Barefoot Doctors by Aaron Levine MD

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Something in the news triggered a synapse in my brain. Flashbacks (nonhallucinogenic) occurred. I remembered the great cultural revolution (also called a purge) that swept China under the last years Of Mao’s reign in the 1960s. I was in premed and med school during that time. I remember American students (presumably college) wearing China garb and holding the red book of the Sayings of Mao (I am not sure of the actual name). One thing that was championed was China’s Great Barefoot Doctors. This brought medical care to the underserved.  There are significant parallels for what is going on here today. The Barefoot Doctors is the name of the participants who the Chinese trained to act as doctors for the masses. Most educated doctors followed the western model and concentrated in urban areas. Although the economy was reportedly classless, there were those some more classless than others. There were masses without doctors. The power was taken away from the physicians and given to the government. These leaders (and I do not recall the title) determined who and what was to be practiced. Farmers received 6 months of training and went to treat the hundreds of millions in the country. They were given a handbook to follow. They dared not veer from it. I remember the news reports of how successful this was. I later met Chinese doctors who had their own impressions, but the government determined this was a successful program that brought equitable health care to the country. I stumbled upon an English translation of the Barefoot Doctor’s manual while I was on active duty. If memory serves right, it was a good cookbook/first aid manual with was no variance permitted. Today, the US is trying to provide equitable care with all the doctor shortages projected. Programs are being pushed to train NPs and PAs to practice independently. There are guidelines that are to be closely followed based upon the science of “evidence based medicine” (replacing the art of medicine). A homogenous quality is the goal with quality standards being determined by the government.  Reaching these standards will determine quality.   “Everything old is new again.”

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  11 comments for “Barefoot Doctors by Aaron Levine MD

  1. mamadoc
    November 13, 2013 at 9:30 pm

    “Great personal wealth?” This guy is either mental or didn’t get his hydrocodone filled timely, or maybe just his Seroquel. Reckon who he’ll call when he needs his appendix out? Maybe he’ll just do it himself with a mirror and the internet, since “many people can be trained” to do that.

  2. George
    November 11, 2013 at 1:52 pm

    Fact of the matter was that most US physicians historically went into the profession in the hope of amassing great personal wealth and prestige. If they helped a patient or two along the way while cultivating their sizeable ego, that was merely a side benefit.

    Many physicians still suffer from the unfortunate illusion that they are the smartest, most noble people to tread this planet. Given an opportunity, many people could be trained to do almost everything you do. You are not that special. Get over it.

    • Doug Farrago
      November 12, 2013 at 6:13 am

      Great personal wealth? As a family doc? Hmmmmm. You must know something I don’t know. Smartest? Not sure about that but to get into medical school you sure have to work your ass off, study hard and get great grades. Given an opportunity? Yes, you are correct. EVERYONE could do what I do with the proper training and education. First, you must get selected into medical school (see above). Then you must pay $200K in school bills. That’s after college bills, mind you. Then you must work thousands of hour for pennies on the dollars as a resident for 3+ years. After losing a decade of earning potential, and your youth, because you are schooling/training, you can then enter the workforce to be the bitch of some hospital administrator. Or is this some unfortunate illusion? You see, Georgie old boy, you are an idiot and know nothing of what you speak. This has nothing to do with ego, either. Those are just the facts. Do you want to come join my profession? Great, do it. We need you. Just pay your dues (again, see above). If not, then go away and stop making stupid comments.

    • Sir Lance-a-lot
      November 12, 2013 at 8:39 am

      Smartest, George? Maybe, maybe not, but definitely smarter than you.

      By the way, ever hear the term “IP address”?
      How about “blacklist”?
      See first line of this post.

    • Pat
      November 12, 2013 at 10:23 am

      Let me say a word of defense for George…even as he shoved his rhetorical face into the buzz saw, he is performing a service with his visit. George is the product of generations of irrational hatred, incubated, cultivated, brewed, and batched by years of class warfare, pushed by union types, do-gooders, most Republicans, and all Democrats. George is only a representative of the thinking that has turned patients into a commodity, even if he hasn’t the wit to understand how, or his role in the farce. George is the product of diseased self-esteem, manifested as collectivism, wherein a patient thinks that 1) medicine, it’s diagnostics and therapeutics, and those who deliver them, all just…happen, and 2) he has a right to it.

      Colleagues and casual readers alike, society is full of George’s, and their number grows every day. We may – and should – fight against this ignorance, but the only real cure for it will be our absence. Then George can enjoy swallowing his ballon, along with his Kool-Aid, when not screaming for the would-be rich, self-deluded doctors who will no longer be available to him.

    • Ken
      November 12, 2013 at 11:27 am

      Wow George, did someone just decide not to refill a percocet prescription?

  3. Pat
    November 10, 2013 at 2:21 pm

    Oh, i almost forgot: back in 1991, I went to a forum on health care reform seeking “solutions”. The only physician on the panel commenting on US health care was a Canadian psychiatrist originally from South Africa. The event was sponsored by some forgotten coalition of lefty do gooders, and the panel and audience reflected it. There were heated exchanges on stage and a couple after the meeting ended. The place was packed with a lot of union members as well as college students, and it was chilling. As Clinton was only starting to be a national name, and Obama was still memorizing his own l’il red book at Harvard, a great many people in this meeting were already publicly advocating the government take charge of all health care and medical training, even to the point of assigning where physicians live!

    Call me an old Cold War hysteric if you like, but a lot of people would quickly get on board with this mindset if allowed.

  4. Pat
    November 10, 2013 at 9:51 am

    A wait a minute Adam and Lance, I live in such an area, and you two have no idea what you’re talk…oh wait a minute, you’re both exactly right, and dead on the point. Human beings were (still are) raw materials in Red China, mere property of the state. That is what doctors have already become in the eyes of most politicians, and I believe, most citizens.

    There is no heroism, glory, nobility, or compassion in carrying out the orders of a government that will otherwise punish you. This IS U.S. Medicine, and it’s fixin’ to get a whole lot worse.

  5. Susan
    November 10, 2013 at 9:32 am

    Yes, everything old is new again. It was simply, Mao’s, “The Red Book” in terms of philosophy. Mostly the barefoot doctors were trying to understand the epidemic of esophageal cancer and they did few tests other than one for it. (a balloon on a string was swallowed then pulled back up and sent for cytology/pathology as I recall). Seems they found the agents that were causing it. Matters not. It was medicine “for the people”, which is what Mao was supposedly all about. This is all from memory, but then again, I too have been around a while.

    “But if you go carryon’ pictures of chairman Mao,
    You ain’t gonna make it with anyone anyhow,
    You know it’s gonna be,
    All right.”

    John Lennon

  6. Sir Lance-a-lot
    November 10, 2013 at 9:00 am

    In the context of a huge and technologically backward third world country, such as China was at the time, and especially one with a shortage of doctors (and, in fact, of all educated people), as they had been sent into the fields to harvest rice, imprisoned, or executed (I guess it seemed like a good idea at the time…), the Barefoot Doctors made sense. They took a crash course in basic Western and Chinese medicine, and were far better than nothing in the very remote rural areas where they were sent.

    Of course, in the US of the 21st century, no village is similarly isolated, and ubiquitous communication and information technology creates a very different set of needs.
    Sending out “partially trained” people to practice medicine in the US today makes sense only if the people you are sending them to are only “partially deserving” of medical care. A national program to encourage rural medicine, encompassing recruiting the right people (people who want to spend years in rural areas), providing them with free or extremely low cost medical school educations, and assuring them of not only appropriate salaries, but also budgets to keep their offices open in locations where large portions of their population have no way of paying for their services, is about the only thing I can imagine that would get medicine out where it’s needed.
    I’ll be looking for a news story about it when I see a pig fly past my window.

    Or, you could send “physician extenders” out to treat them. I mean, they chose to live where they do, and it’s not like they actually deserve care from an actual doctor or anything, right?

  7. November 10, 2013 at 8:50 am

    Doug,

    I read your story with interest. In my physician assistant program, we covered the relationship between the PA profession and barefoot doctors, as well as other similar efforts in other parts of the world. While there is a relationship with such programs, PAs are not trained to “not deviate” or to turn medicine into a mechanized function. I work for a supervising PA who gives me autonomy and I do what I think needs doing. I can always call him that I am exceeding my knowledge and need some advice.

    As PAs and NPs become more autonomous, I don’t think that that should be equated to having them be robots or to feel that they should be making decisions without ever consulting anyone else. From what I have learned from practice is that all of us — regardless of our degrees — need to know when we are getting to the edge of our knowledge and need to consult someone else. Other physicians sometimes ask me questions and I ask do the same. One would have to be pretty cavalier with their patients to not ask for help when then need it.

    I enjoy your posts very much and subscribed to your magazine back in the day. Best wishes on your new venture.

    Barry Brownstein, PA-C
    Columbus, OH

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