a sign for Scotty's Beachside BBQ that advertised "Smokin' BBQ with a Sizzlin' View." Another few minutes of no motion on the highway made the decision easy, and we turned in to Scotty's.

     As I looked over the menu, I noticed a highlighted box with the following excerpt titled "Hey, What Makes Scotty's So Special?" Here's what it said:

     You may think you've had ribs, smoked meats and BBQ sandwiches before, but odds are you haven't. Did you know that most restaurants simply boil their ribs and then grill them when you order? Or that most smoked meats in a restaurant are simply baked in an oven, then doused with a chemical called liquid smoke? Scotty considers this unseemly.

     The modern way of describing our wood smoke BBQ is low and slow. The meat is cooked at a very low temperature for up to 15 hours; all the while our hickory wood smolders in its own separate chamber that allows the wood smoke to waft through the meat chamber. Through the smoking process, we add our secret rubs of spices to make our own genuine BBQ flavor. We round it out with our homemade BBQ sauces. That's the way meats are supposed to be prepared. It takes time and costs more, but the results are incomparable.

     What I found most intriguing was that the owner, Scotty, felt it was important to explain to his customers why he chose to prepare his food the way he did. Scotty could have done things faster or cheaper, but chose instead to do things right.

     Now, think about our profession, when you've seen someone extricated from a car using rapid extrication when the patient was not in a life-threatening situation (the main reason rapid extrication was first conceived) and would have had better spine stabilization with standard extrication using a vest-type device.

     Here's another example shared with me by a friend about his ride-along with a big city department. On the very first call for a lady having difficulty breathing, my friend noticed that, other than a small jump kit, the EMS crew took nothing in with them. He was more surprised when they walked the patient out to the rig. When he asked about this after the call, he was told, "If they're talking, they're walking!" In both cases, neither patient received what, at a bare minimum, would be termed competent care, and in all likelihood, neither patient knew any better, so they just took what they got.

     This is similar to Scotty's explanation about cheaper and faster ways to create pseudo-BBQ, where most of his customers, in their previous BBQ experiences, may not have known how their BBQ had been prepared, so they, too, just took what they got.

     Another interesting point was that Scotty chose to take time to educate his customer base. I think it's unlikely that in either of the cases cited above, there was any consideration given to educating those patients about what was really going on. Imagine the explanations: "We really should have extricated you a different way that would have been safer, but we just didn't feel like it." Or how about, "You really shouldn't be exerting yourself if you are short of breath, but we were too lazy to carry you down to the ambulance." How do you think either of those would have played?

     The commitment to do things right in our profession involves a personal commitment from all of us. With patients whose expectations for care are often driven by what they see on television, it's up to each and every one of us to do our jobs properly. As we all know, the gap between what is shown on TV and real medicine is huge. I would venture to guess that most of our patients really don't know good prehospital care from marginal or bad care.

     If I hire a bricklayer to build a fireplace mantle, I have to make a leap of faith and assume he will do his job right, since I don't know anything whatsoever about bricklaying. Every time a citizen dials 9-1-1, they make a leap of faith that we will do things right. When we choose to sidestep good medicine for any reason, we have betrayed the public's trust in us. Given that, I believe that leaves us with just one choice, and it's the same choice that Scotty made with his BBQ; Do things right.

     Until next month...