The line from administration usually goes something like, “Hey dummkopf, don’t aggravate EMS. They bring a lot of admissions to us.” Translation – forget medical oversight, we don’t want the gravy train (bus) going elsewhere.

This only had to happen once for me to divorce myself from the proper relationship. My shift today was a good example of how my behavior has changed. EMS was called to a home where an ancient man had collapsed. The resuscitation was started and then quickly stopped when a DNR order was produced. Rather than calling the coroner, they transported a dead body for emergency care.

We proceeded to register a dead body and then I confirmed that he was, in fact, not only merely, but sincerely, dead. The tough part was getting the signature. Did I say anything to the medics? Do you slam your hand in the door more than once?

Later in the day a different crew transported someone with altered mental status who required intubation. They nasally intubated and were bagging him on arrival. Trouble was, I could hear laryngeal sounds. We pulled the tube and the resident orally intubated him. Luckily there was enough spontaneous respiration that he never desaturated and all was good. I would have liked to have a conversation about technique and confirming placement and all the rest.

Who wants to deal with the negative consequences? The distorted culture does not invite this type of interaction any more.

This was a rare day, and, in general, I feel EMS does a good job. The issue is not one or two mishaps. These things happen, and we all can benefit from feedback about our work.

The issue is that many emergency physicians just keep their mouths shut rather than have a friendly conversation about patient care. In the end this is supposed to be about the patient and everyone doing the best job they can for the patient. Instead there is silence in order to prevent ruffled feathers and wrathful CEOs.

And the patients are better for this how?

Dr. Baehren lives in Ottawa Hills, Ohio. He practices emergency medicine at Wood County Hospital. Your feedback is welcome at DBaehren@premierdocs.com.