The Home Cook vs. the Professional Chef – What EMS Can Learn from Cooking

Before her nose turned up too far at the plate I had put in front of her, I was able to convince my daughter to try the brussels sprouts I’d roasted to go along with our dinner. Our family’s healthy eating transition has been hard on our long-suffering pre-teen, but she’s managing. More veggies and less junk have become the norm in our household and while we’ve collectively dropped a lot of weight as a family, 50lbs of that being my own former EMS-related lard, the daughter still misses the bad old days and detests the healthy stuff that we’ve been forcing her to eat. She’s been coming around though, and after she tentatively attempted ingestion of the brussels sprout, she smiled and had another. She liked them, which was good, because of course she was going to have to finish them before she was excused from the table because I’m simply the meanest dad in the world.

Before the brussels sprout averse members of my audience get too disturbed out there, I’ll tell you that these were *really good* roasted baby cabbages. They’re also easy to make with fresh sprouts: You cut off the stem, cut the sprout in half, and spread them all out on a baking sheet covered in foil and a little cooking spray. Throw all the loose leaf pieces that fall off while you’re cutting them in the pan as well and jostle the sprouts to get them to open up a bit more. Then give a light spray of cooking spray over the sprouts, mix them up by hand, and sprinkle some garlic salt and pepper on them. Mix them again, then lay them out in a flat layer in the baking sheet. Pop them in a 425 degree oven for about 20-25 minutes until you can see some of the smaller loose leaves starting almost to burn a bit and the bigger pieces getting nicely browned. This will make for crunchy sprouts that disappear almost like French fries. Seriously, these are really good. I’ve been having to double the recipe lately because the sprouts almost all disappear before they get to the dinner plates. They’re like a vegetable appetizer. You could sit down with a bowl of these in front of the TV instead of a bag of potato chips. They’re just awesome.

When they look like this, they're done.

When they look like this, they’re done.

But you don’t come to my EMS blog for recipes, do you?

The daughter asked me: “How do you get them to be so crispy and good like this?” and I tried to explain to her the science of the cooking process before her eyes rolled up so far in her head that I got scared they were gonna get stuck like that. I told her “Well, I use a bit of oil to help conduct heat inside the sprout and to help soften them up, then I heat them in a hot and dry oven to induce the Maillard reaction and brown them which helps create the flavor we like. Then the surface area to mass ratio of each individual sprout helps them achieve different levels of…” I didn’t really trail off there in the actual conversation, but I had lost her by that point and I’m afraid of losing you as you read this as well. Suffice to say, food science is fascinating. I’ve always liked cooking, but this healthy eating adventure has not only improved my fitness and made my attraction to gravity less intense, but it has also forced me to become innovative as a chef and move away from the more fattening fare I used to produce. Seriously, you should see what I can do with a sweet potato and some asparagus.

Relating this to EMS is easy. You see, I could have simply told my daughter “I roast them in the oven until they’re brown and then they’re done” like I did when I was explaining the recipe above, but I didn’t because I want her to appreciate how science works in every aspect of our lives. Think about this: for most of you, the description I used above for the brussels sprouts recipe was sufficient information for you to recreate the dish and cook it for yourself because the chances are low that any professional chefs come to read my EMS blog. For home cooks who dabble in the kitchen and follow recipes from cook books, the above information is perfect. However, a professional chef would probably desire to have more information. They’d be able to look at the recipe, understand the cooking science behind what is happening with the ingredients and the method of cooking being used, and then be able to tweak the ingredients and the recipe to make it even more delicious. These people wouldn’t be “cookbook” cooks, they’d be chefs who understood the science behind what they were doing and would be able to go deeper into the process to get better results. An amateur might not need to know about how the Maillard reaction causes the exterior surface of a food to dehydrate and create complex flavor molecules and colors at a certain temperature and moisture level, but a professional should. Just as your average civilian with a first-aid card doesn’t need to worry about the finer points of assessing a patient in favor of just knowing when to recognize that something is wrong with someone and seeking medical care, a professional paramedic or EMT should need to know quite a bit about how a good patient assessment is performed and about how to interpret the subtle pieces of information they obtain from performing one.

Your EMS textbook and protocols are like cookbooks. Those things and the mnemonics you learned in school were great for helping you to absorb the volume of information you needed to learn in class and know for testing. They were cookbooks. They gave you the base information you needed to know to follow a recipe and obtain reasonable results. Chest pain? MONA. Pulmonary edema? MONA and CPAP. GCS Less than 8? Intubate Right?

Not really. Those outdated things are for cookbook medics and aren’t the best choices for your patients. A professional clinician needs to know more information beyond just the basics and simple memory aides. They need to know the physiology and the science behind the things they do and should make it their professional goal to keep learning continuously about their craft to hone their skills. After all, why would you do something for a career if you didn’t have the passion and the drive to truly excel in your field? Why would you be a cookbook amateur when you could be a professional chef?

By studying deeply into the science of why we do what we do, we provide better patient care. Our patients deserve us to learn everything we can about the things they come to us to take care of. It is our responsibility as professionals to be curious about our craft.

You may not need to know about the Maillard reaction, but there is no such thing as “Too Much Information for a Paramedic” when it comes to healthcare knowledge. Professional clinicians need to know things like that the AVOID O2 “Air Vs. Oxygen In STEMI” trial) has shown reasonably clear evidence of harm for patients with MI who are not hypoxic. They need to know how to provide adequate pain management for patients who are non-verbal and also that high dose nitroglycerine is the treatment of choice along with CPAP for patients with pulmonary edema. Professional clinicians should take pride in knowing how to tell if their patient with chest pain is most likely experiencing a pulmonary embolism, aneurysm, pneumothorax, pericarditis, or an acute coronary syndrome (PAPPA for chest pain) and know how to differentiate between and tailor their treatment towards those conditions.

Don’t just learn about EMS, learn about medicine. Learn deeply. Take pride in learning and in seeking out more knowledge. Learn everything you can about your craft. Learn the science. Be a professional. Your patients deserve it.

You should also probably eat more vegetables.

I cooked these up for my dinner while on shift. Eating healthy can be awesome.

I cooked these up for my dinner while on-duty at the station. Eating healthy can be awesome.

  • Eric Smith

    I’m actually a professional chef and I always have a fun time explaining things such as the malliard reaction to my crew. I’ve been following your blog for years now and you always have fantastically written posts. Keep it up!

    • You’re the guy? I knew I had a chef or two in the audience! Thanks for the kind words.

  • Amy Lee

    Cookbook medicine. The Medical Director of my Paramedic School…way back when…was fond of saying that. It was a term I took seriously, and wasn’t afraid of branching away from those “recipes”. I still take it seriously as a LPN, working geriatric dementia. Some people get stuck, or don’t bother to utilize the critical thinking skills that they have, if they have them. There are times that I may be wrong about something, but you can’t be afraid of that; otherwise, you are only harming your patient.

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  • RCA Ambulance Service

    Very useful