Guest Editorial: Intelligent Disobedience

"The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy."

 —Martin Luther King, Jr.

Like the Borg on Star Trek, for years paramedicine providers have been told to assimilate and conform. Assimilation keeps you safe, conforming makes you a good employee.

Over my 45-year career in paramedicine, I have heard managers spout numerous clichés regarding assimilating and conforming: “Don’t rock the boat,” “Stay the course,”  “Be seen, not heard,” and “Promotions come from quietly putting your time in.” 

Why do managers say these things? They say them because it’s easier to manage than lead. They want reticent personnel who never question their decisions or the system. They want “yes people” who do not think for themselves. Managers tell you, “Follow the algorithm, and the system will reward you with a promotion.” Leaders want you to participate in and improve the process to make patient care better.

Me, I have always been that loud “Why?” guy—the guy in the room who asks what others are too afraid to ask. Talk to anyone I have ever worked with, and they will tell you I am a natural disrupter, the paramedic who questioned everything. Why are we doing this procedure when this one is simpler and has better outcomes? Why are we using this medication when this works better for the patient? Where is the evidence behind this? Why can’t we provide top-quality CE, and why are we not providing it to our personnel? Why can’t we support our personnel in acquiring degrees? Don’t we want the best educated, clinically competent, and socially adept paramedicine providers?

I vividly remember one manager I worked with telling me my desire to educate paramedics in critical care and public health medicine was by far the dumbest notion I had ever had. Not looking so dumb now, am I?

I am proud of who I am: A paramedicine leader who thinks outside the box, a known practitioner of intelligent disobedience, and a purveyor of positive deviance. These are the traits that move a profession forward and bring about the positive changes needed to grow. Are you proud of who you are?

Our profession started in 1966 through the release of the National Academy of Sciences’ groundbreaking report Accidental Death and Disability: The Neglected Disease of Modern Society, better known as the the “white paper.” We’ve come a long way in these 55-plus years, but we have much farther to go, and we do not want our past to hobble our future.

So as my career starts winding down, I find myself issuing a challenge to my students and other up-and-coming paramedicine professionals: Don’t spend your life and career trying to conform to what others think you should be or do. Be a leader! When you are told to “stay the course” or “don’t rock the boat,” laugh and ask them how that has worked out for them and start rocking!

Remember, the meek and the quiet are herded and manipulated. Managers like them because they are easy and manageable. I know you’ve heard providers who push back on the norm are argumentative and aggressive. True leaders prefer the terms maverick and creative, as they are much more accurate. It is the mavericks, the creators, and the positive disruptors who will truly lead and grow our profession.

So I ask you, which are you? Are you the meek and manageable, or you the barking, educated sheepdog who protects and serves? Are you a competent, credible, and ethical paramedicine professional who is not afraid to step up to be intelligently disobedient and positively defiant? You decide: Do you lead, do you actively participate, or are you just about getting out of the way and doing your time? 

John Todaro, BA, NRP, RN, TNS, NCEE, CHSE, CHSOS, is the director/principal consultant at Eagle Emergency Education Consultants. He is a member of the EMS World editorial advisory board.