I should not be so quick to say ‘Fire Departments’ because what I really mean is community life safety based organizations. That could be a municipal non-private EMS service, a fire-district, or a fire department.

As far as what choice I mean – The choice of who you want delivering telehealth to your community.

Here is why I believe this fact;

Having spent 30 years in EMS this year, I am reminded regularly that every part of medicine can have a dark-side. That dark-side is mostly seen when profit or money is the predominant driving force behind any medical service or profession. This has jaded my view of medicine to not be so quick to buy in to the philosophy of ‘capitalism without concern’ mind-set. The ying to this yang of capitalism is to maintain patient-centered mindset.

This is my constant inner-monologue – I must keep the patient as my focus because if I do not, I will cut-corners and take the ‘cheaper’ path. In order to do that I must feel supported to keep patient care as my predominant motivation of what I do.

Now I ask you…

Do you say that to yourself when you go to work?

Do you feel supported to accomplish that mission?

More specifically…Do you feel as if the owners and managers are just interested in running more and more calls or are they showing by their actions by being first worried about taking care of you and that patient (and the rest will handle itself)?

I believe from my experience, the later focus is the better medical focus paradigm.

Still, while maintaining this ‘first focus’, we all must be aware that we must be able to sustain what we do. Meaning, we need to create a revenue (read money for that word) to sustain this important work. Think of it this way – People that commit their time and energy to serve and treat patients should get paid for what they do so they can commit to that purpose. There is a cost-benefit neutrality there. We must cover our expenses, have money left over to enhance our medical services and we must be able to expand what we do into un-reached areas.

In order to do that revenue, of some form, must be taken.

At the same time, when the bottom-line gets in the way of the patient…the human-being… the family member of someone we are treating… we will have lost mission-focus and potentially the life we are trying to save.

There truly is a balance-point between these two apparently competing issues.

Hence, when you look at medicine and it’s various services and products, and you understand the motivation behind those that are in charge of those various services you suddenly realize that to maintain the patient at the center of focus we must be ok with doing things that occasionally cost-us personally and things that sometimes cost us as a service, business or practice. Truly that is the ‘right’ thing to do.

But, when the only goal is profit we can no longer maintain neutrality.

So here is the point, when private EMS agencies goals are the profits of the stock-holders how can there be a balance? In the same way, a fire department or municipal EMS service focus is making sure its citizens are served, those citizens comprise a large portion of their patients. Hence the motivation is the patient.

Is there any other choice?

I believe the answer is no.

  • Nathan A. Lewis RN, MICN

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