What medicine can learn from the fire department about team-based care


Through a thoughtful, community-based education program at my medical school, I spent a week rotating with my local fire department. Immediately, I was immersed in the first-responder field. I learned how to set up a transcutaneous pacemaker, properly unfold a fire hose, and plan ground strategy for wildfires. But what I will remember most years from now is something much less technical: the incredible value of team camaraderie.

More than once, firemen came up to me and said, “Isn’t this the best job ever?” Another one told me,“There’s nothing else in the world I would rather do.” When I asked why, I was surprised that the most common response was not related to the nature of the work, but that it was “each other.” This is when I started to pay attention to their vigorous camaraderie.

Teamwork is sewn into the fabric of the fire department. Each firefighter and paramedic has clearly delineated responsibilities; they work efficiently, communicate well, and interface with other organizations (ambulance, police, trauma doctors, etc.) with little tension. Best of all, they have a great time doing it. After calls, they would tell each other “good job” or “great work.” There was an abundance of compliments and positive reinforcement. Outside of calls, they worked out, cooked, and joked together. For a week, I was part of this team. I started to understand the love they all had for each other, because I felt it, too. After each response, I felt the rush of accomplishing something together, and I was aware that our mutual respect had been integral to every accomplishment. After that week, I was sad to leave.

This camaraderie stands in stark contrast to what I have thus far observed in medicine.  In medicine, the work is efficient, but there is not much positive reinforcement. Patients are roomed, interviewed, treated, and discharged, but there is no spirit infused into these processes.

Further, hierarchy is ever-present in medicine whereas in firefighting, it is only in the background. Each firefighter has individual responsibilities that require different training, just like doctors and nurses do, but one role is not made to be better than another. They are simply different, important components. This equality extends socially, too. The captains and chiefs ate dinner with us, did the dishes alongside everybody else, and put in an effort to be part of the community. Meanwhile, on my clerkships, I have seen groups of nurses organize after-work socials together, and I have seen doctors mingle with each other, but I have almost never seen those two groups, or any others, do so together.

For being so different in work culture, these two fields are actually very similar. Medicine operates in life-or-death stakes and utilizes a broad, interdisciplinary care system just like firefighting does. So why do these differences exist? I considered possible reasons:

Is the medical field too competitive to allow for interprofessional empathy? However, first-responders are also internally competitive. In Southern California, for example, there is a major surplus of individuals trained in these fields compared to the number of jobs and promotions.

Parts of medicine are dry and slow-moving. Is there some innate group euphoria that comes from responding to emergencies for first responders that cannot be generated when treating chronic illness? However, the collegiality was a part of nearly every aspect of the firefighters’ daily activities, not just the exciting ones (even paperwork!).

Much of medicine is profit-driven. In contrast, the fire department is a completely public organization. Physicians have to work under external financial pressures from hospital administrators, pharmaceutical companies, and insurers that may influence their behavior, but that do not plague first-responders.

The critical difference might lie in sheer workload. In the fire department, there was downtime to eat, talk, laugh, and rest between emergencies. In medicine, there is no such thing. The demands of patient visits, documentation, responding to consults, and taking calls are unrelenting, and perhaps prohibitive of a happy workplace.

Regardless of the reasons, team-based care is not a foreign term in medicine. It was discussed during my medical school interviews, preclinical curriculum, and clerkships. But until I contrasted the spiritless, practical teamwork of medicine to the lively camaraderie of the fire department, I never truly understood the extraordinary potential of team-based care to improve not just patient outcomes, but also provider satisfaction and happiness. There is a sense, I think, that in medicine there is no time to create a positive work culture, and no necessity for one. But what I experienced in that week of firefighting was enough to convince me that camaraderie does not have to be out of the question for medicine if we make simple, intentional changes.

Physicians and physicians-in-training are in a unique position to improve this. The attending physician is described as being the “director” of each health care team. But by assuming the skills necessary for this role are merely clinical, we are underestimating what this role requires. He or she is responsible for setting the standard for the team dynamic; active positive reinforcement, respect, and inclusion to all team members is vital. Trainees should be involved in this transformation, too. We spend hours of medical school practicing the art of the patient interview, learning how to cultivate rapport and trust with patients. We should be placing similar emphasis on honing inter-team communication during our training.

The insight I gained is just a fraction of what medicine could stand to learn from other professions, and similar interprofessional education should be promoted across all medical schools. Of recent, our profession has been shaken by the recent suicides of students, residents, and physicians across the country, calling greater attention to the academic stress and competitive environment of medicine. Rather than assume that the culture we perpetuate is status quo, let us be open-minded enough to see its flaws and empowered enough to fix it.

Pooja Desai is a medical student.

Image credit: Shutterstock.com


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