The dangers of miscommunication in EMS

In EMS, lives and livelihoods are saved and broken based on the simple difference between what is said and what is intended

Since the first caveman grunted to the second caveman, interpersonal communication has been responsible for the creation and destruction of entire cultures, civilizations, and relationships.

Through the ages, individuals have arranged and rearranged words to elicit emotion and convey feeling, to strike fear and bring calm, to help and to hurt. William Shakespeare's "A rose by any other name would smell as sweet" has endured for generations as a means to say: "it is what it is." In stark contrast, the original meaning behind the phrase: "Mission Accomplished," seems to have been obfuscated and its newest meaning seems to be: "Mission Accomplished, but we are nowhere near finished and have a long way to go and the mission is not, in fact, accomplished by any stretch of the imagination."

Simply put, words are just words until they are arranged and given meaning and context: that's when they become communication. That's when things can go wrong.

It is said that sticks and stone break bones, but words will never hurt you. Of course, anyone older than 10 knows that nothing could be farther from the truth. Overt verbal abuse (negative communication) has led to violence among nations and suicide among individuals of all ages — and that is just words.

Just look at the news. Naturally, it doesn't take a rocket scientist to figure out that overt negative communication is a sure way to drive any relationship into the ground. Hopefully, for patient-care-oriented providers and success-oriented supervisors, managers, and owners, negative communication is not part of the lexicon. Even though I know it often is.

On the other hand, it is the miscommunication — the mixed message, the misunderstood or misinterpreted phrasing — that can lead to irreversible damage to one's image, reputation, and the agency altogether.

In EMS, for example, lives and livelihoods are saved and broken based on the simple difference between what is said and what is intended. "Oh, it's just old Hank, again. He's probably still drunk," is an opinion until something bad happens, and then it becomes evidence.

"No, you can't switch shifts to have your son's birthday off," may be true and for good reason, but that message, standing alone, tells the provider that he or she is not important enough to you and he or she need not bother helping you in the future. "You shouldn't eat that, it's not good for you," though intended as commentary on eating healthier and lowering cholesterol, actually sounds like: "Wow, you're fat." Indeed miscommunication has led to many sleepless nights on lumpy sofas.

In EMS, interpersonal communication is the glue that holds everything together. How a manager communicates with a provider directly translates into how that provider communicates with fellow providers and the public, which translates into how providers view each other and how the public views the agency, which translates into how local government supports and funds the agency. Communication connects and affects everything.

So why is it traditionally so bad?

It's uncomfortable to talk about, but this problem is real and must be addressed for EMS to transform into a profession from a long history of being just a job.

In 20-plus years in and around EMS, I've seen the same things most of you have seen: ignorant, rude, condescending, and threatening supervisors and managers; cliques and factions of providers seemingly at war with one another (usually A-shift vs. B-Shift vs. C-Shift, etc.); racism, sexism, and every other ism that manifests in the way providers treat each other and the public.

While I don't know scientifically why such environments exist within EMS, I can hazard a guess that I think is pretty close and requires only simple math: leadership by example.

Field providers follow the lead of their supervisors. Field providers promote to supervisors and to managers without any additional training, without any guidance on how to motivate or communicate. Instead, they are issued the white shirt and the bugles or bars and sent out into the world to regulate, supervise, and manage. When the ill-equipped nice guy routine doesn't yield the necessary results, and they begin to feel some uncomfortable pressure from above, they revert to the only thing they have ever known from their supervisors: management by fear. And the cycle of abuse and discontentment continues.

To make matters worse, we live in an age of instant and incessant communication. Face to face and voice to voice communication has given way to the sterility of email and the emotionlessness of text and the limitations of Twitter's 140 characters. Context is no longer divined from facial expression and body language, vocal inflection and intonation. Context has become a matter of first impression; a veritable crap-shoot as to how a given message will be received. And once received and perceived, there is no going back. What was once a simple face-to-face confab with discernable context and tone — and personal connection — is now a text message or electronic memo whose context and tone are left to the imagination of whoever reads it.

And the electronic sword cuts both ways. The same tools used to depersonalize communication are also used to opine (publicly) about people and agencies alike. It has reached the point now where provider agencies have enacted policies that prohibit individuals from using electronic media to discuss issues with or opinions about the agency or the people in it.

Remember, too, that communication is not limited to words. Providers and agencies are being sued for what employees and coworkers have communicated by both word and deed.

So, what do we do?

Well, when it comes to leadership, never forget the power of the human face and the strength of the human voice. Remember that nobody does business with a business — we do business with people. I will be the first to say that "business is not personal, it's business," but business relationships are very much personal and must be respected accordingly. Likewise, collegial transactions may be business, but collegial relationships are also personal, whether you like it (or agree with it) or not and must be respected accordingly.

The philosophy for leadership communication is simple: The customer is not always right, but the customer is always the customer. In this context, the patient, the public, or the provider is always the patient, the public, or the provider and how we communicate with each one of them can and often does affect every other one of them.

The remedy is easier. Remember to convey messages, not words; tell people what you want them to hear, not what you want to say. Consider the likely response to the words you use, not what you mean by them. Good intentions are not enough to prevent the damage from poorly chosen words. After all, the road to hell is paved with good intentions, as the saying goes.

Basically, think before you speak and let success happen.


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