Should You Speak Up When You Might Be Wrong?

As a paramedic, I once watched a fire captain teach probationary firefighters how to restrain a patient in psychological distress, standing up: a backboard held behind them, restraints tied to their arms and legs. The patient was cooperative, and we were three blocks from the hospital. Nothing in any protocol called for it, and I said so. He pulled the incident commander card. I stopped arguing and waited until the patient was in my care.

Right or wrong, speaking up brings value. A lot of the time, people stay quiet so they don’t look incompetent, but over time, they end up feeling unheard and their concerns never met with curiosity. Solomon Asch’s conformity experiments found that even a dissenter who was also wrong made it easier for the rest to give their own answer. So this one is for both sides of the room. If you’re outranked, say it, and leave the heat out of it. If you hold the rank, let the “dumb” questions get asked. Either you teach something, or you learn something.

Last issue was about listening. This one is about the other half: speaking up!

Transfer of care

My time as a paramedic was nonstop ego battles, humbling but tiring. Most of them were over small things, since everyone on scene knows how to handle the critical parts of medicine. This one was small, too.

The patient was in psychological distress, standing there, cooperative, not making much of a scene. The Captain was teaching his probationary firefighters how to restrain someone standing up, and they were doing as directed: holding a backboard behind the patient and tying restraints to the arms and legs.

Backboards had long since been retired for this. We’d gone from stiff plastic boards to soft restraints and seatbelts on the stretcher, and in paramedic school we were taught the field was moving toward no restraint at all, because restraints cause more distress and can make symptoms worse.

I said something right away. “What are you guys doing? You know we don’t do this anymore.”

He said something close to “Well, I do.”

I told him it wasn’t in any protocol and it was actively harmful. That’s when he pulled the card: he was the incident commander on this scene, and I would do as directed.

There was no arguing past that, and I’d pushed back on enough calls like this to know it. The board wasn’t really going to hurt anyone. Arguing longer would have done more harm. So I said, “Okay, well, I’m just going to remove it, so do whatever you want,” refused to help, and waited until they were done.

Then the patient was mine. Once care transfers, it’s my responsibility, and legally it lands on the transporting paramedic. I couldn’t in good faith show up at the hospital with the patient presented that way.

“Sorry about all of that,” I told them. “Let’s remove this.” The board came off. “Are you more comfortable now?”

They said yes. We were three blocks from the hospital.

Later, the Captain came back and apologized for yelling. He explained he’d been doing it to teach the probies, and he understood what I was saying. He never quite said I was right.

What the probies learned

If I’d said nothing, the probies would have learned that it’s acceptable to tie down someone in a psychological crisis, without understanding what we’d been taught about restraint and distress. There’s also a chance they already knew and just weren’t saying it. That’s groupthink up close: a team that wants to conform can look a lot like a team that agrees.

Speaking up was safe for me in ways it wasn’t for them. I wasn’t in their organization, and checking medical accuracy, including someone else’s, was my job. We both had responsibility for that patient, but legally it lands on the transporting paramedic. The probies had none of that cover. They were on probation, taking instruction from the person running the scene. (For the record, I’ve never pulled rank and been wrong. There was never any rank for me to pull.)

Work has the same split. The person who holds the rank and the person who carries the consequence are often two different people, and the second one has to live with the call.

So was stopping wisdom or surrender? One reading: the board wasn’t going to hurt anyone, arguing longer would have done more harm, and I acted the moment the decision was mine. The other: the last thing the probies saw in that argument was rank ending it. Both readings hold.

What I did learn, much later, is that speaking up was right and getting heated in the moment wasn’t. The ego battles that went somewhere were the ones with another critical thinker on the other side, and sometimes that person came back to hash it out, the way the Captain sort of did. That’s the part the research backs: a dissenting voice changes how the rest of the room thinks, even when the dissenter is wrong.

The Vitals

The article. Solomon Asch, "Opinions and Social Pressure," Scientific American, November 1955.
Who and what. 123 male college students at three schools matched line lengths in a room where every other person had been coached to give the same wrong answer on 12 of 18 rounds.
The finding. Alone, people erred less than 1 percent of the time. Facing the unanimous group, they accepted the wrong answer on 36.8 percent of judgments. About a quarter never gave in.
The dissenter effect. One truthful partner cut errors to a quarter of that rate. A dissenter who was also wrong, just differently wrong, still cut errors to 9 percent.
The supporting line. Charlan Nemeth's work found that exposure to a dissenting minority produced more divergent thinking and better solutions (Nemeth and Kwan, 1987), and that an assigned devil's advocate reinforced the group's starting view instead of widening it (Nemeth, Brown, and Rogers, 2001).
How to read it. A 1950s lab task with college men judging lines. It shows a mechanism, that unanimity carries the pressure, and gives no workplace rate.

Sources: Asch, S. E. (1955), Scientific American 193(5), 31-35. Nemeth, C. J., and Kwan, J. L. (1987), Journal of Applied Social Psychology 17, 788-799. Nemeth, C., Brown, K., and Rogers, J. (2001), European Journal of Social Psychology 31(6), 707-720.

The Handoff

Raise your voice, even when you might be wrong. Even if you are, you’ve put a different perspective in front of the room, and whether anyone admits it or not, there’s something in it to learn. And even if it’s not about learning, it’s about problem solving. We see this heavily with juries, the longer they have to debate against someone unwilling to move, the more creative they are in their approach to change the other’s point of view.

For teaching moments; If you’re the smartest person in the room, you can still learn from someone else’s view. And if you’re the one teaching, let the “dumb” questions get asked. That’s how the next person learns to do it right. If you can’t teach it, or they don’t seem to understand, that’s something for you to learn.

The one conversation this week is the next one where someone pushes back on you.

Priority One: When someone pushes back on you this week, ask one follow-up question before you answer.

So, wisdom or surrender? Hit reply and tell me which you’d call it.

This is my second newsletter, and I’d love to hear your experiences, questions, and concerns, or whether there’s anything you think I can help with. I’m happy to share my personal struggles back, as I believe it’s important to share what may seem like a weakness. How could you possibly know what’s normal without hearing shared experiences? I’ll also be writing weekly for the time being, so be on the lookout! Lastly, I plan on reading every single response, and do apologize if I can’t get a meaningful reply back.

With love,

Jim Sullivan