What is a skills monkey?
A skills monkey is someone who has been trained to perform skills well enough to pass a simple choreographed test of that skill.
Medical skills monkeys are not limited to paramedics or EMT basics. Doctors, nurses, PAs (Physician Assistants), NPs (Nurse Practitioners), et cetera can all be skills monkeys.
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What is most important in the use of medical skills is not the ability to do what we practiced on a mannequin, but the understanding to know when to treat the patient with that skill and when not to treat the patient.
Because it is the Standard Of Care! is not a competent reason to harm a patient with a skill. Every skill can harm patients.
Why are we using a particular treatment?
What are the possible benefits?
What are the possible adverse effects?
If we do not know of many more possible adverse effects of a treatment (than possible benefits), we probably do not know enough about the treatment to use the treatment safely.
How will we possibly know what to expect?
How will we know what to watch out for?
How will we know when to stop, when to increase, when to repeat, or when we have good evidence that what we were treating the patient for is not what is making the patient sick?
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A skills monkey does not understand anything more than –
Α. Select a protocol.
Ω. Follow the protocol to the letter.
Skills monkeys tend to be literalists. Literalists generally cannot comprehend abstract thought and should probably not be allowed to make decisions. Skills monkeys tend to be only aping what they have seen others do. Their reasoning is – That’s what the protocol says to do.
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Here are some examples from the skills monkey playbook –
Crackles = Lasix, even if the crackles are from pneumonia.
Fall = backboard, collar, and straps, even if the patient has contraindications to this treatment.
Pain management = transport to the hospital so that someone who has a clue can take care of this scary treatment.
It is better to do nothing than to do something that might be wrong.
If that is what we believe, we should not be making any decisions that affect patients. We can teach that kind of thinking in grade school.
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You were expecting a monkey? This kind of thinking does not require the higher thinking skills of a primate.
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Everything has the possibility of causing harm.
If we cannot handle that, we should not be permitted to hide behind protocols, or medical command permission requirements, or Standards Of Care.
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