Navigating the Challenge of Giving (and Following) Clinical Advice

In the critical care retrieval environment, decisions made on the fly can mean the difference between life and death. The stakes are high, the environment is intense, and clinical advice/assistance might be crucial. Yet, one of the more perplexing challenges for educators and senior practitioners is giving clinical advice to ALS practitioners, only to watch it either be disregarded or partially implemented.

Here’s a look at why this happens, why it matters, and how we can better navigate this tricky terrain.

The Complexity of Clinical Decision-Making in Real Time

In emergency and critical care settings, practitioners operate in a high-pressure environment. They’re forced to make complex decisions rapidly, with limited resources and often incomplete patient information. The margin for error is slim, and while clinical guidelines offer valuable structure, every scenario has its nuances. When senior practitioners give clinical advice, it’s with the aim to support, guide, and improve outcomes based on a broad understanding of these challenges. However, translating that advice into action isn’t always straightforward. Often the senior who is advising the team is able to see the case from a much broader perspective.

Why Is Clinical Advice Often Not Followed?

1. Cognitive Overload

Treating practitioners face an overwhelming influx of information, stimuli, and decisions. Adding advice—even well-intentioned advice—can sometimes be just one input too many. They may hear the advice but prioritize what feels immediately actionable, inadvertently deprioritizing or adjusting the guidance given. Sometimes the advice is heard but not interpreted, and then not followed.

2. Variability in Field Conditions

Advice is often based on optimal scenarios, whereas practitioners operate in real-world conditions with unique variables. Environmental factors like equipment limitations, access to certain medications, and even patient positioning might mean that following the exact advice isn’t feasible.

3. Confidence and Experience Gaps

In moments of intense pressure, practitioners may fall back on what feels familiar or what they know works within their skillset, even if it slightly deviates from best practice. This doesn’t necessarily mean a lack of trust in the advice given—it’s often a survival instinct.

4. Fear of Unintended Consequences

Changing course based on someone else’s advice can introduce new uncertainties. Clinical practitioners may feel that they are better off managing a situation within their own skill set, rather than introducing a change that may lead to unforeseen complications.

Why Following Advice Matters

In critical care settings, decisions are cumulative; each action builds on the last. When advice is disregarded or partially followed, it can introduce inconsistencies in care that lead to unpredictable outcomes. There’s a clear gap between training and implementation, and bridging that gap is essential—not only for the patients but for the professional growth of clinical practitioners.

Bridging the Gap: Strategies for Effective Advice-Giving

If you find yourself being contacted to provide assistance on a clinical case, the following may be helpful to make the information and assistance as useful as possible.

1. Contextualize the Advice

Instead of simply directing an action, frame advice within the immediate scenario. Give rationale that connects the advice to the specifics of the current case. For example, rather than saying, “Increase the fluid rate,” try, “Given this patient’s low blood pressure and fluid deficit, let’s increase the rate to manage circulation more effectively.”

2. Create Space for a Brief Dialogue

While time is limited, a few seconds of two-way communication can be invaluable. Encourage the practitioner to voice any hesitations they may have, creating a brief dialogue that clarifies expectations and allows you to adapt advice to their context. Listen to the provider and try to take information from the cues they give you, when they pause over a certain idea or concept, explore that if you can to find the barriers to implementation.

3. Follow Up in Debrief

If the advice wasn’t followed, rather than assuming negligence, open the discussion in the debrief. Approach it with curiosity, asking, “I noticed you adjusted X—was there a particular reason?” This can reveal barriers or constraints they faced, providing insights to guide future interventions. Having these conversations with the provider after the fact, in a calm and stress free environment is vital, not only to give the provider feedback but also to allow for learning on your part through feedback.

4. Prioritize Core Actions

While it can be tempting to address everything observed, focusing on the top one or two interventions they should prioritize helps minimize the cognitive load. Give actionable, specific advice rather than overwhelming them with an exhaustive list.

5. Model Decision-Making in Simulations

Simulations can be a powerful tool for bridging the advice-action gap. By modeling high-stress decision-making and allowing practitioners to experiment with clinical advice, we can make the act of following guidance more intuitive and natural in real settings. We should be practicing not only taking advice and patient interaction, but also working through simulation examples where the way in which we interact and give clinical advice can be practiced.

6. Use cheat sheets and references where possible

Its impossible to remember everything, but there are millions of tools and systems that can assist you to give the best possible, evidence-based advice for the patients best possible outcome. There is no room for ego in these situations.

Conclusion

Giving clinical advice to any other practitioners is both a privilege and a responsibility. It’s an opportunity to support, refine, and enhance not only the person calling's practice but also your own. It's a very delicate balance. Advice must not only be evidence-based and relevant but also adaptable to the chaotic and variable nature of the field. Ultimately, our role isn’t just to impart knowledge but to empower other practitioners to act on it confidently, shaping their own expertise in the process.

By understanding the challenges we all face and approaching advice-giving as a collaborative process, we foster a culture where sound clinical decisions become second nature—benefiting both patients and practitioners alike.

Share your experiences of either giving or receiving clinical advice or in clinical interactions, what interactions have shaped your experiences?