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Two Physicians Speak Out on Diagnosis

Yesterday, during the final day of EMS Today 2014, I was on my way to the podcast lounge to find a comfortable seat while I edited some product videos I had taken on the exhibit hall floor.

Before I could sit down, Chris Montera dragooned me into being his third guest on EMS Garage. The other two guests were Keith Wesley and Jeff Myers, both physicians and EMS medical directors. The show's topic was "Do we even need medical directors any more?" discussing whether EMS was ready as a profession to move to independent practice. Montera wanted the medical director's take on the subject.

Surprisingly, neither physician began frothing at the mouth in indignation at the question being raised.

That alone distinguishes them from many of the EMTs on Facebook pages insisting that we don't diagnose.

After we hashed out the question (all of us were in agreement that EMS is not ready yet for independent practice, for various reasons), I had the chance to ask both doctors a question: "Do paramedics diagnose, and if so, are you offended at a paramedic's use of the term?"

Dr. Myers answered (paraphrased), "Of course paramedics diagnose. How could they do their jobs otherwise? And no, it doesn't offend me to hear a paramedic use the term. Many healthcare providers form diagnoses. The word isn't owned by physicians."

Dr. Wesley went one better, saying (paraphrased), "Of course paramedics diagnose. And not only that, EMTs diagnose as well. Every day, and on every patient encounter. I wouldn't want an EMT working for me who didn't at least have an idea of the underlying cause of the patient's symptoms, and that's what diagnosis is."

That's two nationally respected EMS physician medical directors, published authors and EMS advocates, both board-certified emergency physicians, and in the case of Keith Wesley, also board-certified in the subspecialty of EMS medical director.

And both of them think this idea that EMS people should avoid the D-word at all costs is just silly, and both of them deplorie the notion that EMTs and paramedics provide symptomatic treatment only.

I doubt this will drive a stake in the heart of the whole "EMS doesn't diagnose" myth, but feel free to liberally link this and the other posts whenever some mouth-breathing cretin with a paramedic patch insists, "We don't diagnose. We ain't doctors, and we'll get our asses sued if we do!"

For further reading:

A Lawyer Speaks Out On Diagnosis

Demystifying Diagnosis

Yes, We Do Diagnose


Comments - Add Yours

  • pediem

    Count me as a third physician who agrees. I’ve had kids’ lives saved by paramedics who correctly diagnosed and began treatment in the field. Those field diagnoses got the kids to me with a heartbeat and gave me the time I needed once they arrived in the ER.

  • Denis George Miller

    I am a first responder in rural Saskatchewan. We are not EMTs but our role is basically neighbourhood (within 20 miles!) first medical responder to medical calls. our role is really to keep the patient alive for the ambulance, take info on condition, etc, first aid and prepare the patient for transportation. Even at this level we make diagnosis so we know what treatment to give!

  • Barefoot in MN

    THANK YOU for this piece. I’m a new First Responder, now in an EMT class. On one of my first clinicals I was scolded by a nurse/EMT in the crew for even expressing my opinion that it was good that the patient had just gotten his back checked a month previous to this new sudden onset of pain; my opinion was “that’ll be helpful when the dr’s compare the current data with previous.” In my opinion that wasn’t a diagnosis! But I was verbally crucified during AND after the call, charged with the crime of “diagnosing”. That crew member isn’t usually that inexact or so “snarlly” but it still left me with a wariness of expressing (or even having) a thought of my own. Rather a depressing effect, & not conducive to enthusiastic study. Please do get the word out about this consensus, since I sadly doubt it will be accepted coming from lowly life-forms like me. Thanks again.

    • T from Salem, OR

      Kudos to you guys from a retired nurse. Keep up the GOOD work’ the already broken healthcare system couldn’t function without you!