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Yes. And my answer may make a lot of people upset, especially since my observations will touch on more than just emergency medical services (EMS).When I was a new emergency medical technician (EMT) I assumed EMT-Paramedics (Paramedics) were gods. I mean, seriously, anyone who could read those squiggly ECG rhythms must be magical! We even called them “paragods.”Later I learned that though there are a few very good medics, the vast majority are mediocre and just get by. There is also a significant number of truly scary, incompetent medics that manage to squeak by, possibly because many systems have at least two medics respond to each call, the stronger medic usually covering for the weak medic. Very good medics are quite rare. A very few are true professionals who think with excellent logical processes based on a solid understanding of physiology and pathophysiology, while the remaining medics stumble along using a splash of real understanding coupled with memorized protocols in a sort of medicine via “rolodex” fashion, i.e. “I see this sign and hear this symptom and it matches protocol 2A, so use protocol 2A and hope that works.”PS: Not my creation, but reflective of the fear of one's incompetent peersThough the EMS Profession officially abhors this “cookbook medicine,” it’s a reality that exists due to several factors, including shortages of EMTs/Paramedics, lack of funding for longer and more thorough training periods, and competition between programs for students, the result being quality of care where, as the joke goes, “Patients survive despite our best efforts.” Later still, I realized the same holds at several levels to include nurses, physicians assistant and, to a lesser degree, physicians.On a personal level, knowing there were really bad or stupid paramedics out in the field did help me because, several times during my own program, my confidence would waver and I’d wonder if I would be able to pass. It was at these times I’d think to myself: “If so and so could pass medic school, so can I.”Perhaps the biggest systemic shortcoming in EMS in the USA is the lack of a consistent feedback loop for EMTs and Paramedics. For example, when I assess and treat a patient in the field, turn the patient over to the ER, and the patient is then treated & discharged, or admitted to the hospital, there is NO built in mechanism to tell if my actions were correct. Learning the outcome of the case, thereby helping to improve my assessment, diagnostic, and treatment skills, involves a tedious process of phone calls and often personal visits to the hospital in question to catch the right nurse while they're on shift. Much of this happens on my off-duty time.“Sorry, can’t tell you that. Its because of HIPAA you know. Click.”Complicating this are the US HIPAA laws which, though designed to allow sharing of relevant case information for training and education, are so poorly understood, hospital and medical staff will almost never give you any info unless you have a personal rapport with whichever nurse you’re talking to. In a perverse way, the system-wide ignorance of the privacy law’s intent reinforces continued ignorance, making Continuous Quality Insurance (CQI) something of a joke.To be perfectly fair, in Southern California at least, hospitals often have a single Paramediic Liaison Nurse (PLN) with the additional duty of helping curious paramedics find out what happened to a particular patient, and they can be very helpful. However, as one nurse, often saddled with a myriad of other duties, their ability or willingness to do the chasing down of any given patient’s particular outcomes is quite variable.Currently (as I write this), I'm awaiting to find out what happened to a patient. The effort has thus far required repeated outreach via text, phone calls, and emails. With any luck, next Thursday the right person will be on shift and have enough time to get me an answer. Fingers crossed!Overall, the proces is such a headache hardly any medics bother, making feedback something that happens only if something went really wrong, and the hospital thinks you're to blame.Put EMS care another way, it’s as if EMTs/Paramedics are shooting baskets at a basketball net hidden behind a high wall. You can’t see the basket, but you keep shooting for it without seeing if you’re getting the baskets or not, or how badly and in which way you’re missing.Why no one addresses this has many factors, not the least of which is the administrative headache and costs of coordinating thousands of providers with tens of thousands of health care facilities, local area governments, etc. So EMS is guided largely by protocols used by paramedics and EMTs from programs that vary WIDELY in quality and product.As a patient, your choices when it comes to EMS are much more constrained. But when it comes to other health care providers of ANY level, you truly must shop carefully because the health care field is full of incompetent providers, including among specialists.I wouldn't care so much about the wide range of competence, except in healthcare, incompetence hurts. It is responsible for an incredible volume of unnecessary suffering and unneeded deaths and disability. A Johns Hopkins study suggests medical errors are third-leading cause of death in U.S. Keep in mind this study used data on death certificates which often use generic terminology of death, e.g. “heart failure" or “multi system organ failure” which is sort of like mechanics saying “the car broke because it didn't work,” i.e. it tells you little.Put another way, the researchers relied on what attending physicians documented as the cause of death without knowing the truth of things. Few hospitals autopsy patients anymore, meaning for many, if not most patients, the cause of death is an uneducated guess. No one argues with “heart failure” or “cardiac arrest” or “multi-system organ failure” because those are the end result of pretty much any fatal disease process.The decline in autopsies has several reasons, including reduced quality control standards, cost and possibly lack of interest, but the lack of autopsies probably robs medical personnel of invaluable feedback on pathological processes that must now be assumed rather than “proven" (insofar as an autopsy can prove certain causes of death. In 1972, almost 1 out of 5 deaths were autopsied. From 1972 through 2003, however, the autopsy rate dropped 58 percent from 19.3 percent to 8.1 percent. Although the autopsy rate has increased slightly since 2003, only 8.5 percent, or fewer than 1 out of 10 deaths, were autopsied in 2007 (Products - Data Briefs - Number 67 - August 2011).The authors from the previous study continue "Right now, cancer and heart disease get a ton of attention, but since medical errors don't appear on the list, the problem doesn't get the funding and attention it deserves." In other words, no one (or at least not enough people) really care, therefore, we simply don’t know, and I don’t know if we really do want to know.

State and Federal Voter Identification Requirements:In most cases, California voters are not required to show identification before casting ballots. If you are voting for the first time after registering by mail and did not provide your driver license number, California identification number, or the last four digits of your social security number on the registration card, you may be asked to show a form of identification when you go to the polls. Make sure you bring identification with you to the polls or include a copy of it with your vote-by-mail ballot. Following is a partial list of the more than 30 acceptable forms of identification. You can also visit the Secretary of State’s website and look for “Help America Vote Act Identification Standards” at www.sos.ca.gov/elections/elections_regs.htm.Driver license or state-issued ID cardPassportEmployee ID cardCredit or debit cardMilitary IDStudent IDMore information from http://www.sos.ca.gov/elections/regulations/hava_id_regs_from_barclays_3_3_06.pdf:... proof of residency or identity, shall consist of presenting an originalor copy of any of the documents described below in either paragraph (1) or (2).(1) Current and valid photo identification provided by a third party in the ordinary course of business thatincludes the name and photograph of the individual presenting it. Examples of photo identification include,but are not limited to, the following documents:(A) driver's license or identification card of any state;(B) passport;(C) employee identification card;(D) identification card provided by a commercial establishment;(E) credit or debit card;(F) military identification card;(G) student identification card;(H) health club identification card;(I) insurance plan identification card; or(J) public housing identification card.(2) Any of the following documents, provided that the document includes the name and address of theindividual presenting it, and is dated since the date of the last general election, unless the document is intended to be of a permanent nature such as a pardon or discharge or unless the date requirements of paragraph (F) apply, including:(A) utility bill;(B) bank statement;(C) government check;(D) government paycheck;(E) document issued by a governmental agency;(F) sample ballot or other official elections document issued by a governmental, agency dated for theelection in which the individual is providing it as proof, of residency or identity;(G) voter notification card issued by a governmental agency;(H) public housing identification card issued by a governmental agency;(I) lease or rental statement or agreement issued by a governmental agency;(J) student identification card issued by a governmental agency;(K) tuition statement or bill issued by a governmental agency;(L) insurance plan card or drug discount card issued by a governmental agency;(M) discharge certificates, pardons, or other official documents issued to the individual by a governmental agency in connection with the resolution of a criminal case, indictment, sentence, or other matter;(N) public transportation authority senior citizen and disabled discount cards issued by a governmentalagency;(O) identification documents issued by governmental disability agencies;(P) identification documents issued by government homeless shelters and other government temporary ortransitional facilities;(Q) drug prescription issued by a government doctor or other governmental health care provider;(R) property tax statement issued by a governmental agency;(S) vehicle registration issued by a governmental agency; or(T) vehicle certificate of ownership issued by a governmental agency.

I’m not sure what the rule is in other states of the U.S. or in other countries but in California, licensed physicians are issued plastic credit card sized licenses meant to be carried in your wallet.[sample California medical license wallet card with identifying data redacted]We are asked to provide a copy of our license for license / hospital privilege / insurance contract certification and recertification. So strictly speaking, one wouldn’t need to have the license on one’s person for those purposes. I also checked with the Medical Board of California online guide to laws governing physicians in the State of California[1] and was unable to find any specific reference to a requirement that a physician must carry the license wallet card on his or her person.All certifying bodies do maintain copies of a physician’s current medical license on file. Nonetheless, where physicians work in hospitals or clinics that are subject to unannounced audits by regulatory bodies, it would seem prudent for the health care professional to carry the license with him or her.[While this is a simulation of an in-flight emergency, I can attest to the fact that I’ve been called upon to assist with these events more frequently than you might believe. Image courtesy How airlines deal with in-flight medical emergencies 1 in every 604 flights involves medical situation, study says. In-flight Medical Emergencies "Be Prepared".]On several occasions, I have been asked to provide emergency medical services while in-flight. When this first happened during the period between 10 and 20 years ago, it was rare for the flight attendants to request a copy of my medical license and I didn’t have to fill out any forms. However, during the in-flight medical emergencies to which I was called during the past 10 years, flight attendants nearly always asked to see my license and requested that I complete a history and physical exam form, detailing my findings. By the way, in case you were wondering, health care professionals provide these in flight services voluntarily as “Good Samaritans” and are not reimbursed for their time, nor should they expect any form of remuneration.Footnotes[1] http://www.mbc.ca.gov/About_Us/Laws/laws_guide.pdf (http://www.mbc.ca.gov/About_Us/Laws/laws_guide.pdf