If you didn’t learn it, or you’ve forgotten, here’s how to get back on the wagon.
There’s an old saying that goes “Knowledge is power, guard it well.” Actually, it’s not that old and it’s from Warhammer 40,000 so I guess it’s not the best quote. But the first part is true: knowledge is power, especially in healthcare. The more you know, the better your patient care will be. Underpinning all of this is a knowledge of anatomy and physiology. Most of us in Australia will learn it at university – and probably forget large chunks of it as we go along, because a lot of it doesn’t seem to have a direct relevance to our practice. But it’s important to keep up with it, and important to revise it. How do you go about it? How do you increase your knowledge? That’s today’s topic.
Why do I need to learn it?
For my US visitors, who usually don’t undergo extensive A&P learning as part of their ‘certification’, the question may be raised as to why you’d need to bother learning it. I mean, Nancy Caroline has a section on pathophysiology, and each section in the book has a little overview of the essential A&P, so what difference does it make? Why learn about the intricate details of the cells when it doesn’t really change your practice?
The little overviews in your paramedic textbook are the bare minimum standard of knowledge. And I do mean “bare minimum”. They’re just enough to grasp some basic concepts to help you understand, at a fundamental level, different conditions and treatments. But they’re all over-simplified – and when you start to step outside of the limited knowledge they give you, it starts to fall apart. I don’t mean to criticse them too much – they have such a limited amount of space that they can’t cover things in too much depth. Also the knowledge they give you is functional – it’s enough to get you started, to give you an appreciation for what you’re doing. It’s just inadequate for anything beyond that.
When you learn anatomy and physiology, you unlock the ability to understand pathophysiology and pharmacology to a much greater degree. When you understand all of that, you stop doing things because the protocol says so, and start doing things because they’re clinically appropriate. You don’t fit the patient into the little pigeon hole to push down the protocol line – you start making informed decisions about patient care. It also opens up a world of evidence-based practice – whether you can actually utilise it or not depends on your system, but either way you’ll think more about what you’re doing rather than just going through the motions. It’s the difference between giving the patient GTN every 5 minutes because the acute coronary syndrome protocol says to do so, and giving them GTN titrated to effect because it’s an inferior STEMI with right ventricular involvement and you’re worried about dropping the preload too far and destroying left ventricular output.
You don’t lose anything by putting a little bit of time into learning A&P. Do you need to know the names of every single bone in the body? No. Do you need to understand exactly how the mitochondria work? Not really. Does it matter if you forget the various layers of the intestinal wall? Well, in practical terms – probably not (you’re not a surgeon). But knowing a few fundamentals will definitely help. Knowing where the kidneys actually sit and how they work, and the effect they have on fluid balance and blood pressure is important. Understanding the mechanics of breathing and neural control of ventilation is essential. The more you know, the better you can understand other resources and increase your knowledge as a clinician.
Is it hard? Well, yeah – nothing’s easy. Your paramedic degree or certification wasn’t easy. But if you care about delivering quality patient care, that won’t matter to you.
The Simple Way – An EMT A&P Textbook
If you get Dr Bledsoe’s Anatomy and Physiology for EMTs and Paramedics, you’ll have a decent start for understanding A&P (or for reviewing it if you haven’t studied it in a while). There’s also an AAOS counterpart, but I have no idea if it’s any good or not.
While this book lacks some of the raw detail that other books lack, it does offer a fairly decent introduction to anatomy and physiology, and expands upon that working knowledge you gain from basic instruction. It’s really focused on things that are clinically relevant to a paramedic. It goes over each body system but only drops down into the cellular level when it’s really relevant – otherwise, it stays at the tissue level, which keeps things easy to understand yet also imparts a fairly good understanding of physiology. If you’ve done A&P at university, you’ll find that it’s more basic than your A&P units, but it’s also quite concise and useful to go over topics that you’ve otherwise forgotten or don’t use very much.
For many people, this is where they’ll want to stop – and that’s fine. As I said, this is a good working knowledge of A&P that enables you to start understanding more detailed concepts. You could conceivably go off and read a nursing-level pathophysiology or pharmacology book without much difficulty. This approach also has the lowest barrier for entrance – you don’t need any chemistry or physics knowledge. It’s all here for you. This is a good starting point, and probably just enough for those who are happy having a fairly decent understanding of A&P.
If you’re just after a bit more information to help you understand your job and your patients, this is probably sufficient. Alternatively, this can be a stepping stone to another textbook – if you study up on the fundamentals, you might be able to step up to the medschool-level books.
The Degree Way – A dedicated A&P Textbook
Tortora’s Principles of Anatomy and Physiology is like a “baby medschool” textbook, and it’s what I used for my nursing degree (but, strangely enough, not my paramedic degree, which relied on a simpler book). Some people actually make use of this book during medschool here in Australia, but it’s more popularly seen in allied health disciplines or biomedical science courses.
A textbook like this gives you a lot more detail than the EMS-focused book above; it delves right down into the cellular level, to a degree of detail that doesn’t appear to have any real practical purposes. And to be fair, knowing the cellular processes down in the gastrointestinal system probably won’t significantly change your practice – but it does open the door to understanding more about various pathological processes and pharmacology, hence it’s worth investing a bit of extra time if you can. There aren’t any real compromises here – it’s all very in-depth with little hand-holding. If you want to learn as much as you can, this is a good middle-ground way to learn it from one book.
It has some downsides though. You might need to brush up on some chemistry knowledge – while the introductory chapters will fill in the most important pieces, it might not be enough for you to get by. Also there’s a lot of information here – I wouldn’t really say it’s overkill because more knowledge is always good, but if you’re focused predominately on practical knowledge, it might not be worth it.
Honestly this is a good middle of the road way for those who want to go beyond the basics but don’t want to get too out of their depth.
The Pseudo-Medschool Way – Dedicated Books
If you really want to go balls out, you can try and do it how medschools ‘recommend’ their textbooks. Now, that said, like with any degree program you’ll find that medschool students frequently don’t buy the textbooks (at least in Australia) unless they absolutely have to and try to rely on lecture notes or borrowing books. Whether or not a med student would actually make a lot of use of these books is open for debate.
Having dedicated textbooks for anatomy and physiology separately offers a big advantage – the book can focus on its specific topic in a lot of depth, and not be compromised to try to cram everything in together. If you don’t want an anatomy book (and to be fair, most of the basic anatomy seen in paramedic textbooks is generally close enough for practical purposes) you can just focus on a physiology textbook.
So what ones are worth looking at?
- Gray’s Anatomy for Students – A popular anatomy book that keeps things fairly basic and easier to understand. Great for figuring out where things are in the body.
- Guyton and Hall Textbook of Medical Physiology – One of the big name textbooks, this book will tell you pretty much everything about physiology, but it might be a bit too heavy for your average paramedic. You’ll need a fairly decent grasp of chemistry at least to get through it, but this is one of the more detailed books out there.
Some others worth considering:
- Moore Clinical Orientated Anatomy – Another popular book often used in Australian medical schools, is more in depth than Gray’s but might be overkill for paramedics.
- Netter’s Atlas of Human Anatomy – Super detailed, straight up anatomy atlas that basically says “This is where shit is, the end.” Probably not recommended.
- Costanzo’s Physiology – Don’t have it myself but heard good things about it.
- Sherwood Human Physiology – Also don’t have it, but I’ve heard that it’s more basic and thus easier to grasp.
There’s a big disadvantage to taking this path – it’s all much, much more difficult to understand than a basic paramedic textbook. While the anatomy book isn’t hard to wrap your head around, the physiology most definitely is. If you’ve done a university degree and are looking to refresh or update your knowledge, this won’t be a problem. If you haven’t, then jumping straight into this probably won’t help you. If you lack the fundamental knowledge and really want to advance to the next level, I’d suggest picking up these books after reading the EMS-level text, because it’ll probably give you enough of the fundamentals to start reading the book, and Googling whatever doesn’t seem to make sense.
Also this is bordering on impractical knowledge now. It’s definitely helpful if you want to read medical resources like Tintinalli or Rosen, but reading at this level might not be beneficial if you’re just looking to gain more information about what you’re doing on road. But hey, it’s up to you! If you want to be the best you can be, this is how you get there.
What I don’t recommend
- Colouring books on their own. If it’s an adjunct to a real textbook, that’s great. If it isn’t, you’re not learning anything useful.
- “Nursing” level books. I often see Ross & Wilson paraded around like some sort of gift to EMS. It’s not – Bledsoe’s book is actually better for depth. These simple entry-level nursing A&P books aren’t any better than the EMS A&P books. Don’t waste your money on them, you’re not a nurse, your level of knowledge should be higher. Yes, even you, USA EMT-P.
- Relying too much on Wikipedia. No, not because it’s wrong (it might be, but it usually isn’t) – but because it’s bad at teaching fundamentals. You have to crawl before you can walk, and textbooks help you get to that stage.
- Trying to read the higher level books without the underlying knowledge base. It might be tempting to just buy Guyton and Hall and try to struggle through it, but I don’t know how much you’ll get out of it if you don’t understand basic chemistry. Some med students can’t make their way through it unaided.
Either way, please keep learning
It doesn’t matter how you learn or where – just keep learning. Our jobs are changing and the expectations are starting to grow, and we need to prove that we’re a professional service that adapts to change and maintains our knowledge – not because we have to, but because we want to improve service delivery. We don’t do that by not understanding the basics of our profession. If you haven’t studied A&P, start doing it yourself now. If you’ve forgotten it or haven’t revised it in a while, pick up a book and go over it again. Knowledge is power.