In this episode of EMS One-Stop, Dr. Linda Dykes joins Rob Lawrence from the UK for a wide-ranging, transatlantic conversation that starts with workplace culture and ends with a practical look at how health systems can keep patients safely at home.
In the first half, Linda breaks down her newly published (open-access) qualitative paper, provocatively titled “It’s not bullying if I do it to everyone,” drawn from UK NHS “Med Twitter” responses: a raw, heartbreaking window into the red flags of toxic workplace culture, how bullying is experienced in the eye of the beholder, and why incivility and silence are not just HR problems — they’re patient safety threats.
In the second half, Linda brings listeners into the UK’s evolving admission alternative world: frailty care at home, urgent community response models, and the increasingly important interface between EMS and community-based teams. She explains the UK’s SPOA (single point of access) concept, why she dislikes the term “admission avoidance,” and how ED crowding and access change the risk-benefit equation for hospital vs. home.
Rob connects the dots back to the U.S. reality — reimbursement, APOT/wall time, treatment-in-place policy — and why this work is becoming a shared challenge on both sides of the Atlantic.
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Memorable quotes
- “Toxic cultures have become increasingly recognized and some of the behaviors that were previously regarded as normal, increasingly realizing that they weren’t actually very healthy at all.” — Dr. Linda Dykes
- “Poor behaviors are very deeply rooted in some organization’s and very prevalent to at least some extent in many.” — Dr. Linda Dykes
- “A 1655 Friday email … if weaponized, is an incredibly dirty trick to play on people.” — Dr. Linda Dykes
- “Your job as a leader … is to be the sponge. Your job is to absorb the stuff so that your staff are not exposed to it.” — Dr. Linda Dykes
- “We were trained … in how to put people into what they call ‘pressure bubbles’ …. people don’t realize that their micro-movement, their micro-aggression, their micro-actions … are actually part and parcel of this.” — Rob Lawrence
- “Hands up in the room if you know when your boss is having a bad day … everybody puts their hand up.” — Rob Lawrence
Timeline
00:51 – Rob opens, recaps NAEMSP in Tampa and recent content.
02:25 – Rob introduces Linda as the “triple threat” (emergency medicine, primary care/GP, geriatrics) and tees up two-part discussion.
05:39 – Rob introduces Linda’s paper: “It’s not bullying if I do it to everyone.”
06:13 – Linda explains why toxic culture is increasingly visible and how the tweet prompt became a dataset.
07:33 – “Flash mob research group” forms; Linda explains social-media-to-qualitative methodology and limitations.
10:03 – Rob asks about bias; Linda clarifies purpose: insight, not representativeness.
16:39 – Linda defines gaslighting and why it’s so destabilizing.
18:21 – Reactions to publication; resonance, sharing and uncomfortable self-reflection on learned behaviors.
20:18 – The “16:55 Friday email” as a weapon — and as an accidental harm.
23:29 – Leadership as “the sponge” — absorbing pressure rather than passing it down.
25:27 – “One thing right now”: know the impact your words can have, especially on vulnerable staff.
26:41 – Rob on “pressure bubbles,” micro-movements and atmospherics: how leaders shift climate without realizing it.
30:53 – SPOA explained: single point of access and urgent community response behind it.
33:03 – EMS interface: calling before conveyance to find safe pathways to keep patients at home.
35:47 – Linda on mortality risk of access block/long waits and how that reframes risk decisions.
37:19 – Evolving models: primary care-led response vs. hospital at home approaches.
39:34 – Clinical myths challenged: oral antibiotics sometimes non-inferior to IV in conditions we assumed needed admission.
40:34 – Outcomes: hospital at home trial signals safety and fewer patients in institutional care by 6 months.
42:00 – Telemedicine/telehealth: underutilized but useful; when you still need a senior clinician in person.
44:50 – Closing takeaways: read the paper (with trigger warning); admission alternative work is deeply satisfying.
Additional resources
- Mesinioti P, Dykes L, Rigney R, Sheard L. “It’s not bullying if I do it to everyone”: What are the red flags of a toxic healthcare workplace culture? #MedTwitter responses from UK NHS healthcare professionals – A qualitative study.” ScienceDirect
- NHS England: Single point of access (SPoA) – Guidance to support winter resilience 2024/25
- Health Tech Newspaper: NHSE shares guidance on single point of access functions, including role of digital and data
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