What it said is “treat the patient, not the monitor.”
What I really hear is “I don’t know how to accurately interpret the monitor, so I can just ignore what is on the monitor.”
For example: your patient is a 73 year old male. He is pale, cool, and diaphoretic. He has normal mentation and complains of weakness. His heart rate is 40, and weak at the radials.
Do we seriously not base our next treatment off the interpretation of the monitor?
He could be in symptomatic bradycardia, and might need a little atropine. He could be having a humongous inferior MI and need a large bolus of diesel. He could be in a complete heart block and need to be paced. He could be in ventricular bigeminy and need some oxygen and a fluid bolus.
But no. You treated your patient, and not the monitor.
What is said is “I know he doesn’t have neck or back pain, but I’m going to board him anyways because of the mechanism.”
What I really hear is “I totally have no idea that immobilization causes harm, and besides, I don’t know how to perform an accurate assessment anyways.”
For real. If you are going to immobilize someone to a spine board, at least have the cojones to say “I was legitimately concerned about the possibility of an unstable cervical spine fracture, so I performed the immobilization.”
We shouldn’t base any treatment based on mechanism alone. Should every victim of a gunshot wound get bilateral lines, oxygen, and transport to a trauma center?
What is said is “I have to do treatment x because it is protocol.”
What I really hear is “I’m just doing what I’m told, and may or may not know better. I might be interested in changing the protocol, but probably not.”
If your medical director wrote a protocol that instructed EMTs to apply a brown paper bag to the face of any tachypneic patient, would you do it?
If your medical director wrote a protocol that instructed you to perform spinal immobilization on every patient who might have a head injury, would you strap down the old demented lady with kyphosis who rolled out of bed on the wrong side?
Or would you stand up for your patients, and for your profession, and point out the wrongs?
I guess I’m just irritated.