Seeing the Forest Beyond the Tree - Understanding the Heathcare System as a Whole

I had the fortune to witness an organ harvest as part of a hospital practicum. Though the moment was awe-inspiring, it came at the culmination of a day of patient care in an intensive care unit. Along the way, I was struck by the level of interaction and cooperation between multiple units and specialties within the hospital. Phlebotomists took blood work, doctors interpreted and ordered new therapies. Pharmacists prepared the new medications and shipped them to the unit. Nurses initiated the new treatments while providing daily care. Respiratory therapists maintained the patient’s ventilator. The organ transplant team confirmed which patients would receive the organs that could be harvested. The surgical team conducted the harvest. Finally, the organs were taken by specialized transport teams to the airport to fly to different hospitals throughout the country to be transplanted into the recipients.

Though the organ harvest may have been a more rare event, this level of interaction is common-place for a patient in a hospital and makes up the majority of a patient’s healthcare experience. The role paramedics would play in this organ harvest would be fairly limited, driving the organs from a hospital to the airport and vice versa at its destination. Since our role is so brief, specialized, and separate from the rest of the hospital system, we miss out on the chance to see the entirety of the system and take in the amazing things that can happen along a patient’s healthcare journey. To put it another way, we miss the rest of the forest hiding behind our tree.

Because we rarely see the different parts of the system enough to fully understand the roles and specialties, we also misunderstand elements. Consider the paramedic who is frustrated because the nurse delivering report doesn’t have the patient’s full story memorized. We are so used to having a single patient that we struggle to conceive that we are the exception to the rule, few healthcare practitioners benefit from such an advantageous ratio.

By better understanding the healthcare system as a whole, we can better understand ourselves and the role we play within it. Each element of the system has its role and is specialized as such. There is overlap between elements as different skills are necessary in multiple fields (IV access, for example). We are transport specialists. Our job is to move patients - to and from the hospital, and between hospitals. Our skills are prioritized as such, focusing on the assessment of immediate threats to life and symptom relief that will allow for a smoother transport to hospital. Few, if any, of our treatments are purely definitive since patients will receive further assessment, diagnostics, and care at the hospital. Our specialty is in getting a patient to the hospital, managing a hectic, chaotic scene and packaging a patient for transport.

We can also understand the limitations of our role. Our focus on emergent conditions and transport limits our understanding of chronic health conditions and long-term patient care concerns. We may be well suited to handle a (suspected) heart attack, but unable to identify the kind of infection a patient may have and the correct antibiotic therapy to initiate. At best, we can provide a general understanding of a patient’s journey through the hospital system.

Unfortunately, there is little overlap between paramedics and the hospital service. Our brief forays into the emergency department, and occasional transfers into specialized units does not give us a chance to see what goes on in a hospital and the many roles within. Similarly, those practitioners do not get a chance to experience pre-hospital care. I was fortunate enough in my many hospital rotations to get a chance to experience some of the forest, but not everyone gets that chance. Imagine how much better we could understand each other if we were to foster more exchanges and share in each other’s respective roles and responsibilities.