Too Much Information

It’s the week before the final exam and my EMT class is feeling the pressure. The two-hundred question final looms large on the horizon and, in less than a week, the students will need to perform five randomly selected skills stations perfectly. This is the task that has most of the students really feeling the heat.

So we do what we do every class. We practice and practice and practice. So there we were, gathered around in groups, practicing our National Registry skills sheets. That’s when Joey asked me the question that absolutely floored me. It floored me and annoyed me, but really didn’t surprise me. I’ve heard the question asked before in many different ways.

Joey finished up his medical scenario and I was giving him some feedback on his performance. He looked down at the fictional patient’s medication list that I had provided him and he shrugged his shoulders. “We don’t really have to know what all these mean right?”

I told him I didn’t understand. He mulled the thought over in his head and took another stab at it. “I mean…we need to write these down and report them to the doctor, but it isn’t important for us to know what they all do. (Pause.) As EMT’s. (Pause.) Right?”

I thought my answer over carefully and then I explained that knowing the actions of the patients home medications was not a part of the standard EMT curriculum but it was a great educational goal. I gave him a few examples of why I thought the information was important. I explained why a septic patient taking beta blockers would present differently than one who was not. I explained why a trauma patient taking Coumadin would be examined with a higher index of suspicion than one who was not.

And then I told him something that I hope he carries with him into his EMT career. I said, “Joey, the world is going to work hard to place limitations on you. Don’t waste your time placing limitations on yourself.”

The world is full of people like Joey. Working hard to place limits and boundaries around their knowledge and their abilities.  People struggling to define the outer limits of the worlds expectations.

I gave a 10 minute talk on evaluating nystagmus to a group of EMS educators and had an EMT instructor write on my evaluation form, “This is too advance for EMT’s.” I felt sorry for that instructor, but I felt more sorry for her students. Greg Friese recently thumbed through a stack of classroom evaluations to come across the remark, “This is too much information for a paramedic.” What the heck is too much information?

What makes us so willing to fence in our ability? Why are we so inclined to define the outer limits of what we should know and understand? I think there are three closely related reasons.

1) We like to keep the bar low.

As much as we might hate to admit it. We’re more comfortable with the bar set low. Life is easier when we know that we can clear the bar. When we’re confident that we can barely clear the bar, we naturally resist anyone who looks like they might want to set the thing higher.

“Wait a minute!” our comfortable self proclaims, “Nobody said we needed to jump that high.” Instead of warming our legs up and refining our technique we simply attack the bar raisers. Who needs them? Life is easier without them. Once the bar is firmly established we can switch over to cruse control and stop growing.

What we forget is that every living thing is either growing or dying. Not growing seems like the most comfortable choice, but the consequences of refusing to grow always catch up with us.

2) We fear the limitless and undefined.

Unlike many areas of knowledge, our current understanding of medicine is so vast that no single human being could possibly grasp it all. It stretches out in all directions and continues to grow each day. Swimming in the pool of medical knowledge is like swimming in the ocean. It has no boundaries that we can see and that leaves us with a lot of freedom. How far should we swim? How deep should we dive? How long should we tread?

This can induce a lot of fear. We long for someone to define the boundaries for us. We want a swimming zone sign and one of those neoprene ropes with the little floaty buoy’s on it. Nothing induces fear quite like our own freedom. And so we respond to our fear by creating the limits and blowing the whistle on anyone who tries to swim past the rope.

Nobody ever became a really great swimmer by staying inside the rope. As soon as you feel strong enough, swim past the rope.

3) We are inherently insecure.

On second thought, there might be one thing we fear more than unlimited freedom. We fear failure. Once someone raises the bar into unknown territory we invariably begin to imagine ourselves failing to clear the bar. We imagine ourselves crashing down in front of all of our peers and exposing ourselves as faliable and human.

What could be worse than the public humiliation of failure? The very idea of failure is so scary that some of us spend our whole lives only trying new things when the possibility of success is almost certain. And when someone challenges that feeling of certainty we lash out.

Fear is a powerful thing.

Now it’s your turn: What do you think? Is there such a thing as “Too much information?” Leave a comment and let us know.

And then go check out what Greg Friese of Everyday EMS Tips and Chris Kaiser over at Life Under The Lights have to say about this subject. Special thanks to Greg for inviting us to write on this topic.

Comments

  1. Ckemtp - Life Under the Lights says:

    Howdy Steve, Great post!

    I too have heard the “something” (pause) as EMTs (pause) and have met many people who shoot at the people raising the bar. In fact, in my own attempts to raise it I’ve been shot at quite a bit. There’s a lot of people who are quite comfortable in their zone of apathy and resist any and all changes.

    We need to make EMS education exciting, fun, and pertinent. There needs to be a clear benefit to knowing more that everyone can see. When learning becomes an avocation, knowledge comes easily.

    Great stuff as always, Sir. Looking forward to doing this again.

  2. “Will this be on the test?”

  3. medic 322 says:

    I am a cop as well as a EMT. Soon to be a Intermediate. Anyway. I was working with a new Paramedic on our crew. We had a Pt. on the truck. Young guy. He had been drinking. So I did a short Horizontal Gaze Nystagmus test on him. You can get a fair idea of what his EtOH level will be. Based on the test. My Paramedic looked at me like I was from a another universe. Talking under his breath. Something to the effect. We just don’t do such a thing. I got a big kick out of it.

  4. If you’re afraid to be different, you’ll never make a difference!

  5. You gotta stick your neck out there to see if something will work. This profession is all about raising the bar and doing things outside of the box. Awesome job on your article!

  6. There is such a thing as too much information. I think it all has to do with how you qualify it. Clearly, I believe there is no such thing as “too much information for a paramedic.” I have never landed an airplane on the deck of an aircraft carrier but I think it would be possible in that crux moment of committing to the act of landing that there could be too much information to the pilot. At that moment the pilot does not need more information he needs the right information. I am sure there are parallels in the EMS during patient assessment when we need to focus on the quality of information over the available quantity.

    Steve thanks for writing on this topic with Chris and me.

  7. Three things:
    1. I agree. It’s amazing to me how bent out of shape people get when I start looking at an EKG. They ask “when did you start medic school?,” and they’re shocked when I tell them I’m not in medic school (yet), just really interested in learning.

    2. It’s hard to keep learning with that kind of attitude around me – people seem to resent my questions, and when I write down the drug I don’t know to look it up when I get home (after my 16 hour +2 hours of late calls shift), I’ve forgotten the patient. Even if I do look it up, I have a hard time remembering what I learned the next time I see the patient.

    3. Why would a patient on beta blockers in septic shock present differently from a patient not on beta blockers?

  8. I’m a new Paramedic myself, and I not only saw this with classmates in EMT class, but medic school, and my current EMT partner who is in medic school.

    Just yesterday I quizzed him on what PT and PTT were used for in relation to cardiology. When I explained it he said it was pretty much useless knowledge for our jobs…that dumbfounded me.

    In school, I was told by a classmate (who ended up being at the bottom of the class, who woulda thunk?) that I knew too much.

    My bad. I thought that in medicine it was a GOOD thing to know as much as we possibly could that related to taking care of our patients.

    To quote my old teacher, “That’s what separates a paramedic from a great Paramedic”

  9. Sean Fontaine says:

    Rarely do I do this here, but I’ll play devil’s advocate. Like Greg said there can be too much information, however we need to look @ it in perspective. I was guilty and its likely that everyone else was too; there is a period in paramedic school where your head is so full that you can’t effectively run calls for a while because you’re zebra hunting due to your head being crammed so full of school material that you haven’t assimilated into a functional manner yet. Along with that every student moves forward at a different speed than their peers.
    My point here is this; until each student learns how to come up w/likely differentials, perform quick door assessments, ask streamlined questions (instead of the splatter approach), listen to the pt’s responses and ask your next question based on that info, work in physical and diagnostic findings, and Hx, there will be times that students feel there is too much information. In the long run however, our patients benefit from us constantly expanding our knowledge and pushing forward through our fear of failure to continue learning.
    In response to your students meds question, I remember being tested on over 250 home meds in addition to the drug formulary in our protocols during school, and what that knowledge has given me is a snapshot of each patient’s medical Hx as well as knowing what expected Sx or changes in expected Sx may be present/adverse rxns or contraindications I may face during my Tx of them.
    So, yes there can be too much information until we understand how to appropriately use all that we have learned and no as a profession there is not such a thing as too much information. Fear of failure may be present ,but is not a valid argument for expecting less of ourselves and others.

  10. Good post, and thought-provoking comments, too. I think “too much information” is an incorrect notion. We are often presented with information we don’t know what to do with yet, which might be construed as “too much” information. The response shouldn’t be “I don’t need to know this/this is too much info” but rather “How can I use this to improve my skills?”

    I’m a new EMT B with a strong background in medicine, including pharmacology. That “extra” knowledge, while not strictly necessary to do my job as an EMT-B, has proven extremely helpful in even the most routine assessments.

    Knowledge builds on knowledge; even if something seems beyond my grasp right now, I still make note and file it away for future use. It never ceases to amaze me how a situation will come up and some previously insignificant bit of info will come to mind that proves really helpful.

  11. Sean Fontaine says:

    LR, said it right. Even if it’s beyond your scope doesn’t mean it won’t lend useful information. One of my partners always said there are cookbook paramedics-who treat down the algorithms and do their job without hurting anyone, the cavalier ones- who may well hurt someone by varying from the protocols without reason, and the complete package ones-who can seamlessly move from one differential to another/merging differentials and bending or going beyond protocols in an informed manner/including a medical consult when done. The complete package medics are the ones who dovetail all the info we come across and more into their daily practice and as such continually set the bar high. They usually seem to be able to speak with any population with what appears to be total ease no matter the situation as well.

  12. I’m not an EMT. I’m a Girl Scout Leader with a 16 hour wilderness first aid course. I found this site while doing a Google search for something (don’t remember what) and now I come back from time to time because it’s interesting.
    Today I came here and thought, “should I really be here; am I over reaching when I expect I could use what’s here?”. Then I read “too much information”.
    Thanks.
    I’ll be back.

  13. Spot on again. I would always go home after my EMT-B class and google on various subjects for more in depth coverage and related articles. I find that the more I read outside of a particular subject the better the basics of that subject become ingrained in my mind. It really helps piece everything together. What better way to study than to over-read (time-permitting of course). I don’t want to just know just what a condition presents as and how to treat it, but why it happens, what related bodily processes are involved. WHY WHY WHY!!!??? The human brain can hold sooo much information. Why sell yourself short when knowledge is available so freely?

    On a related note, can anyone recommend a good book or source of info on diabetes? I still find that to be a incredibly in depth subject, and I feel it was really rushed by in my classes. Having grandparents who are both extremely diabetic, I feel a personal drive to learn more about it. Preferably something available at the library, but a reputable online source would be cool too.

    Keep it up Steve!

  14. Huge bump here, but I’m taking some time before my EMT class (and test) starts. Just had my personal “Get It” moment. We have limited field time, and limited ER time. Something as simple as forgetting a piece of an assessment (pulse oximetry which we never hit hard in the lab) or not giving advice after treating at the scene (simple lac taken care of with a band-aid, and letting a family member know to keep it clean and put some neosporin on it) So when I get back to the station with my preceptors kicking myself for not knowing these things I told myself why even continue on if I miss what seems like simple things. I was quitting before starting, I was resistant to what in reality was learning.

    “The world is going to work hard to place limitations on you. Don’t waste your time placing limitations on yourself.”

    I get it now

Trackbacks

  1. […] shined a light in a confined space about know it all Paramedics who feel they are overwhelmed with too much information. This type of complacency isn’t limited to the responders, but there are alot of agencies out […]

  2. […] A busy month indeed at The EMT Spot. This month I experimented with quality over quantity and I hope you found enough good stuff to stimulate your noggin. We started with another installment of the ultimate guide to EMT vital signs. This month we looked at respiration. Then I took another run at the controversial phrase, “Patient’s define their emergencies.” After that we talked about doctors watching EMS care on cameras and we wrapped it all up with the question, “Is there such a thing as too much information?“ […]

  3. […] Too Much Information and Risk Management Tue, 31 Aug 2010 20:23:42 +0000 By Rogue Medic Leave a Comment Steve Whitehead discusses the problem of Too Much Information the problem of people avoiding learning by claiming that they are being presented with Too Much Information. […]

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