This is your profession. Make of it what you will

Three truths about relationships for new paramedic graduates to succeed as professionals in a radically changing world of health care

I recently had the honor and privilege of addressing a number of paramedic school commencement exercises. While it is always a privilege to speak about EMS to my peers, I am particularly honored by these opportunities, because I was asked to speak not based upon a proposal I had submitted on a particular topic, but because of who I am, and my place in the EMS profession. It’s a tall order to fill, particularly because David Givot has already done it so well, but this is my answer.


Congratulations, you’ve finished the marathon that is paramedic school. You’ve memorized your drug dosages, you’ve learned complex anatomy and physiology, and the pathophysiology of dozens of diseases. You’ve survived the crucible of pharmacodynamics and pharmacokinetics, and been baptized in acid-base balance and the nuances of the electron transport system. You’ve practiced megacodes and intubation until you can do them in your sleep.

And right now, if your teachers have done their jobs right, you’re brimming with confidence, tempered with the sober realization of the responsibility that will soon be in your hands. You’re ready to go out and save some lives.

But none of you, really, know what’s in store for you. Even I don’t know, and your teachers don’t know.

For the duration of your course, they’ve struggled with the daunting task of educating the paramedics of the future, without actually knowing what the paramedic of the future will be. Medicine is changing so fast, none of us can predict what form EMS will take — and what will be your role in it — in 10 or 20 years. What we do know is that it will be different than it is now.

So what I will tell you here today has nothing to do with medicine.

I’m going to talk about the truths that will serve you well over a long career, no matter what form that career will take. Even when technology and the forces of health care finance have radically transformed the face of your profession, there will still be patients, there will still be practitioners, and there will still be peers.

And your relationships with each of them will be what make the difference between your life’s calling and paramedicine being just another job.

Choose your mentors wisely

In the coming months, you’re going to learn how to apply the lessons of the classroom to practice on the street, and people with more time on an ambulance than you will have differing ideas of how to do that. I want you to choose your mentors well, because age does not necessarily convey experience, and experience does not necessarily convey wisdom.

The paramedics with twenty years of experience are far outnumbered by the paramedics with one year of experience repeated twenty times, for whom the only lessons learned were how to dodge calls, and the location of all the burger joints that give EMS discounts.

You’ll know the real EMS professionals not only by their clinical acumen, but by how they treat people. They’re the people with superior knowledge and skills, who have also discovered that a kind word and holding a hand are great therapy, too.

Clinical knowledge and technical skill don’t make you a great paramedic, they merely make you a competent one. You can’t take pride in those things. They’re what you owe to each and every patient.

The best thing you can give to your patients, the gift that distinguishes a great paramedic from a good one, is your compassion. Your patients are never going to understand or appreciate your mad intubation skills, or your encyclopedic knowledge of cardiology. They’re going to notice — and remember — how nice you were.

Never stop learning

I want you to become lifelong learners. Roughly half of what you learned in class — paramedic school, nursing school or medical school — is wrong. The problem is, no one knows which half.

The only way you will ever discover what information was valid and what was not, is by constantly trying to learn new things. If you spend just 15 minutes a week reading current EMS and emergency medicine research, you will be among the top 10 percent of your profession. If, five years from now, you are still approaching patient care in the same way you do now, you will have fallen far behind.  

Do the small things well

I want you to understand that the little things matter. As Aristotle said, "We are what we repeatedly do. Excellence, therefore, is not an act, but a habit."

A supervisor once told me, "If you show up to work on time with your uniform pressed and your boots shined, turn in billable paperwork on time, wash your rig inside and out every shift, and don’t get any patient complaints … you can retire here, without ever having been a good paramedic."

And he’s absolutely right. You can spend twenty years doing just enough to get by, being comfortably anonymous and drawing a paycheck, and EMS will never be more than just a job to you.

What’s more, you can climb the career ladder into management with the same strategy. Management is filled with people who were great employees and mediocre medics. And a great many of them are poor leaders, as well.

Your standards should always be higher than your employer’s.

"If it falls your lot to be a street sweeper, sweep streets like Michelangelo painted pictures, sweep streets like Beethoven composed music, sweep streets like Leontyne Price sings before the Metropolitan Opera. Sweep streets like Shakespeare wrote poetry. Sweep streets so well that all the hosts of heaven and earth will have to pause and say: Here lived a great street sweeper who swept his job well."
- Martin Luther King, Jr.

There is no such thing as a call that is beneath you. Even a routine BLS transfer affords you the opportunity to enrich your life by connecting with another human being. Pay attention to little details, both in the care you provide, and the way you treat people, and you may one day become that rare creature, the great manager who was also a great paramedic.

Never doubt your impact

Many of you will go to work at agencies where the culture is the polar opposite of the admonitions I’m giving you today. You’ll feel outnumbered by apathetic or burned out co-workers, people whose commitment to our profession extends no farther than their next patient and their next paycheck.

But I want you to remember one thing: one person can make a difference.

A lone, mad monk named Martin Luther sparked the Protestant Revolution. Jonas Salk’s vaccine ended the scourge of polio. Five hundred seventy-six Florida voters decided the 2000 Presidential election.

Less than three percent of colonists took up arms in the American Revolution. They were outnumbered four-to-one by their own countrymen, yet they still managed to throw off the yoke of the most powerful nation in the world.

All it takes is a few committed people too angry to accept the status quo, too naive to realize that meaningful change is impossible, and too stubborn to quit. Be a Three Percenter for EMS, and we can shape the future of this profession ourselves.

In closing, I urge all of you to become stewards of emergency medical services. Live the example of your wise mentors. Pass on that culture of compassionate professionalism and learning to the next generation. Constantly question dogma. Call out unprofessionalism and misbehavior when you see it, and don’t let unethical acts hide behind a false notion of brotherhood.

This is your profession. Make of it what you will.

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