We all know that one therapist. The one who gets their workload done, but never calls to check on the rest of the crew. The one who gets their coffee in every day, but somehow manages to disappear whenever the pagers go off. The one who gets "swamped" with a handful of aerosol orders.
That therapist is a problem. But this is not about that therapist.
Slothful workers are found in any line of work, and the solution to that problem is fairly simple (even if managers are sometimes loathe to flip that switch). Instead, we need to talk about a far more insidious type of sloth, the laziness borne of complacency. Unfortunately, this sloth can be far more difficult to weed out, because we often don't even admit to ourselves it exists.
The first big way complacency manifests in respiratory care is the philosophy that We've Always Done It That Way. This is the form that almost seems baked-in to our profession at times. We rely heavily on tradition and custom because until relatively recently, we didn't have objective clinical research to support many of our procedures. We've had to use common sense, anecdotes, and the wisdom of elders to chart our path, and we've usually done all right with that. But this tradition has also caused us to all-to-often be resistant to surrendering our sacred cows on the altar of evidence-based practice. Routine endotracheal saline lavage. CPT. IPPB. All things that have little to no supportive evidence, and all things that some therapists will swear work every time.
It's hard to break this view when even the upper echelons of our profession frequently subscribe to it. Let's look at the AARC's legislative efforts. While they have admirably pivoted away from a standalone Medicare reimbursement bill (after repeated attempts in a hostile environment), the new telehealth initiative still focuses on changes at the national level. Accordingly, GovTrack (a website that uses statistical analysis and modeling of previous bills to analyze current proposals) has given it a <1% chance of becoming law. We cannot abandon the national legislative scene, but clearly, some alternative methods to affect national healthcare policy can be developed while we wait for Congress to get back to work. Strategies for member recruitment and public relations also remain stagnant, despite admitted major issues in both areas. Even one of the pillars of respiratory care, Dr. Robert Kacmarek, recently called out the institutional inertia of the AARC in failing to achieve many of the goals of the 2015 and Beyond program, a program he was instrumental in guiding. When this was mentioned in a discussion on LinkedIn, instead of offering a true rebuttal engaging in constructive debate, an AARC representative said, "History has shown us that people that blindly follow proverbial leaders or hearsay often have disastrous results." In other words, keep doing the same thing you've always done and get in line behind us.
That leads us to the other manifestation of sloth, Someone Else Will Do It. A big part of the reason we have that institutional inertia is that a relatively small group of people are the ones who consistently answer the call to leadership. This is true with the state societies as much as it is with the AARC, because it's easy to assume that they're just there, no matter what. We have to remember that the state societies that put on outstanding educational conferences, lead the push for higher professional standards, and are the front lines against deregulatory efforts are made up of therapists just like you and me. They need help. They need fresh ideas and new insights, and they need input as to the most pressing concerns for therapists of all stripes. They need YOU. It's not enough to sit back and wait for others to do it. It's time to climb down from that comfy branch and get to work building the profession we all deserve.
This post is dedicated to the memory of a man who was the antithesis of sloth, virtually to the end of his days. RIP Dr. Forrest Bird (1921-2015).