'Love the one you're with'

What to do when working with a difficult medical director

By Dave Ross

If you're down
And confused
And you don't remember
Who you're talkin' to
Concentration slips away
Cause your baby's so far away

A recent occasion of some significance might have slipped under the rug. No, you didn't forget your spouse's birthday. (At least I hope not.)

Over the past summer, some of us fondly observed the 40th anniversary of Woodstock.

A few deadheads might still be able to vaguely recall the landmark rock music festival held on a New York state farm over the weekend of August 15–18, 1969. Maybe a few of you were there and actually survived the rain and multiplicity of mind-altering substances. Today, Woodstock is not even a footnote in the history books for the majority of young EMS crews.

While flashing back to 1969 this past summer, I recalled a song Crosby, Stills, and Nash did not do at Woodstock. Actually written by Steven Stills in 1970, it was titled "Love the One You're With." And, though it was composed post-Woodstock, the message is straight from that cow pasture.

Well, there's a rose in a fisted glove
And the eagle flies with the dove
And if you can't be with the one you love, honey,
Love the one you're with

Once reminded of this tune during my summer "trip" in time (just be glad you didn't have to listen to me try to sing it), I have been thinking there must be a message somewhere in the song for EMS. And by gosh, after some serious pondering, I think there are some pearls in the lyrics.

My vantage of the EMS world is primarily from that of a medical director (for fairly apparent reasons). It's what I like to do when I am not taking care of patients — or living in the '60s. But most physicians have no desire to get into this line of work.

The fact is that most dodge an EMS assignment with an energy investment similar to that of H1N1 or Hepatitis C avoidance. This principle is nicely driven home in the cartoon below by my buddy, Steve Berry.

Steve Berry Cartoon

Reflections on Woodstock and "Love the One You're With"

For EMS neophytes to whom Woodstock means nothing — and for veterans who remain in a smoke filled haze from the '60s and don't remember much of anything — gather round the camp fire for a brief recap.

Woodstock was an extravaganza billed as "An Aquarian Exposition: Three Days of Peace & Music." Punctuated by heavy rain and lack of facilities, the planned three-day festival stretched into four. Thirty-two acts played in front of an audience of over 500,000.

A live album was recorded and a movie made depicting the details of the event. Notable bands and performers included the Grateful Dead, Creedence Clearwater Revival, Janis Joplin, The Who, Jimi Hendrix and Santana to name a few. One of the acts was Crosby, Stills and Nash (CSN).

The song "Love the One You're With" was originally recorded by Stills as a solo artist, but he was backed up by singers Rita Coolidge and John Sebastian (of Lovin' Spoonful and the Welcome Back Kotter theme song fame) and none other than David Crosby and Graham Nash. In 1971 the song was featured on the live album by Crosby, Stills, Nash and Young – "Four Way Street".

(And by the way, when we talk album from this era, we mean the real McCoy — Made the way they were supposed to be made. Vinyl. 12 inches. Played on a turntable. At 33 1/3 rpm. Genuine scratches. With real artwork on the cover. Pride in ownership. None of this sissy electronic/ digital baloney).

During the course of writing this piece, I happened on an interesting conundrum. The good news is that I was able to remember the lyrics to this song by heart. The bad news is that I can't remember what I had for breakfast. I'm not sure exactly what this means, but it can't be good. Like a lot of us old Woodstockers, these days, things just don't work quite as well as they used to.

D'D' Doo! D'D' Doo!

So, what does this mean and what do we do? We go back to our song, of course.

Don't be angry, don't be sad,
Don't sit cryin' over good things you've had,
There's a girl right next to you
And she's just waiting for something you do.

If you're at an EMS agency with a medical director who doesn't really get it, is behind the times, is not around much, and is just generally a pain to work with — bummer, man. But there are choices to be made.

You can lament and complain and in doing so become a cancer in the locker room torpedoing team morale. You can even pick up and find another employer (whose medical director might turn out to be no better, or even worse — God forbid.)

You can tolerate the medical director and accept the flaws you perceive and live with them.

Or you can do your part to make a silk purse out of a sow's ear and at least attempt to be part of the solution.

Get interested and involved. Be creative. Approach the doctor, if possible, where they do their clinical care (i.e. the office or the emergency department). This is, of course, assuming that they do not come to your agency where you might chat with them. When you do encounter your medical director, strike up a brief conversation.

If you do have a chance to talk to your medical director while they are providing patient care, be mindful of their workload and time commitments. If you sense that they need to move on, be sure to give them that space before they begin to resent you for delaying them.

Most physicians don't bite (at least not too hard) and generally appreciate at least brief interactions with EMS crews — especially if you follow the premise I am laying out. If you are able to establish some reasonable relationship with your medical director, it makes it easier to later discuss future innovations you might want to see incorporated by your service.

If your service does not pay the medical director (or not very much), consider what might be done to encourage management to fix that. One of the serious problems in EMS involving medical direction is that physicians are often very poorly compensated, if paid at all.

Now I know that I am preaching to the choir when I bring up lousy reimbursement to EMS readers. As a result, it might be a stretch to expect any sensitivity for physician pay. But the fact is that when a doctor looks at how he or she should spend their limited time, low pay often means low involvement. In other words, we get what we pay for.

Turn your heartache right into joy
She's a girl, you're a boy,
Get it together make it nice
Ain't gonna need anymore advice.

Despite my recommendations for learning to "Love the One You're With," sometimes things just may not improve. So if you look yourself in the mirror and can honestly say, "I gave it my best shot, and this schmuck isn't getting any better," you are now faced with few options.

If the doctor will be staying on, you have to decide if you can at least "Tolerate the One You're With" — or not. Obviously, if you can't, it's time to throw in the towel and move to a new job before the situation brings you down any more.

Or you can decide that the job is worth continuing if the pluses still outweigh the negatives of the physician. Ultimately, you have to choose what is best — and that will vary depending on individual circumstance.

And sometimes a physician, who cannot be coerced into being more actively involved, will ultimately determine that it is in everyone's best interest to hang it up. The hope that this might happen is probably not worth sticking around in what you perceive to be a really bad situation. But if it is tolerable — you never know; a new, and more interested medical director may someday descend from the heavens.

If lightning does strike and an opportunity to recruit and hire a new medical director comes along, do your best to get on any interview or hiring committee. This is the ideal time to have a say in who your service selects. Ultimately, the doctor they pick will likely be with your agency for years, so it is critical to be a part of the process if the chance comes your way.

Well, there's a rose in a fisted glove
And the eagle flies with the dove
And if you can't be with the one you love, honey,
Love the one you're with
Love the one you're with

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